Management Of Occupational Exposure Research Articles

Infections Associated with Health-care Personnel: Vaccine-preventable Diseases and Bloodborne Pathogens.

Health-care personnel (HCP) are at risk for infection from occupational exposure, and can transmit infectious pathogens to patients and other personnel. The risk of disease acquisition depends on factors including the virulence of the causative organism, the mode of pathogen transmission, and the immune competency of the exposed individual. This article reviews the management of occupational exposure, infection, and strategies for the prevention of transmission of selected vaccine-prevent- able diseases (varicella zoster virus, influenza, pertussis) and bloodborne pathogens (hepatitis B virus, hepatitis C virus, human immunodeficiency virus). Recommended strategies include surveillance, vaccination, infection control measures, and postexposure prophylaxis. Improved detection, management, and prevention strategies are needed to reduce the risk of trans- mission of infection to HCP.

PHARMACOLOGIC MANAGEMENT OF HIV/STD EXPOSURE

Emergency physicians must be familiar with management of occupational exposures to HIV-infected bodily fluids. Victims of sexual assault also may be exposed to HIV and other sexually transmitted diseases. The Centers for Disease Control and Prevention guidelines for the management of occupational exposures include recommendations for administration of combination antiretroviral therapy to reduce the risk for HIV transmission. Antiretroviral therapy also may be indicated for certain types of sexual exposure to HIV. Drugs that are used to treat sexually transmitted diseases also may be given to prevent infection after possible exposures. This article reviews current recommendations for prophylaxis against HIV and other sexually transmitted diseases and the scientific basis for these recommendations.

The management of occupational exposures to blood and saliva in dental practice.

Accidental injuries when handling sharp or rotating instruments can allow inoculation of a dental team member by the patient's blood or saliva. The risk of transmission of HIV from occupational exposure among dental workers is low and to date no occupational exposure has resulted in HIV transmission. However, hepatitis B and C have a high morbidity and mortality and are more infectious than HIV. This paper demonstrates how occupational exposures to blood and saliva could be managed in general dental practice and outlines the legal responsibilities of a dentist in the management of these exposures.

Molecular methods of measurement of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection: implications for occupational health practice.

Over the past decade, several molecular techniques for the detection of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) have been developed that have implications...

Issues related to human immunodeficiency virus transmission in schools, child care, medical settings, the home, and community. American Academy of Pediatrics. Committee of Pediatric AIDS and Committee on Infectious Diseases.

Current recommendations of the American Academy of Pediatrics (AAP) for infection control practices to prevent transmission of blood-borne pathogens, including human immunodeficiency virus (HIV) in hospitals, other medical settings, schools, and child care facilities, are reviewed and explained. Hand-washing is essential, whether or not gloves are used, and gloves should be used when contact with blood or blood-containing body fluids may occur. In hospitalized children, the 1996 recommendations of the Centers for Disease Control and Prevention (CDC) should be implemented as modified in the 1997 Red Book. The generic principles of Standard Precautions in the CDC guidelines generally are applicable to children in all health care settings, schools, child care facilities, and the home. However, gloves are not required for routine changing of diapers or for wiping nasal secretions of children in most circumstances. This AAP recommendation differs from that in the CDC guidelines. Current US Public Health Service guidelines for the management of potential occupational exposures of health care workers to HIV are summarized. As previously recommended by the AAP, HIV-infected children should be admitted without restriction to child care centers and schools and allowed to participate in all activities to the extent that their health and other recommendations for management of contagious diseases permit. Because it is not required that the school be notified of HIV infection, it may be helpful if the pediatrician notify the school that he or she is operating under a policy of nondisclosure of infection with blood-borne pathogens. Thus, it is possible that the pediatrician will not report the presence of such infections on the form. Because HIV infection occurs in persons throughout the United States, these recommendations for prevention of HIV transmission should be applied universally.

Risk assessment and management of occupational exposure to pesticides

Occupational exposure to pesticides in agriculture and public health applications may cause acute and long-term health effects. Prevention of adverse effects in the users requires actions to be undertaken in the pre-marketing and post-marketing phase of these products. The pre-marketing preventive actions are primary responsibility of industry and the public administration. Admission of pesticide use (registration) is carried out by considering the toxicological properties of each pesticide (hazard identification), determining the dose-response relationship (NOEL identification), assessing or predicting the exposure level in the various scenarios of their use, and characterising the risk. The decision about admission takes into consideration the balance between risks and benefits. The post-marketing preventive activities consist of the promotion of a proper risk management at the workplace. Such a management includes the risk assessment of the specific conditions of use, the adoption of proper work practices, and the health surveillance of the workers. Each country should develop an adequate National Plan for Prevention of Pesticide Risk which allocates different roles and tasks at the central, regional and local level.

Hospital infection prevention and control: A global perspective

Hospital infection prevention and control: A global perspective

Emergency department management of occupational exposures to HIV-infected fluids

The emergency department is where many healthcare workers will seek medical advice and care after a potential exposure to bodily fluids contaminated with the human immunodeficiency virus (HIV). The estimated risk of HIV infection in healthcare workers with percutaneous exposures to HIV-infected blood is estimated at 0.3% to 0.32%. Zidovudine (AZT) post-exposure prophylaxis has been associated with a 79% reduction in the risk of seroconversion in a case-control study sponsored by the Center for Disease Control and Prevention (CDC), and has become part of the standard prophylactic treatment for patients with occupational HIV exposure. This article reviews the current CDC recommendations as well as our institutional practice guidelines for the management of healthcare workers who are exposed to potential or confirmed HIV-infected fluids.

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

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

Time course of viremia and antibody seroconversion following human immunodeficiency virus exposure

Rational application of diagnostic assays in the management of healthcare workers (HCWs) following occupational exposure is needed to rule out pre-existing human immunodeficiency virus (HIV) infection, detect HIV infection or seroconversion as early as possible in the small proportion individuals who become infected, and to rule out infection in the high proportion of individuals who remain uninfected following occupational exposure to HIV. An understanding of the time course of viremia and seroconversion following HIV exposure is essential in developing recommendations for management of occupational exposure among HCWs. Several data sources that address the timing and dynamics of HIV viremia and seroconversion following primary infection are reviewed. The implications of each data source for management of occupational exposure among HCWs is assessed. Although the majority of infected HCWs seroconvert within 2 months of exposure, the possibility of delayed seroconversion is well established, with approximately 5% of infected HCWs estimated to seroconvert >6 months after exposure. In contrast, the period of viremia (detectable by p24 antigen or RNA assays) preceding antibody seroconversion is consistently brief (1-3 weeks). Animal inoculation studies indicate that a variable period of localized viral replication in lymphoid tissue draining inoculation sites exists prior to systemic viremia and subsequent seroconversion.

Update: Provisional Public Health Service Recommendations for Chemoprophylaxis After Occupational Exposure to HIV

Although preventing blood exposures is the primary means of preventing occupationally acquired human immunodeficiency virus (HIV) infection, appropriate postexposure management is an important element of workplace safety. Information suggesting that zidovudine (ZDV) postexposure prophylaxis (PEP) may reduce the risk for HIV transmission after occupational exposure to HIV-infected blood prompted a Public Health Service (PHS) interagency working group, with expert consultation, to update a previous PHS statement on management of occupational exposure to HIV with the following findings and recommendations on PEP.

Postexposure Prophylaxis for Occupational Exposures to Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus

Bloodborne pathogens are becoming increasingly prevalent in, and therefore contributing increasing levels of risk to, the health-care work-place environment. This problem is magnified in the blood-intense operating room and obstetric environments. Whereas we will never be able to eliminate such risks entirely from the health-care workplace, a multifaceted approach to the management of these risks throughout the hospital environment and particularly in risk-intense environments will likely create a safer milieu and climate. Such an improved environment will clearly be necessary as we continue to strive to provide optimal care for all patients, irrespective of their bloodborne infection status.

Management of occupational exposure to HIV.

Many health care workers (HCWs) are potentially at risk for occupationally acquired human immunodeficiency virus (HIV) infection. 1,z Although improved methods of exposure prevention remain the mainstay of further risk reduction efforts, the likelihood that exposures will nevertheless continue to occur has made it necessary for institutions to develop and continually update procedures for postexposure management.-7 This chapter focuses on the management of occupational exposures and discusses issues regarding attempted postexposure prophylaxis with antiviral agents such as zidovudine. Many such incidents also require evaluation and management of possible exposure to other blood-borne pathogens (e.g., hepatitis B and C viruses) and tetanus prophylaxis, as discussed elsewhere.s’9

Management of Occupational Exposures to Blood-Borne Viruses

Exposures to blood-borne pathogens pose a serious occupational threat to health care workers. Safer needle devices for performing phlebotomy and other procedures and universal infection-control precautions will not completely eliminate the risk, and prophylactic treatment will remain an important component of prevention efforts. This article will review post-exposure care for the three blood-borne pathogens that are most commonly involved in occupational transmission — hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).Assessment of ExposureOccupational exposures include contact of the eyes, mouth, other mucous membranes, or broken skin and parenteral contact with blood or other . . .

Management of occupational exposures to bloodborne pathogens: hepatitis B virus, hepatitis C virus, and human immunodeficiency virus: Gerberding JL, Henderson DK. Clin Infect Dis 1992;14:1179–1185. Reprint requests: Dr. J. L. Gerberding, Medical Service 5H-22, San Francisco General Hospital, 1001 Potrero Ave., San Francisco, CA 94110

Management of occupational exposures to bloodborne pathogens: hepatitis B virus, hepatitis C virus, and human immunodeficiency virus: Gerberding JL, Henderson DK. Clin Infect Dis 1992;14:1179–1185. Reprint requests: Dr. J. L. Gerberding, Medical Service 5H-22, San Francisco General Hospital, 1001 Potrero Ave., San Francisco, CA 94110

Zidovudine prophylaxis after accidental exposure to HIV

To evaluate the use of zidovudine prophylaxis in HIV-exposed health-care workers (HCW) in Italy and to determine its short-term toxicity. Longitudinal, open study with retrospective and prospective collection of data. All Italian clinical centres that care for HIV-infected patients and are licensed by the Ministry of Health to dispense zidovudine and 30 hospitals participating in the Italian Multicentre Study on Occupational Risk of HIV Infection. HCW and other individuals who accepted zidovudine prophylaxis after accidental exposure to HIV. Data were collected for 224 HIV-exposed individuals until 30 June 1991. An increase in zidovudine prophylaxis was observed. All but 10 subjects received 1000-1250 mg zidovudine per day. Anaemia (five cases), neutropenia (one case) and an increase in serum alanine aminotransferase levels (two cases) were the only haematochemical side-effects observed; none of the subjects ceased prophylaxis because of side-effects. More than 50% of subjects had constitutional reactions; as a result, prophylaxis was stopped by 29 patients. These adverse effects began within 10 days of prophylaxis; all resolved after prophylaxis was stopped. No HIV-antibody seroconversions were observed after a mean follow-up of 8 months. Zidovudine prophylaxis has become a feature of the management of occupational exposures to HIV in health-care settings; short-term toxicity is mild, dose-related and reversible. Further studies are needed to assess the risk of long-term sequelae.

United States Public Health Service (USPHS) statement on management of occupational exposure to HIV, including considerations for zidovudine (ZDV) use

United States Public Health Service (USPHS) statement on management of occupational exposure to HIV, including considerations for zidovudine (ZDV) use

Zeroing in on the Appropriate Management of Occupational Exposures to HIV-1

Zeroing in on the Appropriate Management of Occupational Exposures to HIV-1

Zeroing in on the Appropriate Management of Occupational Exposures to HIV-1

Transmission of human immunodeficiency virus type 1 (HIV-1) in the healthcare setting continues to be a concern for the healthcare community. Although in the tenth year of the HIV epidemic in the United States we have learned a great deal about some aspects of the occupational risks associated with the provision of care for HIV-l-infected individuals, we still lack several important pieces of information regarding these risks. While several prospective clinical studies have provided information regarding the magnitude of risk for HIV-1 infection associated with percutaneois or mucous membrane exposures to body fluids containing HIV-1,1 we have yet to gain much insight into factors associated with occupational injuries that influence risks for infection. For example, most of the instances of documented occupational/nosocomial transmission of HIV-1 described in the literature have resulted from inadvertent occupational exposures to what might be called hot needles (i.e., healthcare worker infections resulting from parenteral exposures to needles [or other sharp objects] that had been removed from HIV-l-infected patients or from specimens containing blood from such patients only moments prior to the exposure).1 Such exposures are also likely to produce the most obvious concern among healthcare providers and are, therefore, perhaps the most likely to be reported and carefully documented. Thus, the precise role of the immediacy of the exposure in producing occupational infection remains unclear.