Occupational HIV Transmission and Prevention Among Health Care Workers
Fewer than 60 cases of occupational transmission of HIV to health care workers have occurred in the United States. The proper use of gloves and goggles, along with safety devices to prevent injuries from sharp medical devices, can help minimize the risk of exposure to HIV in the course of caring for patients with HIV. When workers are exposed, the Centers for Disease Control and Prevention (CDC) recommends immediate treatment with a short course of antiretroviral drugs to prevent infection.
- As of 2010, 57 documented transmissions and 143 possible transmissions had been reported in the United States.
- No confirmed cases of occupational HIV transmission to health care workers have been reported since 1999. Underreporting of cases to CDC is possible, however, because case reporting is voluntary.
- Health care workers who are exposed to HIV-infected blood at work have a 0.3% risk of becoming infected. In other words, 3 of every 1,000 such injuries, if untreated, will result in infection.
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 fluids.
- Carefully handling and disposing of sharp instruments during and after use.
Safety devices have been developed to help prevent needlestick injuries. If used properly, these types of devices may reduce the risk of exposure to HIV. Many percutaneous injuries, such as needlesticks and cuts, are related to the disposal of sharp-ended medical devices. All used syringes or other sharp instruments should be routinely placed in “sharps” containers for proper disposal to prevent accidental injuries and risk of HIV transmission.
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 issued guidelines in 2005 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 Prophylaxis.
These guidelines outline 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, starting as soon as possible after exposure. 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 antiretroviral agents, and toxicity of PEP regimens, are also discussed in the guidelines. Occupational exposures should be considered urgent medical concerns, and PEP should be started within 72 hours—the sooner the better; every hour counts.
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 the importance of reporting occupational exposures. Organizations should develop and distribute written policies for the 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. 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 regimens that include new antiretroviral agents, should be monitored and evaluated continuously. Furthermore, health professionals who administer PEP should communicate possible side effects before treatment starts and should follow patients closely to make sure they take their medicine correctly.
All cases of suspected occupationally acquired HIV should be reported to state health department HIV surveillance staff and the CDC coordinator for “Cases of Public Health Importance” at 404-639-0934 or 404-639-2050.