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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

  1. CDC. Update on acquired immune deficiency syndrome (AIDS)--United States. MMWR 1982;31:507-8, 513-4.

  2. 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.

  3. CDC. Acquired immune deficiency syndrome (AIDS): precautions for clinical and laboratory staffs. MMWR 1982;31:577-80.

  4. CDC. Acquired immunodeficiency syndrome (AIDS): precautions for health-care workers and allied professionals. MMWR 1983;32:450-1.

  5. Williams WW. Guideline for infection control in hospital personnel. Infect Control 1983;4:326-49.

  6. 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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