Occupational HIV Infection Research Articles

Expanding Population of Elders With HIV May Catch Nursing Homes Off Guard

Expanding Population of Elders With HIV May Catch Nursing Homes Off Guard

Expanding Population of Elders With HIV May Catch Nursing Homes Off Guard

Expanding Population of Elders With HIV May Catch Nursing Homes Off Guard

Роль гігієнічних умов праці у формуванні ризику професійного інфікування віл медичних працівників

Роль гігієнічних умов праці у формуванні ризику професійного інфікування віл медичних працівників

Quantification of HIV-1 viral RNA in the blood in needles used for venous puncture in HIV-infected individuals

Occupational HIV infection among healthcare workers is an important issue in exposures involving blood and body fluids. There are few data in the literature regarding the potential and the duration of infectivity of HIV type 1 (HIV-1) in contaminated material under adverse conditions. We quantified HIV-1 viral RNA in 25×8mm calibre hollow-bore needles, after punctures, in 25 HIV-1-infected patients selected during the sample collection. All of the patients selected were between the ages of 18 and 55. Five samples were collected from 16 patients: one sample for the immediate quantification of HIV-1 RNA in the plasma and blood samples from the interior of 4 needles to be analyzed at 0 h, 6 h, 24 h, and 72 h after collection. In nine patients, another test was carried out in the blood from one additional needle, in which HIV-1 RNA was assessed 168 h after blood collection. The method used to assess HIV-1 RNA was nucleic acid sequence-based amplification. Up to 7 days after collection, HIV-1 RNA was detected in all of the needles. The viral RNA remained stable up to 168 h, and there were no statistically significant differences among the needle samples. Although the infectivity of the viral material in the needles is unknown, the data indicate the need to re-evaluate the practices in cases of occupational accidents in which the source is not identified.

Lack of risk-awareness and reporting behavior towards HIV infection through needlestick injury among European medical students

Medical students are at risk for occupational needlestick injuries (NSIs) which can result in substantial health consequences and psychological stress. Therefore, an open online survey among final year medical students from Austria, Germany, and the United Kingdom (UK) was conducted. The aim of the study was to evaluate risk-awareness and reporting behavior regarding needlestick injury (NSI), post-exposure prophylaxis, and level of education regarding the transmission of HIV through NSIs. Of 674 medical students, 226 (34%) reported at least one NSI during medical school. Respondents from Austria and Germany experienced a significantly higher number of NSIs in comparison to respondents from the UK. Seventy-six respondents (34%) did not report their most recent injury to an employee health office. Almost one third were not familiar with reporting procedures in case of a NSI and 45% of the study population feared that reporting an injury might have an adverse effect on their study success. 176 respondents (78%) who had suffered a NSI were not aware of the patient's HIV status. Education regarding NSIs and HIV transmission reduced the actual risk of experiencing a NSI significantly. These data indicate that medical students are at high risk of suffering NSIs during medical school. The rate of nonreporting of such injuries to an employee health service is alarmingly high. Improved medical curricula including precise recommendations may contribute to a more efficient prevention of occupational HIV infection in medical students.

HIV prone occupational exposures: epidemiology and factors associated with initiation of post-exposure prophylaxis

Background:Occupational exposures to bloodborne viruses are very common. Whilst occupational HIV transmissions are rare, the serious physical, psychological and cost implications of potential transmission make this an important public health...

Caring for Healthcare Workers A Global Perspective

From the International Healthcare Worker Safety Center, University of Virginia Health System, University of Virginia, Charlottesville. Received December 6, 2006; accepted December 6, 2006; electronically published January 3, 2006. Infect Control Hosp Epidemiol 2007; 28:1-4 2006 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2007/2801-0001$15.00. This issue of the journal reflects broadly upon the risks of bloodborne pathogen exposure—risks faced by healthcare workers (HCWs) everywhere. The articles cover an array of issues, including the impact of work schedules, healthcare settings, culture-specific practices, and the implementation of safety-engineered sharp devices on the occupational risk of injuries from sharp devices and blood contact. It is a fitting occasion to reflect on the state of the art in providing a safe working environment for HCWs and to consider a future path towards equitable access to its basic elements. It has been more than 2 decades since the first case of needlestick-transmitted infection with human immunodeficiency virus (HIV; then referred to as “human T-lymphotropic virus III”) was reported in The Lancet, triggering a high alert for the exposure risk faced by HCWs. Although lifethreatening bloodborne pathogens had been a recognized risk to HCWs for at least a century, it was the epidemic of acquired immunodeficiency syndrome (AIDS) that delivered the wakeup call leading to remedial action. Today, infection from bloodborne pathogens, primarily HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), remains the most lifethreatening occupational risk for HCWs. Despite this fact, we can take heart from the dramatic reduction that has occurred in the magnitude of this risk as a direct result of effective prevention initiatives during the past 20 years. It constitutes one of the remarkable success stories in the annals of public health practice. As a public health target, HCWs are usually considered to be (and treated as) a narrow subset of the general population. But globally, their numbers are large and their impact is felt everywhere. The total number of HCWs worldwide is estimated to be 35.7 million, which is greater than the population of Morocco, the 35th most populous nation in the world. HCWs provide care in every country and to every social and cultural group, in sophisticated and humble settings alike. Their global reach is matched only by the significance of their work. In all corners of the globe we depend on them for lifesustaining services. The effective assault on bloodborne pathogens that plague HCWs began with the availability of the hepatitis B vaccine in 1982. In the United States in 1983, the incidence of HBV among HCWs was 3 times higher than the incidence in the general population; by 1995, it was 5 times lower. The annual incidence fell from 386 to 9 infected HCWs per 100,000. In the early 1980s, it was estimated that more than 12,000 HCWs were occupationally infected with HBV annually, resulting in an estimated 250 deaths per year. Between 1990 and 1998, during which time high rates of HCW vaccination were achieved in the United States, only 13 cases of acute HBV infection in HCWs were reported. The advent of the hepatitis B vaccine was a major advance in preserving the health and lives of HCWs. The risk of occupational infection with HIV, although alarming, has never reached the scale of hepatitis B. As of 1997, a total of 94 documented and 170 possible cases of occupational HIV infection had been identified worldwide; nearly two-thirds of cases were reported from the United States. Since then, 15 more documented cases have been identified. However, most countries, especially those with a high population prevalence of HIV infection, have never instituted surveillance systems that would capture data on such cases. Although the development of an AIDS vaccine still eludes us, new treatments for HIV infection appear to have had an appreciable impact on the risk of occupational exposure and infection. In 1997, it was shown that postexposure prophylaxis with zidovudine alone after occupational blood exposure to HIV reduced the risk of seroconversion by more than 80%. Combination antiretroviral drug regimens, introduced in 1997, are believed to be even more effective at preventing seroconversion in HIV-exposed individuals. Combination treatment has altered the risk equation for HCWs in other ways, as well. Shortly after these drugs became widely available in 1997, there was a precipitous drop in the number of HIV-positive in-patients in US hospitals. The risk of HCWs being exposed to HIV dropped in direct proportion to the decline in the number of HIV-infected patients in hospitals. Furthermore, a low viral load, which is common in patients receiving combination drug therapies, is associated with reduced transmission risk when an occupational exposure to

HIV/AIDS pandemic and surgical practice in a Nigerian teaching hospital.

The objective of the study was to determine the effects of the HIV/AIDS pandemic on surgical practice in a Nigerian teaching hospital. It involved a questionnaire survey of all the doctors practising in the surgical specialties at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, in order to obtain their attitudes and practices toward HIV-positive surgical patients. Sixty-five doctors were interviewed, their ages ranged from 26 years to 62 years with a mean age of 35.1 years. The majority (35.4%) were in general surgery or obstetrics and gynaecology (24.6%). Almost half (47.7%) had operated on known HIV-positive patients and the majority were in support of preoperative HIV screening. Almost all (95.4%) were worried about occupational HIV infection--a significant number of consultants would refuse to be screened if their patient were allowed to know the results (P = 0.014). The cross infection control commonly employed included adequate instrument sterilization, presurgical hand washing and the use of gloves and facemasks. The wearing of eye goggles, double gloving, indirect instrument passing and wearing of water impervious gowns were used less frequently. As HIV/AIDS infected individuals are presenting for surgical procedures in the hospital, there is a need to improve the use of universal infection control measures and to educate all categories of healthcare personnel in order to allay the fears and to prevent discrimination that could militate against effective management of HIV/AIDS patients.

HIV-Screening in Gynäkologie und Geburtshilfe

Objective: To discuss the possible benefits and shortcomings of routine screening for HIV in gynecologic and obstetric pa tients. Method: Literature review. Results: The prevalence of HIV infection in Western Europe is low (0.23%). Epidemiologic data from Austria for the year 1999 show that 74% of all newly diagnosed cases of HIV infection in women occur at an age of 20 to 40 years and only 4% at an age of more than 50 years. Perinatal vertical transmission of HIV from mother to child can be reduced from about 30% to less than 1% by antiretroviral therapy, elective cesarean section, prophylactic therapy of the newborn and avoiding breast-feeding. Thus, the data support screening all pregnant women for HIV infection. The risk of hospital staff for occupational HIV infection is low compared to other blood-borne infections such as hepatitis B or C, Universal precautions for dealing with body fluids should be observed. Screening gynecologic patients for HIV is not an appropriate measure to reduce the risk of occupational HIV infection Conclusions: Because vertical transmission can be prevented, all pregnant women should be screened for HIV infection. In contrast, it makes little sense to screen all gynecologic patients.

Poor assessment of HIV epidemiology and occupational HIV transmission risk by medical students

Due to the increasing global number of HIV-positive patients, the potential risk of acquiring infection with HIV during routine clinical care is on the increase. Assessments of the knowledge of medical students about occupational HIV transmission are therefore important. This study analysed the knowledge of 397 first year and 75 fifth year medical students about the epidemiology of HIV in Germany and their assessment of the risk of acquiring HIV in different clinical situations. Medical students overestimated the incidence and mortality of HIV in Germany, with fewer than 30% knowing the correct numbers. They also overestimated the risk of occupational HIV infection in several clinical settings, such as changing dirty linen or wound dressings. Few differences were found between first and fifth year medical students. For their later work as physicians medical students still need more information and counselling about the epidemiology of HIV, prevention of occupational HIV infections and care for patients with HIV/AIDS.

Aids and anesthesia] .

17 years after the discovery of HIV Aids remains an ultimately fatal disease. Currently no vaccine is available. The worldwide incidence of HIV-infections and Aids associated mortality are rising. Only in Western Europe and in the USA are incidence and mortality of Aids declining; mainly as a result of effective antiretroviral therapy. 20% to 25% of HIV-infected patients require surgery during their illness. The challenges for the anaesthesiologist are possible dysfunction of all important organs and adverse interactions between antiretroviral drugs and anaesthetic agents. If adequate infection control measures are taken the risk of occupational HIV-infection is low, but remains a concern in light of the consequences. Seroconversion after needlestick injury is ca. 0.3%, after contact with mucosa ca. 0.03%.

Application of guidelines for occupational HIV infection control during delivery in Italy

Objective: We surveyed the attitudes of Italian obstetricians toward the application of HIV infection control guidelines during labour and delivery proposed by the Italian National Committee for HIV Infection. Study design: We identified 66 obstetric centres affiliated to the AOGOI (Association of Italian Gynecologists and Obstetricians). A postal questionnaire was sent to 752 physicians in charge in the centres. Results: A total of 419 clinicians (55.7%) completed and returned the form to the coordinating centre. Obstetricians were directly asked about the need for routine adoption of the Italian guidelines for delivery of women with positive or unknown HIV status (indicating the routine use during delivery of protective glasses, impermeable garments, mask and sterile latex gloves, the washing of hands with detergent solution after using gloves and collection of needles and sharp instruments in suitable containers). A total of 319 (76.1%) clinicians agreed that all these procedures should be adopted. In clinical practice, however, obstetricians declared that the use of latex gloves and collecting needles in suitable containers were always adopted, `washing hands after using gloves' less frequently, and other procedures such as protective impermeable garments, glasses and mask were infrequently applied.

Occupational blood exposure and HIV infection among oral and maxillofacial surgeons

Objective. The purpose of this study was to examine occupational blood exposure and the seroprevalence of HIV infection among oral and maxillofacial surgeons. Study Design. Three hundred twenty-one oral and maxillofacial surgeons attending an annual meeting voluntarily and anonymously participated in an HIV serosurvey and completed a questionnaire assessing practice and demographic factors. Statistical tests included the Wilcoxon rank-sum test and the chi-squared test. Results. Eighty percent of those who completed the survey reported one or more blood-skin contacts within the previous month. The mean number of percutaneous injuries within the previous year was 2.36 ± 0.2. Wire was most commonly associated with percutaneous injuries. Oral and maxillofacial surgeons who reported three or more percutaneous injuries performed more fracture reductions than oral and maxillofacial surgeons reporting no percutaneous injuries ( p < 0.01). No participant was HIV-positive; the upper limit of the 95% confidence interval was 1.15%. Conclusion. The findings suggest that the occupational risk for HIV infection in oral surgery is very low even though most oral and maxillofacial surgeons experienced blood contact. Associations of percutaneous injuries with fracture reductions and wire may assist in the development of new techniques and equipment to minimize blood exposures.

HIV/AIDS infection control enforcement: a comparison between Nigeria and the United States

We examined differences in approaches to HIV-related infection control practices in two university teaching hospitals in the United States and Nigeria. Health care workers (n = 202 in Nigeria and 186 in the USA) responded to a previously validated measure of infection control practices. There were significant differences in the estimated probability of treating a person with HIV disease (higher in USA), and a greater probability of peer ridicule as a way of enforcing group norms on infection control in Nigeria. Peer enforcement of norms was significantly lower in the USA. In both countries, more precautions would be taken if it was known that the patient was HIV infected. Infection control practices were more likely to be followed in the USA compared with Nigeria if they were praised for this activity, if appropriate facilities (sharps containers, gloves, etc.) were nearby, and if they felt that infection control procedures were effective. These data point to the importance of normative social pressures in Nigeria and of knowing the patient is HIV infected in the USA and feeling that infection control procedures are effective ways of avoiding occupational HIV infection. The role of normative pressures and assumptions about HIV infection status as well as cues and availability of facilities for infection control appear to differ between these health care workers in Nigeria and the USA.

HIV transmission during invasive radiologic procedures: estimate based on computer modeling.

The primary purpose of this study was to estimate the risk of HIV transmission from physicians to patients during invasive radiologic procedures and to compare this estimate with those previously derived for surgical procedures so that policy on possible practice restrictions can be decided. The risk of HIV transmission from patient to physician, including cumulative career risk for interventional radiologists, was also estimated. The risk of HIV transmission from physician to patient and vice versa was estimated with computer modeling techniques, using available data on prevalence of HIV infection, rates of injury during invasive radiologic procedures, and risk of viral transmission after an exposure. Cumulative career risk of occupational infection was estimated with a computer simulation model. If the physician's HIV status is unknown, the risk of transmission of HIV to a patient during a procedure is estimated to be 0.03 per million procedures (95% confidence interval, 0-3.8 per million procedures). If the physician is known to be HIV-positive, the risk of transmission to a patient is estimated to be 7.5 per million procedures (95% confidence interval, 0-15.3 per million procedures). The estimated risk of transmission from patient to physician ranges from 0.03 to 7.5 per million for a single procedure, and the cumulative risk of occupational HIV infection over 30 years is estimated to be 0.009-16%. The estimated risk of HIV transmission from physician to patient during invasive radiologic procedures is so low that global practice restrictions on HIV-infected interventional radiologists are not warranted. As recommended by the American Medical Association and the Centers for Disease Control, decisions on possible practice restrictions should be made on a case-by-case basis rather than a priori. The risk of HIV transmission from patient to physician is also low, but real. The cumulative career risk of occupational infection with HIV may vary widely based on individual circumstances and the patient population served.

A survey of occupational blood contact and HIV infection among traditional birth attendants in Rwanda.

To investigate the risk of occupationally acquired HIV infection among traditional birth attendants (TBA) in Rwanda, Africa. A serosurvey was conducted among 219 TBA practicing in a rural but densely populated area in southern Rwanda. Each TBA was interviewed about sociodemographic information, work-related habits and practices, and presence of nonoccupational risk factors for HIV infection. The frequency of skin exposure to HIV-infected blood was estimated for each TBA from HIV seroprevalence data collected previously from pregnant women stratified by the geographic zones in which the TBA practiced. Four TBA (1.8%) tested HIV-1-antibody-positive; all four had reported nonoccupational risk factors for HIV infection. We estimated that the 215 HIV-negative TBA had 2234 potentially infectious blood-skin contacts out of a total of approximately 35,000 deliveries assisted in the past 5 years. However, we found no evidence of HIV infection caused by occupational blood contact (none out of 2234; upper limit of the 95% confidence interval because of one potentially infectious blood-skin contact = 0.2%). Although these findings may not be universal to all TBA in Africa, the risk of occupationally acquired HIV infection among TBA appears small. The high frequency of blood-skin contact among TBA in Rwanda highlights the need to include infection control precautions in the training of TBA.

Italian Study Documents Occupational HIV Infection After Mucous Membrane Exposure to Blood

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Prophylaxis of HIV Infection following Occupational Exposure

To review the risk of HIV infection following occupational exposure, the theoretical basis for chemoprophylaxis, investigative experience with chemoprophylaxis in animals and humans, and the economic aspects of postexposure chemoprophylaxis. English-language articles and conference proceedings pertaining to the risk of occupational HIV infection and to postexposure chemoprophylaxis. Studies evaluating chemoprophylaxis of HIV infection following occupational exposure were selected for review. Abstracts reporting ongoing clinical trials were also included. In vitro studies are discussed to provide the immunologic rationale for chemoprophylaxis. Animal studies examining the efficacy of chemoprophylaxis in preventing non-HIV retroviral infection are reviewed, and their applicability to human HIV infection is critically evaluated. Human studies and case reports describing attempts at chemoprophylaxis of HIV infection following occupational exposure are discussed. Chemoprophylaxis of HIV infection following occupational exposure has focused on the use of zidovudine (ZDV) because it was previously the only antiretroviral agent approved for treating HIV infection. Animal models of retroviral infection provide conflicting data regarding the efficacy of ZDV chemoprophylaxis, and there are important questions about the applicability of animal data to human HIV infection because of differences in natural histories of non-HIV retroviral infections, inoculum size, dosing of ZDV, and routes of infection. Human surveillance studies are thus far inadequate to determine the efficacy of ZDV prophylaxis because of the very low HIV seroconversion rates following occupational exposure. ZDV is well tolerated during short-term administration in people without HIV infection, but long-term safety is unknown. In addition, the true cost-benefit ratio of ZDV chemoprophylaxis is uncertain. Current data from in vitro, animal, and human studies are inadequate to define the appropriate role of ZDV in preventing HIV infection following occupational exposure. Limited toxicity data and the high cost of treatment must be weighed against the theoretical benefits of ZDV use in this setting. The decision to employ ZDV for postexposure prophylaxis must ultimately be based on existing institutional policies, the attitude of the responsible physician regarding such practice, and/or the desires of the exposed healthcare worker after being properly informed of potential risks and benefits.

A Survey of Occupational Contact and HIV Infection Among Orthopedic Surgeons

TOKARS, J. I.; CHAMBERLAND, M. E.; SCHABLE, C. A.; CULVER, D. H.; JONES, M.; McKIBBEN, P. S.; BELL, D. M.

Glaxo, Inc., Releases Video on Preventing Occupational HIV Infection in Healthcare Workers

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