Human immunodeficiency virus transmission in health care settings: risk and risk reduction

Article Abstract:

Infection with the human immunodeficiency virus (HIV) leads to AIDS. Health care workers who come in contact with blood samples from infected patients are at risk for developing an infection with HIV. Prior to October of 1990, 149,498 cases of AIDS in adults living in the US had been reported to the Centers for Disease Control (CDC). Occupational histories were available for 122,159 of the people with AIDS, and 5 percent were or had been employed as health care or medical laboratory workers. Prior to July 1991, a total of 40 health care workers were known by the CDC to have acquired HIV or AIDS through on-the-job exposure. Twenty-four of these cases were caused by exposure to infected blood following skin injury (such a needlestick), mucous membrane exposure, or skin exposure. Several studies have tried to estimate the risk of contracting HIV following skin puncture with a sharp object containing infected blood. It is estimated that the risk of developing an HIV infection following a single needlestick with infected blood is 0.3 percent. Exposure to infected blood can be prevented by wearing gloves, and developing safe work habits. Several studies have been performed to determine the rate of HIV transmission from infected doctors or dentists to patients. In one study, 615 patients, each of whom had been operated on by a surgeon with AIDS, all tested negative for HIV. In two other studies, 62 patients and 75 patients operated on by two different surgeons with AIDS were tested, and all were negative for HIV. When the patients of an infected dental student were tested, none of the student's 143 patients were infected. These findings indicate that the rate of transmission from infected doctors or dentists to their patients is likely to be low. (Consumer Summary produced by Reliance Medical Information, Inc.)

Work environment, AIDS (Disease), AIDS (Disease) in the workplace

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Occupational exposure to HIV: frequency and rates of underreporting of percutaneous and mucocutaneous exposures by medical housestaff

Article Abstract:

Medical personnel who work with blood samples or patients infected with human immunodeficiency virus (HIV) are at risk for developing HIV infection. Needlestick injury (sticking oneself with a used needle) is the most common form of exposure of medical personnel to diseases transmitted by blood. Precautionary measures, such as wearing gloves when handling blood samples and not trying to recap used needles, have been helpful in reducing exposure to bloodborne diseases. However, accidental exposure of medical personnel to patient blood samples still occurs. A cross-sectional survey was performed in three teaching hospitals where HIV-infected patients are commonly treated, to evaluate the frequency of accidental exposure to patients' blood. The 86 respondents were housestaff (interns and residents). Nineteen percent said that they had been accidentally exposed to HIV-infected blood, and 36 percent had been exposed to blood from patients at high risk for HIV infection. Eighty-one percent of all needlestick injuries, and 100 percent of needlestick injuries with HIV-infected blood, occurred in housestaff who were in their first or second year (out of four years) of training. Of all the needlestick injuries, only 30 percent were reported at the time of the incident. The reasons for not reporting exposure to blood samples included not enough time, a feeling that the exposure was not significant, uncertainty about how to report the incident, and concerns about confidentiality and discrimination. It is concluded that medical personnel are at substantial risk for contracting HIV infection, and that the majority of accidental exposures to HIV-infected blood are not reported. (Consumer Summary produced by Reliance Medical Information, Inc.)

Officials and employees, Causes of, Hospitals, Occupational diseases, Disease reporting

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Evaluating the benefits and risks of postmenopausal hormone therapy

Article Abstract:

Estrogen replacement therapy has been reported to reduce the risk of coronary heart disease and bone fractures related to osteoporosis (reduced bone density), and to increase the risk of endometrial and breast cancer. However, good randomized clinical trials to determine the effects of estrogen therapy on heart disease, fractures and cancer are lacking. The idea that estrogen may protect against heart disease began with the observation that estrogen tends to lower low-density-lipoprotein cholesterol (LDLC), while increasing levels of high-density-lipoprotein cholesterol (HDLC), and may have beneficial effects on coronary arteries. Several epidemiological studies have produced strong evidence that women who take estrogen supplements have a lower risk of developing coronary heart disease than those who do not take estrogen supplements. However, these studies do not prove that estrogen prevents heart disease. Until randomized clinical trials are performed, this issue will remain unresolved. Progestins have been reported to reduce the risk of endometrial cancer, but they counteract the beneficial effects of estrogen on HDLC. It is not clear whether progestin reduces the beneficial effects of estrogen on heart disease. Studies have reported that long-term estrogen therapy increases the risk of developing breast cancer by 30 percent and endometrial cancer by two- to fivefold. However, these cancers have a better prognosis in women who are taking estrogen therapy than in those who are not. The final decision to use postmenopausal hormone therapy should include a careful analysis of the benefits, risks and the patient's preference for treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Cardiovascular diseases, Prevention, Hormone therapy, Estrogen, Estrogens

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