Skip to main content Accessibility help
×
Home

Usefulness of a Rapid Human Immunodeficiency Virus-1 Antibody Test for the Management of Occupational Exposure to Blood and Body Fluid

  • Michael L. Landrum (a1), Clarissa H. Wilson (a2), Luci P. Perii (a2), Sandra L. Hannibal (a3) and Robert J. O'Connell (a1) (a2)...

Abstract

Objective:

To describe the usefulness of the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, PA) in cases of occupational exposure regarding its use with source-patient sera, effects on post-exposure prophylaxis (PEP) use, potential cost savings, and effects on healthcare worker (HCW) stress reaction symptoms.

Design:

Before-and-after analysis.

Setting:

A 269-bed, tertiary-care medical center with adjacent clinics.

Participants:

All source-patients and HCWs experiencing an occupational exposure during the study period.

Methods:

Use of the OraQuick test with patient sera was validated prior to its use for occupational exposures. Exposures from January 1 through July 10, 2003 (enzyme immunoassay [EIA] group) and July 11 through December 31, 2003 (OraQuick group) were retrospectively reviewed and the use and cost of PEP was compared for each group. Randomly selected HCWs from both groups completed a survey to assess their stress reaction symptoms.

Results:

After exclusion, there were 71 exposures in the EIA group and 79 in the OraQuick group. OraQuick results were 100% concordant with the reference standard of EIA and Western blot using patient sera. The mean number of doses ingested per course of PEP was significantly higher for HCWs in the EIA group (3.8; range, 0 to 6) compared with the OraQuick group (1.2; range, 0 to 3; P = .016). Cost analysis revealed a mean savings of $6.62 with the OraQuick test per occupational exposure. Although the survey failed to detect an overall reduction in HCW stress reaction symptoms using OraQuick for source-patient testing, 11 HCWs in the EIA group had repetitive thoughts of the exposure compared with 5 in the OraQuick group (P= .049).

Conclusion:

Because of the reduction in ingested doses of unnecessary PEP and reduced cost of occupational exposure management with their use, rapid HJV-antibody tests should be the preferred method for source-patient testing following an occupational exposure.

Copyright

Corresponding author

759 MDOS/MMII, Wilford Hall Medical Center, 2200 Bergquist Drive, Ste. 1, Lackland Air Force Base, San Antonio, TX 78236., michael.landrum@lackland.af.mil

References

Hide All
1.Centers for Disease Control and Prevention. Surveillance of Healthcare Personnel With HIV/AIDS, as of December 2002. Atlanta, GA: Centers for Disease Control and Prevention; 2003. Available at www.cdc.gov/ ncidod/hip/Blood/hivpersonnel.htm. Accessed April 27, 2005.
2.Gerberding, JL. Occupational exposure to HIV in health care settings. NEngl J Med 2003;348:826833.
3.Armstrong, K, Gorden, R, Santorella, G. Occupational exposure of health care workers (HCWs) to human immunodeficiency virus (HIV): stress reactions and counseling interventions. Soc Work Health Care 1995;21:6180.
4.Centers for Disease Control and Prevention. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR 2001;50:152.
5.Gerberding, JL, Henderson, DK. Management of occupational exposures to bloodborne pathogens: hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. Clin Infect Dis 1992;14:11791185.
6.OraSure Technologies, Inc. OraQuick Rapid HIV-1 Antibody Test [package insert]. Bethlehem, PA: OraSure Technologies, Inc.; 2004:118.
7.Bio-Rad Laboratories. Multispot HIV-1/HIV-2 Rapid Test. Redmond, WA: Bio-Rad Laboratories; 2005:121.
8.Medmira Laboratories, Inc. Reveal G2 Rapid HIV-1 Antibody Test. Halifax, Nova Scotia, Canada: Medmira Laboratories, Inc.; 2004:113.
9.Trinity Biotech, PLC. Uni-Gold Recombigen. Wicklow, Ireland: Trinity Biotech, PLC; 2004:128.
10.O'Connell, RJ, Merritt, TM, Malia, JA, et al.Performance of the OraQuick rapid antibody test for diagnosis of human immunodeficiency virus type 1 infection in patients with various levels of exposure to highly active antiretroviral therapy. J Clin Microbiol 2003;41:21532155.
11.Branson, BM. Point-of-care tests for HIV antibodies. J Lab Med 2003; 27:288295.
12.Branson, BM, Uniyal, A, Kerndt, P, Fridlund, C, Granade, T. Performance of newer rapid tests for HIV antibody with whole blood and plasma. Presented at the 9th Conference on Retroviruses and Opportunistic Infections; February 24-28, 2002; Seattle, WA.
13.Kaltenborn, JC, Price, TG, Carrico, R, Davidson, AB. Emergency department management of occupational exposures: cost analysis of rapid HIV test. Infect Control Hosp Epidemiol 2001;22:289293.
14.Van den Berk, GE, Frissen, PH, Regez, RM, Rietra, PJ. Evaluation of the rapid immunoassay Determine HIV 1/2 for detection of antibodies to human immunodeficiency virus types 1 and 2. J Clin Microbiol 2003;41:38683869.
15.Machado, AA, Martinez, R, Haikal, AA, Rodrigues Da Silva, MCV. Advantages of the rapid HFV-1 test in occupational accidents with potentially contaminated material among health workers. Rev Inst Med Trop Sao Paulo 2001;43:199201.
16.Salgado, CD, Flanagan, HL, Haverstick, DM, Farr, BM. Low rate of false-positive results with use of a rapid HIV test. Infect Control Hosp Epidemiol 2002;23:335337.
17.U.S. Department of Health and Human Services. Medicare, Medicaid, and CLIA programs: regulations implementing the Clinical Laboratory Improvement Amendments of 1988 (CLIA). Final rule. Federal Register 1992;57:70027186.
18.College of American Pathology. College of American Pathology General Checklist 42020. Northfield, IL: College of American Pathology; 2003.
19.National Committee for Clinical Laboratory Standards. Statistical Quality Control for Quantitative Measurements: Principles and Definitions. Approved guideline, ed. 2. Wayne, PA: National Committee for Clinical Laboratory Standards; 1999.
20.Joint Commission on Accreditation of Healthcare Organizations. 2003 Hospital Accreditation Standards. Oakbrook, IL: Joint Commission Resources; 2003. WT.1.40, QC.1.70, QC.1.80.
21.Wang, SA, Panlilio, AL, Doi, PA, White, AD, Stek, M Jr, Saah, A. Experience of healthcare workers taking postexposure prophylaxis after occupational HIV exposures: findings of the HIV postexposure prophylaxis registry. Infect Control Hosp Epidemiol 2000;21:780785.

Usefulness of a Rapid Human Immunodeficiency Virus-1 Antibody Test for the Management of Occupational Exposure to Blood and Body Fluid

  • Michael L. Landrum (a1), Clarissa H. Wilson (a2), Luci P. Perii (a2), Sandra L. Hannibal (a3) and Robert J. O'Connell (a1) (a2)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed