Occupational Transmission Of HIV Research Articles

Knowledge, attitudes and practices towards patients with HIV/AIDS in staff nurses in one university hospital in Sicily


 Background: nurses’ knowledge, attitudes and practices towards patients with HIV/AIDS are of ongoing interest, especially in developing countries. Nothing or very little is known about Italian nurses.
 Methods: HIV/AIDS knowledge, attitudes and behaviours of the nurses (n=107) from one university hospital inCatania,Sicily, were documented. Comparisons among nurses belonging to different Operative Units (O.U.) were conducted by the chi-square test (P<0.05).
 Results: although HIV was nurses’ main concern in regard to contracting infections in the workplace (54%), the vast majority of them (98%) had never refused an HIV/AIDS patient care assignment. Moreover, despite their concern of being more at risk of contracting HIV than the general population (41%), a not negligible percentage of nurses did not use gloves routinely (21%) and only a few treated all patients as potentially HIV-positive (9%). The vast majority of the respondents knew the meaning of AIDS (87%) and of a positive serological test (78%). On the contrary, a relatively low percentage of them knew what is the ‘window period’ (62%) and were acquainted with HIV pathophysiology (65%). No statistically significant differences in terms of risk perception were found between nurses who had previously attended an HIV/AIDS workshop, lecture or specific course (43%) and nurses who did not (57%). Level of knowledge was positively associated to age (P=0.000) and to education (P=0.016), and it was found higher in nurses working in a O.U. of Infectious Diseases.
 Conclusions: data from our study show that also in developed countries, such as Italy, nurses could have some misconceptions and concerns about HIV/AIDS. The importance of examining the impact of continuing education on nurses’ preparedness to care for patients with HIV/AIDS and to prevent the risks of occupational HIV transmission is discussed. 

STANDARD PRECAUTION ADHERENCE BY NURSING WORKERS: A MIXED METHODS STUDY

ABSTRACT Objective: to analyze standard precaution adherence and associated factors of nursing workers at a university hospital. Method: this is a study of mixed methods of convergent parallel strategy, carried out in Southern Brazil. The quantitative stage had 602 participants, using the instrument of sociodemographic and professional variables and the Instrument of Variables Related to Standard Precautions, analyzed using descriptive statistics. In the qualitative stage, a semi-structured interview was conducted with 24 workers, analyzed through content analysis. Results: the data showed an intermediate standard precaution adherence. In the Individual Factors dimension, the Prevention Effectiveness Scale showed high scores and the Risk Personality, Risk Perception and Knowledge about Occupational HIV Transmission scales, intermediate scores. In the dimension Work-related factors, both in the Obstacles to Following Standard Precautions Scale and in the Workload Scale, the scores were intermediate. In the Organizational Factors dimension, low scores were found for Climate of Safety and Training in Prevention of Exposure to the Human Immunodeficiency Virus and intermediate for Personal Protective Equipment Availability. Qualitative data showed that workers often select patients who they think are at greatest risk for occupational transmission to use standard precautions. Conclusion: standard precaution adherence does not occur fully among participants. Data integration allowed to conclude that, among the main elements that influence this phenomenon, is the lack of clarity of participants as to the purpose, indication and principles of standard precautions.

Patterns of caesarean section in HIV infected and non-infected women in Malawi: is caesarean section used for PMTCT?

BackgroundCaesarean section (CS) is not recommended for PMTCT in Malawi HIV Guidelines, contrary to most high-income countries where CS is indicated if viral suppression is sub-optimal pre-delivery. We describe patterns of CS in HIV-infected and uninfected women in Malawi and explored if insight into the use of Elective CS (ECS) for PMTCT could be obtained.MethodsWe used routinely collected data from individual medical records from 17 large health facilities in the central and southern regions of Malawi, from January 2010 to December 2013. We included data from maternity registers from all HIV-positive women, and randomly selected around every fourth woman with negative or unknown HIV status. We used multivariable logistic regressions and cluster-based robust standard errors to examine independent associations of patient- and facility characteristics with CS and ECS.ResultsWe included 62,033 women in the analysis. The weighted percentage of women who had a spontaneous vaginal delivery was 80.0% (CI 95% 79.5–80.4%); 2.4% (95% CI 2.3–2.6%) had a vacuum extraction; 2.3% (95% CI 2.2–2.5%) had a vaginal breech delivery; 14.0% (95% CI 13.6–14.4%) had a CS while for 1.3% (95% CI 1.2–1.4%) the mode of delivery was not recorded. Prevalence of CS without recorded medical or obstetric indication (ECS) was 5.1%, (n = 3152). Presence of maternal and infant complications and older age were independently associated with CS delivery. HIV-positive women were less likely to have ECS than HIV negative women (aOR 0.65; 95%-CI 0.57–0.74). Among HIV-positive women, those on antiretrovirals (ARV’s) for ≥4 weeks prior to delivery were less likely to have ECS than HIV-positive women who had not received ARVs during pregnancy (aOR 0.81; 95% CI 0.68–0.96).ConclusionsThe pattern of CS’s in Malawi is largely determined by maternal and infant complications. Positive HIV status was negatively associated with CS delivery, possibly because health care workers were concerned about the risk of occupational HIV transmission and the known increased risk of post-operative complications. Our results leave open the possibility that CS is practiced to prevent MTCT given that ECS was more common among women at high risk of MTCT due to no or short exposure to ARV’s.

An investigation of stigmatizing attitudes towards people living with HIV/AIDS by doctors and nurses in Vientiane, Lao PDR

BackgroundDespite global efforts, HIV-related stigma continues to negatively impact the health and well-being of people living with HIV/AIDS. Even in healthcare settings, people with HIV/AIDS experience discrimination. Anecdotal evidence suggests that healthcare professionals in the Lao People's Democratic Republic, a lower-middle income country situated in Southeast Asia, stigmatize HIV/AID patients. The purpose of this study was to assess HIV stigmatizing attitudes within Laotian healthcare service providers and examine some of the factors associated with HIV/AIDS-related stigma among doctors and nurses.MethodsA structured questionnaire, which included a HIV-related stigma scale consisting of 17 items, was self-completed by 558 healthcare workers from 12 of the 17 hospitals in Vientiane. Five hospitals were excluded because they had less than 10 staff and these staff were not always present. The questionnaire was pre-tested with 40 healthcare workers. Descriptive statistical analysis was performed and comparisons between groups undertaken using chi-square test and t-test. Bivariate and multiple linear regression analyses were carried out to examine the associations between stigmatizing attitudes and independent variables.ResultsOut of the 558 participating healthcare workers, 277 (49.7%) were doctors and 281 (50.3%) were nurses. Nearly 50% of doctors and nurses included in the study had high levels of stigmatizing attitudes towards people living with HIV/AIDS. Across the different health professionals included in this study, lower levels of HIV/AIDS knowledge were associated with higher levels of stigmatizing attitudes towards people living with HIV/AIDS. Stigmatizing attitudes, including discrimination at work, fear of AIDS, and prejudice, were lower in healthcare workers with more experience in treating HIV/AIDS patients.ConclusionsThis study is the first to report on HIV/AIDS-related stigmatization among healthcare workers in Lao PDR. Stigmatizing attitudes contribute to missed opportunities for prevention, education and treatment, undermining efforts to manage and prevent HIV. Reversing stigmatizing attitudes and practices requires interventions that address affective, cognitive and behavioral aspects of stigma. Alongside this, health professionals need to be enabled to enact universal precautions and prevent occupational transmission of HIV.

Influência dos fatores individuais, relativos ao trabalho e organizacionais na adesão às precauções padrão por profissionais da odontologia

Justificativa e Objetivos: Os fatores individuais, relativos ao trabalho e organizacionais podem favorecer a adesão de práticas seguras no ambiente laboral, prevenindo a ocorrência de exposições a material biológico entre profissionais da área da saúde. Baseado nisso, objetivou-se verificar a influência de fatores individuais, relativos ao trabalho e organizacionais na adesão às precauções padrão. Métodos: Trata-se de um estudo transversal, de caráter censitário, com abordagem quantitativa, realizado com 79 profissionais da área odontológica (cirurgiões-dentistas e auxiliares em saúde bucal), alocados no sistema público de saúde de um município do interior paulista. Para coleta dos dados, os participantes responderam ao modelo explicativo da adesão às precauções padrão. Trata-se de um questionário validado, constituído por variáveis demográficas e escalas psicométricas, onde a associação destes fatores com a adesão às precauções padrão foi obtida por meio da análise de regressão logística múltipla. Resultados: A análise estatística revelou que a idade do profissional, o tempo de atuação na profissão e de trabalho na unidade; a forma como tomou conhecimento das precauções padrão, a personalidade de risco, a eficácia da prevenção, os obstáculos para seguir as precauções padrão, o treinamento e disponibilidade do equipamento de proteção individual; as ações gerenciais de apoio a segurança do trabalhador, o feedback das práticas seguras e conhecimento da transmissão ocupacional do HIV; além da carga de trabalho, influenciaram positivamente na adesão às precauções padrão entre os profissionais integrantes do estudo. Conclusão: Conclui-se que a adesão às precauções padrão é influenciada, simultaneamente, por fatores individuais, relativos ao trabalho e organizacionais.

Post Exposure Prophylaxis for Occupational Exposures to HIV and Hepatitis B: Our Experience of Thirteen Years at a Rural Based Tertiary Care Teaching Hospital of Western India.

Health Care Workers (HCWs) are at risk of occupational transmission of HIV, Hepatitis B and Hepatitis C, which can be minimized by following guidelines for standard precautions as well as taking Post Exposure Prophylaxis (PEP) measures. There are limited studies from India documenting details of PEP for HIV and Hepatitis B. We aimed to study the efficacy, tolerance, details of PEP regimens used among HCWs exposed to HIV and Hepatitis B as well as vaccination status and (Anti-Hepatitis B Surface Antigen) anti-HBS Antibody Titre Level Among HCWs exposed Hepatitis B. This retrospective observational study was done at a rural based tertiary care teaching centre of Western India. Hospital Infection Control Committee of our institute was maintaining a record of all reported incidences of HIV and Hepatitis B positive exposures since 2003. We analysed reported incidences of exposures to HIV and Hepatitis B positive source occurred during the period of January 2003 to December 2015. Of the total 96 exposures, 48 were to HIV and 48 were to Hepatitis B. Of the 48 exposures to HIV, PEP was warranted in 39. Of 39 exposures, only 14 (35.9%) received PEP within two hours. Basic regimen was used in 22 and expanded in 17 exposures. Only 12 (31.6%) reported side effects to PEP. Zidovudine based regimen was less well tolerated. All side effects were reported by female HCWs only. Of the 48 exposed to Hepatitis B, 33 (68.6%) were completely vaccinated. Out of 33, titre result was not available for eight. Three (12.0%) of remaining 25 were having low titre (<10mIU/ml) of anti-HBS antibody. Five of six with incomplete vaccination status demonstrated anti HBS antibody titre > 100mIU/ml. Of the 48, in 17 (35.4%) incidences no action was required; 23 (47.9%) were managed with booster dose of Hepatitis B vaccine and eight (16.7%) with Hepatitis B immunoglobulin. No cases of sero-conversion was reported either for HIV or Hepatitis B from available data. Inspite of high incidences of exposures to HIV or Hepatitis B positive source, good efficacy of PEP was observed with no sero-conversion. PEP for HIV was well tolerated; female HCWs were less tolerant. Study emphasized the need for creating awareness about timely reporting of incidence, achieving maximum vaccination against Hepatitis B for all HCWs and need for anti-HBS antibody titre.

Implementation and impact of a post-exposure prophylaxis helpline.

Despite a 2007 national and regional training programme, there was poor implementation of a post-exposure prophylaxis (PEP) programme to prevent occupational transmission of HIV in health care workers (HCWs) in Delhi. A new initiative was therefore launched by the Delhi State AIDS Control Society in 2010 to improve uptake of PEP in HCWs. To assess the implementation and efficacy of the PEP programme in Delhi. The initiative included a PEP poster and a telephone helpline together with a workshop for senior doctors of 46 public hospitals nominated as PEP supervisors. Data concerning use of the PEP help line and number of HCWs enrolling for PEP between January 2011 and May 2014 were analysed. Until September 2010, only 61% (28) of Delhi hospitals had PEP drugs and medical supervisors to manage the programme and reports concerning the programme were not sent. After roll-out of the PEP helpline, 4057 HCWs accessed the helpline, all public hospitals started implementing the programme and sent monthly reports. During the same period, 1450 HCWs suffered from occupational exposures, 15% were started on PEP drugs of who 98% completed the full course of prophylaxis. The PEP helpline is probably the first in a developing country and has been helpful for the effective implementation of the national PEP programme in Delhi.

Knowledge of occupational exposure to HIV: a cross sectional study of healthcare workers in Tumbi and Dodoma hospitals, Tanzania.

BackgroundInsufficient knowledge on blood-borne pathogens has been identified as a factor that influences occupational exposure to needle stick and sharps injuries. The objective of this study was to assess healthcare workers’ knowledge on occupational exposure to HIV.MethodsA cross sectional survey was conducted at Tumbi designated regional hospital and Dodoma regional hospital, Tanzania in February 2012. A self-administered questionnaire was used to capture information on knowledge of occupational exposure to HIV infection.ResultsA total of 401 healthcare workers responded to a self-administered questionnaire. High proportion of healthcare workers (96.3%) understood that they are at risk of occupational exposure to HIV. The majority of healthcare workers trained on post exposure prophylaxis procedure and use of personal protective equipment were clinicians (87.1% and 71.4% respectively) and nurses (81.8% and 74.6% respectively). Over a quarter of the healthcare workers were not aware of whom to contact in the event of occupational exposure. One third of healthcare workers did not have comprehensive knowledge on causes of occupational HIV transmission and did not know when post exposure prophylaxis is indicated. Healthcare workers not trained on the use of person protective equipment were less likely to have comprehensive knowledge on occupational exposure to HIV (OR = 0.5; 95% CI 0.3 – 0.9). Knowledge on causes of occupational exposure varied with the cadre of healthcare workers. Nurses were more likely to have comprehensive knowledge on occupational exposure to HIV than non-clinical staff (OR = 2.6; 95% CI 1.5 – 4.5).ConclusionA substantial proportion of studied healthcare workers had little knowledge on occupational exposure to HIV and was not aware of a contact person in the event of occupational exposure to HIV. Training on post exposure prophylaxis and infection prevention and control including the use of person protective equipment provided to nurses and clinicians should be extended to other clinical and non-clinical hospital staff.

Awareness among young dentists about transmission of H.I.V and preventive measures

HIV/AIDS has profoundly affected every aspect of the health sector. Most importantly doctor’s attitude of avoiding treatment of HIV patients is mainly due to their apprehensions caused by their lack of understanding of the disease and its modes of transmission. To assess the knowledge, attitudes, and perceptions of risk of occupational transmission of HIV in a group of dental students. Design-Cross sectional anonymous questionnaire survey of all occupational groups in a large inner city teaching hospital. Overall correct responses were given by most of the respondents. Others either gave wrong responses or answered ‘Not-sure’. Well known modes of HIV transmission like, blood transfusion, needle stick injuries and question about vertical transmission to newborn were answered correctly by more than 90% of the respondents. Correct responses were very low to query of possibility of spread by saliva [58.2%]. Higher percentage of correct responses by BDS graduates compared to MDS graduates was statistically significant [p>0.05]. These findings highlight the importance of teaching the dental students on various aspects of the disease. Universal Work Precautions implementation should be emphasized at an early level of their curriculum and reinforced from time to time.

HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa

This paper is a report of a study exploring HIV/AIDS-related knowledge, attitudes, practices and perceptions of nurses in the largely black and rural Limpopo Province of South Africa. Studies of HIV/AIDS knowledge, attitudes and practices among healthcare workers in developing countries have shown gaps in knowledge and fear of contagion, coupled with ambivalent attitudes in caring for patients with HIV/AIDS and inconsistent universal precautions adherence. A cross-sectional study of a random sample of primary health care (PHC) (n = 71) and hospital nurses (n = 69) was carried out in 2005, using a questionnaire, focus groups and in-depth interviews. Hospital nurses reported a higher frequency of care for patients with HIV/AIDS (P < 0.05), but less HIV/AIDS training when compared to PHC nurses (P < 0.001). HIV/AIDS knowledge was moderately adequate and associated with professional rank, frequency of care and training (P < 0.001). Attitudes towards patients with HIV/AIDS were mainly positive and were statistically significantly correlated with HIV/AIDS knowledge (P < 0.01) and training (P < 0.05). Three out of four nurses reported that they practised universal precautions (76.1%), but fear of occupational HIV transmission and lack of injection safety was found. Seven in 10 nurses reported previous needlestick injuries, but postexposure prophylaxis was not available in all healthcare facilities. Participants reported a higher workload because of HIV/AIDS, lack of training impacting negatively on their work, and stigma and shared confidentiality affecting them emotionally. There is a need for accelerated HIV/AIDS training of rural nurses and for wider implementation of universal precautions and postexposure prophylaxis availability in public health facilities in southern Africa.

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...

Significant Virus Replication in Langerhans Cells following Application of HIV to Abraded Skin: Relevance to Occupational Transmission of HIV

The cellular events that occur following occupational percutaneous exposure to HIV have not been defined. In this study, we studied relevant host cellular and molecular targets used for acquisition of HIV infection using split-thickness human skin explants. Blockade of CD4 or CCR5 before R5 HIV application to the epithelial surface of skin explants completely blocked subsequent HIV transmission from skin emigrants to allogeneic T cells, whereas preincubation with C-type lectin receptor inhibitors did not. Immunomagnetic bead depletion studies demonstrated that epithelial Langerhans cells (LC) accounted for >95% of HIV dissemination. When skin explants were exposed to HIV variants engineered to express GFP during productive infection, GFP+ T cells were found adjacent to GFP+ LC. In three distinct dendritic cell (DC) subsets identified among skin emigrants (CD1a+langerin+DC-specific intercellular adhesion molecule grabbing non-integrin (SIGN)- LC, CD1a+langerin-DC-SIGN- dermal DC, and CD1a-langerin-DC-SIGN+ dermal macrophages), HIV infection was detected only in LC. These results suggest that productive HIV infection of LC plays a critical role in virus dissemination from epithelium to cells located within subepithelial tissue. Thus, initiation of antiretroviral drugs soon after percutaneous HIV exposure may not prevent infection of LC, which is likely to occur rapidly, but may prevent or limit subsequent LC-mediated infection of T cells.

Increasing trends in HIV and TB rates in Odessa and the Ukraine

Our objective was to evaluate the level of occupational risk, attitude and behaviour of surgeons towards HIV-infected patients. A questionnaire survey of 264 randomly selected surgeons in training or in practice in five different health institutions in southeast Nigeria within a five-month period was carried out. A 94% response rate was obtained with completed questionnaires from 264 surgeons. The respondents included obstetricians and gynaecologists (n = 78), general surgeons (n = 121), orthopaedic surgeons (n = 40), dental surgeons (n = 10), ophthalmologists (n = 6), urologists (n = 5), and ear, nose and throat surgeons (n = 4). Of them, 31% (n = 82) were qualified surgeons in practice, while the remaining 69% (n = 182) were resident surgeons in training. In the past five years, 40.2% (n = 106) and 26% (n = 70) of the respondents reported needle-stick injuries and blood splash, respectively, during surgery. The majority of the victims were resident surgeons, obstetricians and gynaecologists, and orthopaedic surgeons. Level of clinical experience and high patient blood loss are likely to contribute to this observation. In all, 89% (n = 236) were engaged in the risky practice of operating on patients with open wounds in their hand and the wounds were contaminated with blood in 5% of cases. During surgical procedures, all (100%) respondents wore protective apron, 65.2% (n = 172) wore double gloves and 30.3% (n = 80) used protective goggles. The use of double gloves and protective eye wear increased remarkably over the past decade, probably because the fear of occupational transmission of HIV was substantial. In total, 83% (n = 220) of the respondents had some reservations about treating patients infected with HIV, while 13.3% (n = 35) viewed them with fear. The remaining 3.4% (n = 9) had a more positive attitude towards HIV-infected patients. Further, 92% advocated preoperative screening, with special precaution during surgery, if the results are positive. In addition, 79.5% were of the view that infected patients should not be discriminated against in treatment, provided necessary protective materials are available. To ensure provision of these protective materials, 91% (n = 240) and 89.4% (n = 236) of the respondents favoured involvement of government and insurance agencies, respectively. In order to achieve a greater commitment from surgeons in developing countries towards caring for HIV-infected patients, there is a need for a comprehensive AIDS management package that would offer specific preventive and psychological training in care of HIV patients and provide requisite funds and resources.

Comfort levels of nursing students regarding clinical assignment to a patient with AIDS.

For educators, preparing nursing students for the care of persons with AIDS is an important responsibility. A review of the literature suggests that many nursing students are fearful of occupational transmission of HIV and that educational interventions may improve the students' attitudes toward caring for patients with AIDS. The author administered Form A of the Nursing Care Comfort scale to a sample of 122 baccalaureate students. Findings revealed variations in comfort levels relative to specific nursing skills.

Knowledge, practice, and behavior of health care workers confronted to AIDS and the occupational risk of HIV transmission in Morocco

Objectives – We wanted to evaluate the knowledge, attitude, and behavior of healthcare workers on AIDS. Method – Two hundred sixty six healthcare workers were surveyed in 2 hospitals, (Rabat and Casablanca). Working conditions presenting a risk of occupational HIV transmission were also analyzed, to develop appropriate prevention. A cross-sectional study was made, using a standardized questionnaire. Ninety one doctors (34.2%), 106 nurses (39.8%), 12 laboratory technicians (8.8%) and 47 support staff (17.6%) working in various departments were included. The mean age was 32.7 years, with 83% under 40 and more than half having worked in hospital for less than 10 years. Results – The personnel knew a great deal about HIV transmission but much less about possible occupational contamination. One person out of 2 was unaware of how to inactivate HIV in hospital environment (Chlorine water, 70% alcohol), and only 18.4% knew that HIV was heat sensitive. Fifty percent thought that a systematic exclusion of patients with HIV was essential and 66% suggested that every patient admitted to the hospital should undergo systematic HIV testing. Anxiety in these settings was expressed by 56% of doctors and 62% of paramedical workers, and 85% thought they were at high risk of contamination. The frequency of occupational injuries was high and such accidents rarely declared (7%). Conclusion – This shows that greater efforts should be made to educate and inform health care workers through the occupational medicine units recently set up for the benefit of the staff.

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.

Education of the trauma team: video evaluation of the compliance with universal barrier precautions in resuscitation.

To assess the effectiveness of an educational symposium designed to improve compliance with universal barrier precautions by the use of video analysis of resuscitations. Prospective single blind analysis of data. Hospital Trauma Unit, Johannesburg, South Africa. 100 severely injured patients who presented to the emergency room, divided into two study periods. An educational symposium held between the study periods, which focused on universal barrier precautions and the risk of occupational transmission of HIV. Compliance with items of universal precautions; mechanism; Injury Severity Score and Revised Trauma Score. There was a significant improvement in compliance from 48% to 74% after the symposium (p = 0.007), with specific improvement in the wearing of masks and visors. Initially there was poor compliance with universal precautions in severely injured patients, which significantly improved to 83% compliance (p = 0.0004). Video analysis of resuscitations is an effective audit and educational tool that allows analysis of compliance with protocol. The education symposium was effective in altering attitudes and behaviour towards universal barrier precautions.

HIV infection: problems with patientsʼ anaesthetic management and healthcare workersʼ exposure

Although infection with HIV has become a global epidemic, current research has provided a better understanding of the virus and its effect on the immune system. Combinations of new antiretroviral agents have been shown to be effective in prolonging the life of infected individuals, and chemoprophylactic regimens have been useful in preventing opportunistic infections. Risk factors associated with the occupational transmission of HIV have been identified and prevention strategies proposed.

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

Risk to the Health Care Worker of HIV Infection and How to Minimize It

Occupational transmission of HIV fortunately is uncommon. The risk of acquiring HIV depends on the mode of exposure, the body fluid involved, and the source patient. Percutaneous injuries carry the greatest risk (approximately 0.3%), and blood is by far the most important source of HIV to which the health care worker is exposed. Universal precautions should be applied to all patients in order to decrease the risk of occupational transmission of HIV. Furthermore, a system must be designed to provide adequate assessment, counselling, and follow-up for exposed health care personnel. Postexposure prophylaxis must be tailored to the specific exposure for each health care worker.