Occupational HIV now low risk

January 22, 2015

A recent report from the US Centers for Disease Control and Prevention (CDC) has said the risk of healthcare workers acquiring occupational HIV is now low. The Morbidity and Mortality Weekly Report found that documented exposure to the virus in a healthcare setting was now rare in the US, marking significant progress for campaign groups and leading experts.

Since 1991, the National HIV Surveillance System has monitored and recorded all cases of occupationally acquired HIV in healthcare workers - defined as paid or unpaid staff working in healthcare settings with the potential to be exposed to infectious materials, contaminated medical supplies or equipment.

This can commonly include everyone from physicians to nurses or dental and laboratory personnel, students and trainees, and persons not even directly involved in patient care such as housekeepers. 

Back in 1987, the CDC recommended the use of "universal precautions," which then became part of "standard precautions" in 1995. Whenever a person is diagnosed with occupationally acquired HIV, it must be documented stating that the healthcare worker has been exposed to a known HIV-positive source. They should then immediately report the exposure to the person tasked with dealing with such matters and general infection control procedures. This should include documentation of the time, source of exposure and any further details, while counselling should also be offered.

Between 1985 and 2013, the CDC reports that there were 58 confirmed and 150 possible cases of occupationally acquired HIV infection among healthcare workers. However, since 1999, there has only been one confirmed case reported and this was a laboratory technician who suffered a needle puncture while working with a live HIV culture.

Out of the 58 confirmed cases, the source of exposure resulting in the infection were: percutaneous puncture or cut (49 cases), mucocutaneous exposure (five), both percutaneous and mucocutaneous exposure (two), and unknown (two). Some 49 healthcare workers were exposed to HIV-infected blood, four to concentrated virus in a laboratory, one to visibly bloody fluid, and four to unspecified body fluids. However, the occupations of those harmed varied widely.

CDC recommends the use of standard precautions to prevent exposure of healthcare workers to potentially infectious body fluids, whether or not they are working with someone who is known to be HIV positive. Due to this, all staff should assume that all body fluids are infectious even if they are not, and use precautions.

Standard precautions are items such as safety devices, gloves and goggles that minimises the exposure risk. To prevent unintentional puncture injuries, the CDC recommends a comprehensive prevention programme consistent, which meet the Occupational Safety and Health Administration's (OSHA) bloodborne pathogens standard.

"Whereas the paucity of cases could be the result of underreporting, it might indicate the effectiveness of more widespread and earlier treatment to reduce patient viral loads, combined with prevention strategies such as postexposure management and prophylaxis as well as improved technologies and training to reduce sharps injuries and other exposures," the authors of the report write.

The CDC recommends the use of medical devices engineered for sharps protection and any used devices such as syringes or other sharp instruments should be disposed of in appropriate containers. 

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