Are universal precautions effective in reducing the number of occupational exposures among health care workers? A prospective study of physicians on a medical service

Article Abstract:

People who work in the health care profession are at risk for exposure to contaminated blood and body fluids. Exposure to these substances pose a health risk for medical professionals because of possible transmission of hepatitis B virus or human immunodeficiency virus (HIV). Exposure to HIV is especially dangerous because it can cause AIDS, a fatal disease with no cure. It has been estimated that the risk of developing HIV infection following skin contact is less than one-half percent. However, the risk for health care workers also depends on the total number of exposures. In an attempt to reduce the incidence of occupational exposure of health care professionals to contaminated body fluids of patients', the Centers for Disease Control has recommended the use of certain universal precautions (UPs). These precautions include treating all patient samples as though they are infected, and handling them with caution using barrier devices (such as gloves) to prevent direct contact with the samples. To evaluate the effectiveness of such precautions, 277 physicians were questioned regarding the frequency and type of exposure to patient samples they experienced. The use of UPs resulted in an increase in the use of barrier devices during sample exposure from 54 percent to 73 percent. The use of UPs reduced the incidence of exposure to blood and body fluids from five to two and a half exposures per physician for a one-month-period. Also, the number of exposures that were prevented was almost doubled when UPs were used. It is concluded that the use of UPs is an effective means of reducing the risk of exposure of health care professionals to patients' body fluid samples that may be infected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Physicians, Medical professions, Occupational surveys, Laboratory infections

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The risk of contracting HIV infection in the course of health care

Article Abstract:

The risk of health professionals with the AIDS virus transmitting HIV, the causative agent, to patients is being widely reported and discussed. Three patients who developed HIV infection during the course of receiving care from one HIV-infected dentist have been identified, but it seems that proper preventive measures were not meticulously observed, resulting in a sad but unique incident. Testing health professionals for HIV as a means of preventing infected individuals from practicing is not logical. First, no other such incident is known to have occurred during the past 10 years. Secondly, information on the transmission of hepatitis B, a more easily transmitted blood-borne virus, suggests that infection control is adequate protection and that most infections result from failure of these protective measures. Third, studies of households where HIV infection is present show that infection is transmitted between individuals through sexual intercourse. Fourth, testing would remove needed health care workers from patient care and cause reluctance to treat HIV-positive patients or even those considered at risk. Finally, antibodies take up to six months to appear, so testing would not be an adequate means of identifying infected individuals. The publicity surrounding these cases has created fear in the face of minimal risk, when it could be better directed at educating the public about the usual means of HIV transmission, sexual contact and sharing intravenous drug needles. Health care workers must be well trained in preventive measures, and these measures must be carefully monitored. Removal from patient care should be based on functional impairment, not HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Communicable diseases, New York Academy of Medicine

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Postexposure Chemoprophylaxis for Occupational Exposures to the Human Immunodeficiency Virus

Article Abstract:

All healthcare workers exposed to HIV should be offered zidovudine alone or in combination with other AIDS drugs to prevent HIV infection. This type of treatment is called postexposure prophylaxis, and animal studies show that it may prevent infection. However, some human studies have not confirmed this result. There are several cases of healthcare workers who have developed HIV infection despite receiving postexposure chemoprophylaxis. Many AIDS drugs have substantial side effects and widespread use of the drugs can lead to viral drug resistance.

Care and treatment

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