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HIV transmission to HCWs virtually eliminated
But vigilance must be maintained
The once rare but very real risk of occupational HIV transmission continues to fade in the face of a host of prevention measures that include needle safety devices and post-exposure prophylaxis. Vigilance remains the word, but occupational HIV transmission has nearly been virtually eliminated, according to surveillance data by the Centers for Disease Control and Prevention.
Through December 2001, there were 57 documented cases of occupational HIV transmission to health care workers in the United States. However, only one reported case has been confirmed since 2001, the CDC reports in recently posted fact sheet. (http://1.usa.gov/eHqBnV) Occupational transmission of HIV is reported in the transmission category that includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.
To continue preventing transmission of HIV to health care workers in the workplace, the CDC reiterates 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:
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 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.
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.