Hostname: page-component-5c6d5d7d68-wpx84 Total loading time: 0 Render date: 2024-08-16T20:36:42.445Z Has data issue: false hasContentIssue false

Management of the Healthcare Worker Infected With Human Immunodeficiency Virus Lessons From Nosocomial Transmission of Hepatitis B Virus

Published online by Cambridge University Press:  21 June 2016

David J. Weber
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina Department of Hospital Epidemiology, UNC Hospitals, Chapel Hill, North Carolina
Karen K. Hoffmann
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
William A. Rutala*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina Department of Hospital Epidemiology, UNC Hospitals, Chapel Hill, North Carolina
*
547 Bumett-Womack Building, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030

Extract

Since acquired immunodeficiency syndrome (AIDS) was first recognized and reported in 1981, more than 175,000 persons with AIDS have been reported to public health departments in the United States.’ Despite advances in therapy, the median survival following the diagnosis of AIDS is approximately two years.” The dramatic increase in AIDS cases and their continued poor prognosis has resulted in great public concern regarding the risks of transmission of human immunodeficiency virus (HIV) from infected healthcare workers to patients.

The report of probable transmission of HIV infection from a dentist to five patients”” has lead in part to the recent publication of recommendations by the Centers for Disease Control (CDC) for the prevention of nosocomial transmission of HIV during exposure-prone invasive procedures from infected healthcare workers to patients.” In brief, these recommendations entail the following: all healthcare workers should adhere to Universal Precautions (UP); healthcare workers who perform exposure-prone invasive procedures should know their HIV status but testing should be on a voluntary basis; and healthcare workers testing positive for HIV or hepatitis B surface antigen (HBsAg) and hepatitis B “e” antigen (HBeAg) should not perform exposure-prone procedures unless cleared by an expert panel, and then only with informed consent of their patients.

Type
Readers' Forum
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Centers for Disease Control. Update: acquired immunodeficiency syndrome-united States, 1981-90. MMWR. 1991:40:358–363, 369.Google Scholar
2. Lafferty, WE, Glidden, D, Hopkins, SG. Survival trends of people with AIDS in Washington State. Am J Public Health. 1991:81:215218.10.2105/AJPH.81.2.217CrossRefGoogle ScholarPubMed
3. Centers for Disease Control. Possible transmission of human immunodeficiency virus to a patient during an invasive dental procedure. MMWR. 1990;39:489493.Google Scholar
4. Centers for Disease Control. Update: transmission of HIV infection during an invasive dental orocedure-Florida. MMWR. 1991;40:2127,33.Google Scholar
5. Centers for Disease Control. Update: transmission of HIV infection during invasive dental procedures-Florida. MMWR. 1991;40:377381.Google Scholar
6. Centers for Disease Control. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR. 1991;40:19.Google Scholar
7. American Medical Association. AMA statement on HIV-infected physicians. Newsletter 1991;8:12.Google Scholar
8. Association for Practitioners in Infection Control, Society for Hospital Epidemiology of America. Position paper: the HIV-infected healthcare worker. Infect Control Hosp Epidemiol. 1990;11:647656.10.2307/30146868CrossRefGoogle Scholar
9. Position on Policy Development for Health Care Personnel Infected With Human Immunodeficiency Virus. New Haven. Conn: Infectious Disease Society of America; 1991.Google Scholar
10. Szmuness, W, Much, MI, Prince, AM., et al. On the role of sexual behavior in the spread of hepatitis B infection. Ann Intern Med. 1975;83:489495.CrossRefGoogle ScholarPubMed
11. Seeff, LB, Wright, EC, Zimmerman, HJ, et al. Type B hepatitis after needlestick exposure: prevention with hepatitis B immune globulin. Ann Intern Med. 1978;88:285293.10.7326/0003-4819-88-3-285CrossRefGoogle Scholar
12. Werner, BG, Grady, GE. Accidental hepatitis-B-surface-antigen-positive inoculations; use of e antigen to estimate infectivity. Ann Intern Med. 1982;97:367369.10.7326/0003-4819-97-3-367CrossRefGoogle ScholarPubMed
13. Eleasley, RP, Trepo, C, Stevens, CE, Szmuness, W. The e antigen and vertical transmission of hepatitis B surface antigen. Am J Epidemiol. 1977;105:9498.Google Scholar
14. Jenison, SA, Lemon, SM, Baker, LN, Newbold, JE. Quantitative analysis of hepatitis B virus DNA in saliva and semen of chronically infected homosexual men. J Infect Dis. 1987;156:299307.CrossRefGoogle ScholarPubMed
15. Bancroft, WH, Snitbhan, R, Scott, RM. et al. Transmission of hepatitis B virus to gibbons by exposure to human saliva containing hepatitis B surface antigen. J Infect Dis. 1977;135:7985.CrossRefGoogle ScholarPubMed
16. Osterholm, MT, Bravo, ER, Crosson, JT, Polisky, HE, Hanson, M. Lack of transmission of viral hepatitis type B after oral exposure to HBsAg-positive saliva. Brit Med J. 1979;12631264.10.1136/bmj.2.6200.1263-aCrossRefGoogle ScholarPubMed
17. Glaser, JB, Nadler, JP. Hepatitis B virus in a cardiopulmonary resuscitation training course; risk of transmission from a surface-antigen-positive participant. Arch Intern Med. 1985;145:16531655.10.1001/archinte.1985.00360090125019CrossRefGoogle Scholar
18. Henderson, DK, Fahey, BJ, Willy, M, et al. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures: a prospective evaluation. Ann Intern Med. 1990;113:740746.CrossRefGoogle ScholarPubMed
19. Rutala, WA. APIC guideline for selection and use of disinfectants. Am J Infect Control. 1990;18:99117.CrossRefGoogle ScholarPubMed
20. Centers for Disease Control. Hepatitis B associated with jet gun infection-California. MMWR. 1986;35:373376.Google Scholar
21. Morris, IM, Cattle, DS, Smits, BJ. Endoscopy and transmission of hepatitis B. Luncet. 1975;ii:1152.CrossRefGoogle Scholar
22. Oren, I, Hershow, RC, Ben-Porath, E, et al. A common-source outbreak of fulminant hepatitis B in a hospital. Ann Intern Med. 1989;110:691698.10.7326/0003-4819-110-9-691CrossRefGoogle ScholarPubMed
23. Centers for Disease Control. Nosocomial transmission of hepatitis B virus associated with a spring-loaded fingerstick device— California. MMWR. 1990;39:610613.Google Scholar
24. Welch, J, Webster, M, Tilzey, AJ, Noah, ND, Banatvala, JE. Hepatitis B infections after gynecological surgery. Lancet. 1989;i:205206.CrossRefGoogle Scholar
25. Carl, M, Blakey, DL, Francis, DP, Maynard, JE. Interruption of hepatitis B transmission by modification of a gynecologist's surgical technique. Lancet. 1982;i:731733.10.1016/S0140-6736(82)92636-8CrossRefGoogle Scholar
26. Coutinho, RA, Albrecht-van Lent, P, Stoutjesdijk, L, et al. Hepatitis B from doctors. Lancet. 1982;i:345346.CrossRefGoogle Scholar
27. Goodman, RA, Ahtone, JL, Finton, RJ. Hepatitis B transmission from dental personnel to patients: unfinished business, Ann Intern Med. 1982;96:119.CrossRefGoogle ScholarPubMed
28. Flower, AJE, Prentice, M, Morgan, G, et al. Hepatitis B infection following cardiothoracic surgery. Abstracts of the 1990 International Symposium on Viral Hepatitis and Liver Diseases. Houston, Texas, Abstract .Google Scholar
29. Goodwin, D, Fannin, SL, McCracken, BB. An oral surgeon-related hepatitis-B outbreak. California Morbidity. 1976:14.Google Scholar
30. Grob, PJ, Moeschlin, P. Risk to contacts of a medical practitioner carrying HBsAg. N Engl J Med. 1975;293:197.Google Scholar
31. Centers for Disease Control. Outbreak of hepatitis B associated with an oral surgeon-New Hampshire. JAMA. 1987;257:1709.CrossRefGoogle Scholar
32. Shaw, FE Jr. Barrett, CL, Hamm, R, et al. Lethal outbreak of hepatitis Bin a dental practice. JAMA. 1986;255:32603264.CrossRefGoogle Scholar
33. Levin, ML, Maddrey, WC, Wands, JR, Mendeloff, Al. Hepatitis B transmission by dentists. JAMA. 1974;228;11391140.CrossRefGoogle ScholarPubMed
34. Anonymous. Acute hepatitis B following gynecological surgery. J Hosp Infect. 1987;9:3438.CrossRefGoogle Scholar
35. Haerem, JW, Siebke, JC, Ulstrup, J, Geiran, O, Helle, I. HBsAg transmission from a cardiac surgeon incubating hepatitis B resulting in chronic antigenemia in four patients. Acta Med Scand. 1981;210:389392.CrossRefGoogle ScholarPubMed
36. Reingold, AL, Kane, MA, Murphy, BL, Checko, P, Francis, DP, Maynard, JE. Transmission of hepatitis B by an oral surgeon. J Infect Dis. 1982;145:262268.10.1093/infdis/145.2.262CrossRefGoogle ScholarPubMed
37. Garibaldi, RA, Rasmussen, CM, Holmes, AW, Gregg, MB. Hospital-acquired serum hepatitis: report of an outbreak. JAMA. 1972;219:15771580.10.1001/jama.1972.03190380011004CrossRefGoogle ScholarPubMed
38. Lattau, LA, Smith, JD, Williams, D, et al. Transmission of hepatitis B with resultant restriction of surgical practices. JAMA. 1986;255:934937.CrossRefGoogle Scholar
39. Hadler, SC, Sorley, DL, Acree, KH, et al. An outbreak of hepatitis B in a dental practice. Ann Intern Med. 1981;95:133138.CrossRefGoogle Scholar
40. Snydman, DR, Hindman, SH, Wineland, MD, Bryan, JA, Maynard, JE. Nosocomial viral hepatitis B: a cluster among staff with subsequent transmission to patients. Ann Intern Med. 1976:85:573577.CrossRefGoogle ScholarPubMed
41. Rimland, D, Parkin, WE, Miller, GB, Schrack, WD. Hepatitis B outbreak traced to an oral surgeon. N Engl J Med. 1977;296:953958.CrossRefGoogle Scholar
42. Acute hepatitis B associated with gynecological surgery. Luncet. 1980;i:16.Google Scholar
43. Ahtone, J, Goodman, RA. Hepatitis B and dental personnel: transmission to patients and prevention issues. J Am Dent Assoc. 1983;106:219222.CrossRefGoogle ScholarPubMed
44. Centers for Disease Control. Protection against viral hepatitis: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR. 1990;39:59.Google Scholar
45. Meyers, JD, Stamm, WE, Kerr, MM, Counts, GW. Lack of transmission of hepatitis B after surgical exposure. JAMA. 1978;240:17251727.10.1001/jama.1978.03290160043019CrossRefGoogle ScholarPubMed
46. LaBrecaue, DR. Muhs, JM Lutwick, LI, Woolson, RF, Hierholzer, WR. The risk’ of hepatitis B transmission from healthcare workers to patients in a hospital setting-a prospective study. Hematology. 1986;6:205208.Google Scholar
47. Williams, SV, Pattison, CP, Berquist, KR. Dental infection with hepatitis B. JAMA. 1975;232:12311233.CrossRefGoogle ScholarPubMed
48. Alter, HJ, Chalmers, TC, Freeman, BM, et al. Healthcare workers positive for hepatitis B surface antigen. N Engl J Med. 1975;292:454457.CrossRefGoogle ScholarPubMed
49. Henderson, DK. AIDS and the healthcare worker: management of human immunodeficiency virus infection in the health-care setting. AIDS Updates. 1990;3:112.Google Scholar
50. Cowan, DN, Brundage, JF, Pomerantz, RS, Miller, RN, Burke, DS. HIV infection among members of the U.S. army reserve components with medical and health occupations. JAMA. 1991;265:28262830.CrossRefGoogle ScholarPubMed
51. Mishu, B, Schaffner, W, Horan, JM, Wood, LH, Hutcheson, RH, McNabb, PC. A surgeon with AIDS: lack of evidence of transmission to patients. JAMA. 1990;264:467470.CrossRefGoogle ScholarPubMed
52. Sacks, JJ. AIDS in a surgeon. N Engl J Med. 1985;313:10171018.Google ScholarPubMed
53. Armstrong, FP, Miner, JC, Wolfe, WH. Investigation of a healthcare worker with symptomatic human immunodeficiency virus infection; an epidemiologic approach. Milit Med. 1987;152:414418.CrossRefGoogle ScholarPubMed
54. Porter, JD, Cruickshank, JG, Gentle, PH, Robinson, RG, Gill, ON. Management of patients treated by surgeon with HIV infection. Lancet. 1990;335:113114.CrossRefGoogle ScholarPubMed
55. Gerberding, JL. Expected costs of implementing a mandatory human immunodeficiency virus and hepatitis B virus testing and restriction program for healthcare workers performing invasive procedures. Infect Control Hosp Epidemiol. 1991;12:443447.CrossRefGoogle ScholarPubMed