Management of Occupational Exposures to HIV: Updated Guidelines for Postexposure Prophylaxis

Abstract

Healthcare workers remain at risk for occupational HIV transmission. According to the Centers for Disease Control and Prevention (CDC) (1998), a healthcare worker is defined as “any person (e.g., an employee, student, contractor, attending clinician, public-safety worker, or volunteer) whose activities involve contact with patients or with blood or other body fluids from patients in a health-care or laboratory setting” (p. 2). An occupational exposure is defined as “a percutaneous injury (e.g., a needlestick or cut with a sharp object), contact of mucous membrane or nonintact skin (e.g., when the exposed skin is chapped, abraded, or afflicted with dermatitis), or contact with intact skin when the duration of contact is prolonged (i.e., several minutes or more) or involves an extensive area, with blood, tissue or other body fluids” (CDC, 1998, p. 3). In addition, any direct contact without a barrier protection to concentrated HIV, such as in research facilities, is considered an exposure. Exposure to body fluids such as saliva, tears, sweat, and nonbloody urine or feces does not constitute an occupational exposure. Human breast milk has been associated with perinatal transmission of HIV but not with occupational transmission of HIV. The risk of occupational HIV transmission remains relatively low; however, the risk must be considered a consistent and substantial risk for healthcare workers. The average risk of HIV transmission after a percutaneous exposure to HIV-infected blood is about 0.3%, whereas the average risk of HIV transmission after a mucous membrane exposure is 0.09% (CDC, 1998). The majority of individuals exposed to HIV seroconvert to HIV positive within 6 months of the exposure. There are three documented cases of HIV healthcare worker seroconversion after the 6-month postexposure period but within the 12-month postexposure period. A total of 54 documented cases of occupational HIV transmission have occurred as of December 1997 (CDC, 1997). Nurses represent the healthcare workers with the largest number of documented occupational HIV transmission cases. Table 1 presents occupational HIV transmission according to healthcare worker occupations. A total of 132 possible cases of occupational HIV transmission have occurred in healthcare workers as of December 1997 and are under investigation by the CDC. Of these 132 possible cases of