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Was glove failure a factor?
A 35-year-old nursing home aide — whose side work as a landscaper left her with dry and cracked hands — occupationally acquired HIV and hepatitis C virus after exposure to the blood and body fluids of an AIDS patient, the Centers for Disease Control and Prevention reports.
Elise Beltrami, MD, medical epidemiologist in the CDC division of healthcare quality promotion, reported the case recently in Toronto at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA). The location of the nursing home was not reported, but the case was co-investigated by the Oklahoma State Department of Health in Oklahoma City.1
The aide cared for an HIV-infected patient who had severe dementia with urinary and fecal incontinence. The worker said that the patient was ill with diarrhea and vomiting at the end of December 1999. The aide recalled numerous exposures to the patient’s emesis, feces, and urine to her chapped and abraded hands. It is unknown whether these fluids contained blood. The health care worker reported wearing gloves while providing care for the patient, but stated that the gloves tore easily.
"We were not really able to evaluate that to know, for example, if the gloves were old or poorly manufactured or whatever," Beltrami told Hospital Infection Control. "We came in eight months after this happened. [There is also the question] of whether she truly was using them as she indicated."
The nursing home aide was found to be infected with HIV and HCV in January 2000 during routine blood-donor screening performed by the Ameri-can Red Cross, where the health care worker regularly gave blood. The worker had provided an HIV-negative, HCV-negative donation six weeks earlier. The health worker had no sexual, injecting drug use, or other risk factors for HIV or HCV infection.
"HIV sequencing and preliminary HCV sequencing is consistent with person-to-person transmission of these viruses from a nursing home patient to the health care worker," Beltrami told SHEA attendees. "Transmission appears to have occurred through nonintact skin exposures to feces, emesis, and urine. Although these body fluids were not reported to be visibly bloody, it is possible that they contained some blood. Transmission may have been prevented in this situation by use of appropriate barrier precautions."
During interviews with investigators, the health care worker’s hands were noted to be cracked, abraded, and lacerated — reportedly due to outside employment as a landscaper. The worker also reported a history of psoriasis that affected the hands. The nursing home patient was not known to be HCV-infected.
The case also underscores, as has been previously reported, that dual transmission of HIV and HCV through occupational exposure does occur. "Special attention should be paid to simultaneous exposures to HIV and HCV," Beltrami said. For one thing, there is some discussion that follow-up testing should be extended if the worker seroconverts to one virus but the source patient is infected with both. The CDC will address that issue in upcoming revisions to its guidelines for post-exposure prophylaxis.
The nursing aide became the 57th health care worker with documented HIV seroconversion following an occupational exposure.
1. Beltrami LE, Kozak A, Fredrickson, et al. Transmission of HIV from a nursing home patient to a health care worker. Abstract 237. Presented at the Society for Healthcare Epi-demiology of America. Toronto; April 2001. n