Acquired Immunodeficiency Syndrome (AIDS): Precautions for
Health-Care Workers and Allied Professionals
Acquired immunodeficiency syndrome (AIDS) was first recognized
in
1981. The epidemiology of AIDS is consistent with the hypothesis
that
it is caused by a transmissible infectious agent (1-3). AIDS
appears
to be transmitted by intimate sexual contact or by percutaneous
inoculation of blood or blood products. There has been no evidence
of
transmission by casual contact or airborne spread, nor have there
been
cases of AIDS in health-care or laboratory personnel that can be
definitely ascribed to specific occupational exposures (4).
CDC has published recommended precautions for clinical and
laboratory personnel who work with AIDS patients (5). Precautions
for
these and allied professionals are designed to minimize the risk of
mucosal or parenteral exposure to potentially infective materials.
Such exposure can occur during direct patient care or while working
with clinical or laboratory specimens and from inadvertent or
unknowing exposure to equipment, such as needles, contaminated with
laboratory personnel who work with AIDS patients (5). Precautions
for
these and allied professionals are designed to minimize the risk of
mucosal or parenteral exposure to potentially infective materials.
Such exposure can occur during direct patient care or while working
with clinical or laboratory specimens and from inadvertent or
unknowing exposure to equipment, such as needles, contaminated with
potentially infective materials. Caution should be exercised in
handling secretions or excretions, particularly blood and body
fluids,
from the following: (1) patients who meet the existing
surveillance
definition of AIDS (1); (2) patients with chronic, generalized
lymphadenopathy, unexplained weight loss, and/or prolonged
unexplained
fever when the patient's history suggests an epidemiologic risk for
AIDS (1,2); and (3) all hospitalized patients with possible AIDS.
These principles for preventing AIDS transmission also need to
be
adopted by allied professionals not specifically addressed in the
previous publications but whose work may bring them into contact
with
potentially infective material from patients with the illnesses
described in the above three groups.
The following precautions are recommended for those who provide
dental care, perform postmortem examinations, and perform work as
morticians when working with persons with histories of illnesses
described in the above three groups:
DENTAL-CARE PERSONNEL
Personnel should wear gloves, masks, and protective
eyewear
when performing dental or oral surgical procedures.
Instruments used in the mouths of patients should be
sterilized after use (5-9).
PERSONS PERFORMING NECROPSIES OR PROVIDING MORTICIANS' SERVICES
As part of immediate postmortem care, deceased persons
should
be identified as belonging to one of the above three
groups,
and that identification should remain with the body.
The procedures followed before, during, and after the
postmortem examination are similar to those for hepatitis
B.
All personnel involved in performing an autopsy should
wear
double gloves, masks, protective eyewear, gowns,
waterproof
aprons, and waterproof shoe coverings. Instruments and
surfaces contaminated during the postmortem examination
should be handled as potentially infective items (5-7).
Morticians should evaluate specific procedures used in
providing mortuary care and take appropriate precautions
to
prevent the parenteral or mucous-membrane exposure of
personnel to body fluids.
These and earlier recommendations outline good infection
control
and laboratory practices and are similar to the recommendations for
prevention of hepatitis B. As new information becomes available on
the cause and transmission of AIDS, these precautions will be
revised
as necessary.
Reported by AIDS Activity, Div of Host Factors, Div of Viral
Diseases,
Hospital Infections Program, Center for Infectious Diseases, Office
of
Biosafety, CDC
References
CDC. Update on acquired immune deficiency syndrome
(AIDS)--United
States. MMWR 1982;31:507-8, 513-4.
Jaffe HW, Choi K, Thomas PA, et al. National case-control
study
of Kaposi's sarcoma and Pneumocystis carinii pneumonia in
homosexual men: Part 1, epidemiologic results. Ann Intern Med
1983;99:145-51.
Francis DP, Curran JW, Essex M. Epidemic acquired immune
deficiency syndrome: Epidemiologic evidence for a
transmissible
agent. (guest editorial) JNCI 1983;71:1-4.
CDC. An evaluation of acquired immunodeficiency syndrome
(AIDS)
reported in health-care personnel--United States. MMWR
1983;32:358-60.
CDC. Acquired immune deficiency syndrome (AIDS): precautions
for
clinical and laboratory staffs. MMWR 1982;31:577-80.
Simmons BP, with Hooton TM, Mallison GF. Guidelines for
hospital
environmental control. Infect Control 1981; 2:131-46.
CDC guidelines on infection control. Guidelines for hospital
environmental control (continued). Infect Control
1982;3:52-60.
Garner JS, Simmons BP. CDC guideline for isolation precautions
in
hospitals. Infect Control 1983;4:245-325.
Cooley RL, Lubow RM. AIDS: an occupational hazard? J Am Dent
Assoc 1983;107:28-31.
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