Prospective Evaluation of Health-Care Workers Exposed via
Parenteral or Mucous-Membrane Routes to Blood and Body Fluids
of Patients with Acquired Immunodeficiency Syndrome
In August 1983, CDC initiated prospective surveillance of
health-care workers with documented parenteral or mucous-membrane
exposures to potentially infectious body fluids from patients with
definite or suspected acquired immunodeficiency syndrome (AIDS).
By
December 31, 1983, 51 health-care workers with such exposures were
enrolled in CDC's surveillance registry through the auspices of
participating hospitals, other health-care institutions, and health
departments in the United States.* None of these workers has
developed signs or symptoms suggestive of AIDS. All but one of
these
workers had been followed for less than 12 months (see below).
Among the 51 exposed health-care workers studied, 19 (37%) have
been reported from New York; nine (18%), from Texas; seven (14%),
from
Pennsylvania; five (10%) from New Jersey; and 11 (21%), from seven
other states. Exposures occurred between April 1981 and November
1983. Length of follow-up of exposed health-care workers ranged
from
1 month to 32 months by December 31, 1983 (mean 5.5 months).
Twenty-four (47%) of the exposed workers were nurses; nine (18%)
were
physicians; five (10%) were phlebotomists; three (6%) were
respiratory
therapists; and the remaining 10 (20%) were health-care workers
with
less direct patient contact, such as laboratory and maintenance
personnel. Eighty percent were white, and 75% were female. Ages
ranged from 18 years to 51 years (mean 29 years).
The majority of exposures occurred in direct patient-care
areas.
Twenty-seven (53%) exposures occurred in patients' rooms or on
wards,
and 12 (24%) occurred in intensive-care units. Seven incidents
(14%)
took place in laboratories, and five (10%) occurred in operating
rooms
or morgues. The types of exposures were: needlestick injuries
(65%);
cuts with sharp instruments (16%); mucosal exposure (14%); and
contamination of open skin lesions with potentially infective body
fluids (6%). Post-exposure treatment consisted of local care only
in
41%; administration of hepatitis B immune globulin (HBIG) alone or
in
combination with immune globulin (IG) or tetanus (Td) prophylaxis
in
24%; IG alone or with Td in 31%; and Td only in 4%. Among the 12
exposed health-care workers receiving HBIG, three were exposed to
AIDS
patients reported positive for hepatitis B surface antigen (HBsAg).
Reported by GA Thomas, MD, MD Anderson Hospital, Houston, Texas; G
Talbot, MD, Hospital of the University of Pennsylvania,
Philadelphia,
J Jahre, MD, St. Luke's Hospital, Bethlehem, C Legaspi, MD,
Veterans
Administration Medical Center, Lebanon, Pennsylvania; D Silverman,
MD,
Bellevue Hospital Medical Center, W McKinley, Beth Israel Medical
Center, J Gold, MD, Memorial Hospital for Cancer, M Grieco, MD, M
Lange, MD, St. Luke's-Roosevelt Hospital Center, J Vieira, MD,
Brooklyn Hospital, New York City, C Matkovic, MD, St. John's
Episcopal
Hospital, Smithtown, A Laporta, MD, Astoria General Hospital, Long
Island City, R Stricof, New York State Dept of Health; JA Jacobson,
MD, LDS Hospital, Salt Lake City, Utah; MA Sanchez, MD, Englewood
Hospital, Englewood, HD Luce, MD, New Jersey State Dept of Health;
JA
McCutchan, MD, University of California Medical Center, San Diego,
L
Thrupp, MD, University of California Medical Center, Irvine,
California; N Jacobson, MD, Coral Reef General Hospital, Miami,
Florida; BP Buggy, St. Luke's Hospital, Milwaukee, Wisconsin; M
Eberenz, Mt. Carmel East Hospital, Columbus, Ohio; P Dennehy, MD,
Rhode Island Hospital, Providence; AH Everhart, Doctors Hospital,
Tucker, Georgia; Div of Immunization, Center for Prevention Svcs,
AIDS
Activity, Div of Host Factors, Div of Viral Diseases, Hospital
Infections Program, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: The principal goal of this surveillance project is
to
evaluate the risk, if any, to health-care workers exposed to
potentially infectious materials from AIDS patients. Epidemiologic
evidence is consistent with the hypothesis that AIDS is caused by a
transmissible infectious agent (1,2). AIDS appears to be
transmitted
by intimate sexual contact or by percutaneous inoculation of blood
or
blood products. There is no evidence of transmission through
casual
contact with affected individuals or by airborne spread, and there
are
no cases of AIDS among health-care workers that can definitely be
ascribed to specific occupational exposures. The risk of AIDS
transmission to health-care workers through percutaneous or mucosal
inoculation of blood or body fluids from AIDS patients remains
undefined, although currently available epidemiologic data suggest
that the risk of transmission, if any, is small.
Recommended precautions for preventing AIDS in health-care
workers
have been published (3-5). These recommendations are designed to
minimize the risk of mucosal or parenteral exposure to potentially
infectious materials from AIDS patients. Based on descriptions of
the
incidents supplied to CDC, over one-third of the exposures among
these
51 health-care workers might have been prevented by following
recommended precautions. Health-care workers are urged to become
familiar with and adhere to these recommendations.
No single form of post-exposure care appears to predominate
among
personnel reported to CDC, although local wound care only was the
largest individual treatment category. Since AIDS patients are
often
in groups at high risk for hepatitis B, post-exposure prophylaxis
should follow guidelines for immunoprophylaxis for viral hepatitis
(6).
The enrollment phase of this surveillance project is designed
to
last 3 years. Institutions and investigators wanting information
on
participation in the project should contact CDC's Hospital
Infections
Program at (404) 329-3406.
References
CDC. Update on acquired immune deficiency syndrome
(AIDS)--United
States. MMWR 1982;31:507-8, 513-4.
Francis DP, Curran JW, Essex M. Epidemic acquired immune
deficiency syndrome: epidemiologic evidence of a transmissible
agent. J Natl Cancer Inst 1983;71:1-4.
CDC. Acquired immune deficiency syndrome (AIDS): precautions
for
clinical and laboratory staffs. MMWR 1982;31:577-80.
CDC. Acquired immunodeficiency syndrome (AIDS): precautions
for
health-care workers and allied professionals. MMWR
1983;32:450-1.
Williams WW. Guideline for infection control in hospital
personnel. Infect Control 1983;4:326-49.
ACIP. Immune globulins for protection against viral hepatitis.
MMWR 1981;30:423-8, 433-5.
*Since December 31, 1983, preliminary reports have been received on
an
additional 50 exposed health-care workers.
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