Prevalence of human immunodeficiency virus and hepatitis B virus in unselected hospital admissions: implications for mandatory testing and universal precautions

Article Abstract:

Nosocomial (hospital-acquired) infection of HIV (human immunodeficiency virus) by health care workers has been reported to be at low levels. As a part of a hospital's role in the prevention of spread of HIV infections among its personnel, routine, mandatory testing of all or selected hospitalized persons has been suggested. The Centers for Disease Control (CDC) has suggested that 'universal precautions' and/or the use of barriers should be implemented to reduce or eliminate contamination with potentially infected body fluids of all patients as a means of curtailing the spread of HIV and hepatitis B (HBV). (Universal precautions involves how contact with potentially contaminated substances and materials is prevented. It includes blood and body fluid precautions of all patients, in all venues, to prevent parenteral, mucous membrane, and non-intact skin exposures of health care workers to bloodborne pathogens.) All patients admitted to the Veterans Administration Hospital in Washington, DC from November 3 to December 3, 1987 were assessed to compare the effects of universal precautions and selected serologic (blood) testing of patients. The prevalence of HIV and HBV in the hospital at that time was also identified. Sera, drawn for other tests, were obtained from 616 of the 636 patients and used in this study. No sera were specifically collected for this evaluation. HIV antibodies were confirmed in 23 of the patients and 12 patients were positive for hepatitis surface antigen. High risk of either HIV or HBV infection was identified in 215 of the 540 patients interviewed, but in only 22 of the infected patients. The use of serological screening as a means of identifying infected cases would have mandated more than 1,200 additional tests during that interval. The costs, legal issues, misclassification, and other factors suggest that the use of universal precautions would be a more efficient means of providing greater staff safety than that obtained by mass screening efforts. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Officials and employees, Prevention, Hospitals, HIV infection, HIV infections, HIV (Viruses), HIV, Medical screening, Health screening, Hepatitis B, Nosocomial infections, Cross infection, Hepatitis B virus

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The risk for transmission of Mycobacterium tuberculosis at the bedside and during autopsy

Article Abstract:

Tuberculosis exposure in an autopsy room may greatly increase the risk for a skin test conversion compared to routine exposure in a hospital setting. A tuberculin skin test conversion occurs when a person who has previously tested negative is exposed to tuberculosis and subsequently tests positive. Researchers investigated the rates of tuberculin skin test conversion of the hospital personnel who cared for a 57-year-old man before his death compared with those employees who assisted in his autopsy. The tuberculosis infection in this man was not suspected until autopsy. Of the 40 skin test negative hospital employees who cared for this man before his death, none of them converted to skin test positive. However, of the 5 members of the autopsy team who had been skin test negative, all converted to a positive skin test after exposure during the autopsy. All 5 were treated with medication and remain healthy.

Health aspects, Medical personnel, Autopsy, Tuberculosis

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