Through December 2001, there were 57
documented cases of occupational HIV
transmission to health care workers in the
United States, and no confirmed cases have
been reported since 1999. Occupational
transmission of HIV is reported in the
Centers for Disease Control and Prevention
(CDC) HIV Surveillance Report1 in the
transmission category that includes
hemophilia, blood transfusion, perinatal
exposure, and risk factor not reported or
To prevent transmission of HIV to health
care workers in the workplace, CDC offers
the following recommendations.
Health care workers should assume that the
blood and other body fluids from all patients
are potentially infectious. They should therefore
follow infection control precautions at all times.
These precautions include
- routinely using barriers (such as gloves and/
or goggles) when anticipating contact with
blood or body fluids,
- immediately washing hands and other skin
surfaces after contact with blood or body
- carefully handling and disposing of sharp
instruments during and after use.
Safety devices have been developed to help
prevent needle-stick injuries. If used properly,
these types of devices may reduce the risk of
exposure to HIV. Many percutaneous injuries,
such as needle-sticks and cuts, are related to
sharps disposal. Strategies for safer disposal,
including safer design of disposal containers and
placement of containers, are being developed.
Although the most important strategy for
reducing the risk of occupational HIV
transmission is to prevent occupational
exposures, plans for postexposure management
of health care personnel should be in place.
CDC has issued guidelines for the management
of health care worker exposures to HIV and
recommendations for postexposure prophylaxis
(PEP): Updated U.S. Public Health Service
Guidelines for the Management of Occupational
Exposures to HIV and Recommendations for Postexposure Prophylaxis2 (September
These guidelines outline a number of
considerations in determining whether health
care workers should receive PEP and in
choosing the type of PEP regimen. For most
HIV exposures that warrant PEP, a basic
4-week, two-drug (there are several options)
regimen is recommended. For HIV exposures
that pose an increased risk of transmission
(based on the infection status of the source and
the type of exposure), a three-drug regimen
may be recommended. Special circumstances,
such as a delayed exposure report, unknown
source person, pregnancy in the exposed person,
resistance of the source virus to antiviral agents,
and toxicity of PEP regimens, are also discussed
in the guidelines. Occupational exposures
should be considered urgent medical concerns.
Building Better Prevention Programs for
Health Care Workers
Continued diligence in the following areas is
needed to help reduce the risk of occupational
HIV transmission to health care workers.
Administrative efforts. All health care
organizations should train health care workers
in infection control procedures and on the importance of reporting occupational exposures. They should develop a system to monitor
reporting and management of occupational exposures.
Development and promotion of safety devices. Effective and competitively priced devices
engineered to prevent sharps injuries should continue to be developed for health care workers
who frequently come into contact with potentially HIV-infected blood and other body fluids.
Proper and consistent use of such safety devices should be continuously evaluated.
Monitoring the effects of PEP. Data on the safety and acceptability of different regimens
of PEP, particularly those regimens that include new antiretroviral agents, should be
continuously monitored and evaluated. Furthermore, improved communication about possible
side effects before starting treatment and close follow-up of health care workers receiving
treatment are needed to increase compliance with the PEP.
Diagnoses of HIV Infection and AIDS in the United States and Dependent Areas, 2009.
Published February 2011. Accessed August 22, 2011.
Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis.