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Occupationally Acquired Human Immunodeficiency Virus (HIV) Infection: National Case Surveillance Data During 20 Years of the HIV Epidemic in the United States

  • Ann N. Do (a1), Carol A. Ciesielski (a1) (a2), Russ P. Metler (a1) (a3), Teresa A. Hammett (a1), Jianmin Li (a1) and Patricia L. Fleming (a1)...
Abstract
AbstractObjective:

To characterize occupationally acquired human immunodeficiency virus (HIV) infection detected through case surveillance efforts in the United States.

Design:

National surveillance systems, based on voluntary case reporting.

Setting:

Healthcare or laboratory (clinical or research) settings.

Patients:

Healthcare workers, defined as individuals employed in healthcare or laboratory settings (including students and trainees), who are infected with HIV.

Methods:

Review of data reported through December 2001 in the HIV/AIDS Reporting System and the National Surveillance for Occupationally Acquired HIV Infection.

Results:

Of 57 healthcare workers with documented occupationally acquired HIV infection, most (86%) were exposed to blood, and most (88%) had percutaneous injuries. The circumstances varied among 51 percutaneous injuries, with the largest proportion (41%) occurring after a procedure, 35% occurring during a procedure, and 20% occurring during disposal of sharp objects. Unexpected circumstances difficult to anticipate during or after procedures accounted for 20% of all injuries. Of 55 known source patients, most (69%) had acquired immunodeficiency syndrome (AIDS) at the time of occupational exposure, but some (11%) had asymptomatic HIV infection. Eight (14%) of the healthcare workers were infected despite receiving postexposure prophylaxis (PEP).

Conclusions:

Prevention strategies for occupationally acquired HIV infection should continue to emphasize avoiding blood exposures. Healthcare workers should be educated about both the benefits and the limitations of PEP, which does not always prevent HIV infection following an exposure. Technologic advances (eg, safety-engineered devices) may further enhance safety in the healthcare workplace

Copyright
Corresponding author
Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-47, Atlanta, GA 30333
References
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1.Stricof RL, Morse DL, HTLVIII/LAV seroconversion following a deep intramuscular needlestick injury. N Engl J Med 1986;314:115.
2.Wormser GRJoline C, Duncanson F. Needle-stick injuries during the care of patients with AIDS. N Engl J Med 1984;310:14611462.
3.Centers for Disease Control. Prospective evaluation of health-care workers exposed via parenteral or mucous-membrane routes to blood and body fluids of patients with acquired immunodeficiency syndrome. MMWR 1984;33:181182.
4.Marcus R, the CDC Cooperative Needlestick Surveillance Group. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N Engl J Med 1988;319:11181123.
5.Henderson DK, Saah AJ, Zak BJ, et al. Risk of nosocomial infection with human T-cell lymphotropic virus type III/lymphadenopathy-associated virus in a large cohort of intensively exposed health care workers. Ann Intern Med 1986;104:644647.
6.Gerberding JL, Bryant-LeBlanc CE, Nelson K, et al. Risk of transmitting the human immunodeficiency virus, cytomegalovirus, and hepatitis B virus to health care workers exposed to patients with AIDS and AIDS-related conditions. J Infect Dis 1987;156:18.
7.Klein RS, Phelan JA, Freeman K, et al. Low occupational risk of human immunodeficiency virus infection among dental professionals. N Engl J Med 1988;318:8690.
8.Chirgwin K, Rao TKS, Landesman SH. HIV infection in a high prevalence dialysis unit. AIDS 1989;3:731735.
9.Cowan DN, Bundage JF, Pomerantz RS, Miller RN, Burke DS. HIV infection among members of the US Army Reserve Components with medical and health occupations. JAMA 1991;265:28262830.
10.Tokars JI, Chamberland ME, Schable CA, et al. A survey of occupational blood contact and HIV infection among orthopedic surgeons. JAMA 1992;268:489494.
11.Lifson AR, Castro KG, McCray E, Jaffe HW. National surveillance of AIDS in health care workers. JAMA 1986;256:32313234.
12.Centers for Disease Control. Surveillance for occupationally acquired HIV infection: United States, 1981-1992. MMWR 1992;41:823825.
13.Centers for Disease Control. Recommendations for prevention of HIV transmission in health-care settings. MMWR 1987;36(suppl 2S):3S18S.
14.Centers for Disease Control. Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health care settings. MMWR 1988;37:377-382, 387388.
15.Centers for Disease Control and Prevention. Alert: Preventing Needlestick Injuries in Health Care Settings. Atlanta, GA: U.S. Department of Health and Human Services, National Institute for Occupational Safety and Health; 1999. Publication no. 2000-108.
16.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(RR 1):142.
17.Beekman SE, Vlahov DT, Koziol DE, Shalley ED, Schmitt JM, Henderson DK. Temporal association between implementation of universal precautions and a sustained, progressive decrease in percutaneous exposures to blood. Clin Infect Dis 1994;18:562569.
18.Fahey BJ, Koziol DE, Banks SM, Henderson DK. Frequency of nonparenteral occupational exposures to blood and body fluids before and after universal precautions training. Am J Med 1991;90:145153.
19.Mendelson MH, Short LJ, Schechter CB, et al. Study of a needleless intermittent intravenous-access system for peripheral infusions: analysis of staff, patient, and institutional outcomes. Infect Control Hosp Epidemiol 1998;19:401406.
20.Centers for Disease Control and Prevention. Evaluation of safety devices for preventing percutaneous injuries among health-care workers during phlebotomy procedures: Minneapolis-St. Paul, New York City, and San Francisco, 1993-1995. MMWR 1997;46:2125.
21.Jagger J. Reducing occupational exposure to bloodborne pathogens: where do we stand a decade later? Infect Control Hosp Epidemiol 1996;17:573575.
22.Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med 1997;337:14851490.
23.Ippolito G, Puro V, Heptonstall J, Jagger J, De Carli G, Petrosillo N. Occupational human immunodeficiency virus in health care workers: worldwide cases through September 1997. Clin Infect Dis 1999;28:365383.
24.Centers for Disease Control and Prevention. U.S. HIV and AIDS cases reported through June 2001. HIV/AIDS Surveillance Report 2002;13:141.
25.Centers for Disease Control and Prevention. Surveillance of health care workers with HIV/AIDS. Atlanta, GA: Centers for Disease Control and Prevention. Available at www.cdc.gov/hiv/pubs/facts/hcwsurv.htm. Accessed August 6, 2002.
26.Centers for Disease Control. A cluster of Kaposi's sarcoma and Pneumocystis carinii pneumonia among homosexual male residents of Los Angeles and Orange Counties, California. MMWR 1982;31:305307.
27.Centers for Disease Control and Prevention. CDC guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR 1999;48(RR-13):131.
28.Ou CY, Kwok S, Mitchell SW, et al. DNA amplification for direct detection of HIV-1 in DNA of peripheral blood mononuclear cells. Science 1988;239:295297.
29.Reitz MS, Hall L, Robert-Guroff M, et al. Viral variability and serum antibody response in a laboratory worker infected with HIV Type 1 (HTLV Type mS). AIDS Res Hum Retroviruses 1994;10:11431155.
30.Centers for Disease Control. Update: human immunodeficiency virus infections in health-care workers exposed to blood of infected patients. MMWR 1987;36:285289.
31.Ridzon R, Gallagher K, Ciesielski C, et al. Simultaneous transmission of both human immunodeficiency virus and hepatitis C virus from a needlestick injury. N Engl J Med 1997;336:919922.
32.Beltrami EM, Kozak A, Williams IT, et al. Transmission of HIV and hepatitis C virus from a nursing home patient to a health care worker. Am J Infect Control. In press.
33.Tokars JI, Marcus R, Culver DH, et al. Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV-infected blood. Ann Intern Med 1993;118:913919.
34.Pratt RD, Shapiro JF, McKinney N, Kwok S, Spector S. Virologie characterization of primary human immunodeficiency virus type 1 infection in a health care worker following needlestick injury. J Infect Dis 1995;172:851854.
35.Jochimsen EM. Failures of zidovudine postexposure prophylaxis. Am J Med 1997;102(5B):5255.
36.Beltrami EM, Luo C-C, Dela Torre N, Cardo DM. Transmission of drug-resistant HIV after an occupational exposure despite postexposure prophylaxis with a combination drug regimen. Infect Control Hosp Epidemiol 2002;23:345348.
37.Henry K, Erice A, Tierney C, et al. A randomized, controlled, double-blind study comparing the survival benefit of four different reverse transcriptase inhibitor therapies (three-drug, two-drug, and alternating drug) for the treatment of advanced AIDS: AIDS Clinical Trial Group 193A Study Team. J Acquir Immune Defic Syndr Hum Retrovirol 1998;19:339349.
38.McNaghten AD, Hanson DL, Jones JL, Ward JW, Dworkin MS. Effects of antiretroviral therapy and opportunistic illness primary chemopro-phylaxis on survival after AIDS diagnosis: Adult/Adolescent Spectrum of Disease Group. AIDS 1999;13:16871695.
39.Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection: HIV Outpatient Study investigators. N Engl J Med 1998; 338:853860.
40.National Center for Health Statistics. Decreasing Hospital Use for HIV: 1999. Hyattsville, MD: U.S. Department of Health and Human Services. Available at www.cdc.gov/nchs/products/pubs/pubd/hestats/hosphiv.htm. Accessed July 26, 2002.
41.Sperling RS, Shapiro DE, Coombs RW, et al. Maternal viral load, zidovudine treatment, and the risk of transmission of human immunodeficiency virus type 1 from mother to infant. N Engl J Med 1996;335: 16211629.
42.Cao Y, Krogstad P, Korber BT, et al. Maternal HIV-1 viral load and vertical transmission of infection: the Ariel Project for the prevention of HIV transmission from mother to infant. Nat Med 1997;3:549552.
43.Chiarello LA, Gerberding JL. Human immunodeficiency virus in health care settings. In: Mandeli GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases, 5th ed. Philadelphia: Churchill Livingstone; 2000:30523054.
44.Ho DD, Moudgil T, Alam M. Quantitation of human immunodeficiency virus type 1 in the blood of infected persons. N Engl J Med 1989; 321:16211625.
45.Chamberland ME, Ciesielski CA, Howard RJ, Fry DE, Bell DM. Occupational risk of infection with human immunodeficiency virus. Surg Clin North Am 1995;75:10571070.
46.Jagger J. Introducing A.E.P: a new opportunity to make the health care workplace safer. Advances in Exposure Prevention 1994;1:2.
47.Cardo D, Marcus R, McKibben P, Culver D, Bell D, the Cooperative Needlestick Study Group. Preventability of hollowbore needle exposures among health-care workers (HCWs). Infect Control Hosp Epidemiol 1994;15:20. Abstract.
48.Haiduven DJ, DeMaio TM, Stevens DA, A five year study of needlestick injuries: significant reduction associated with communication, education, and convenient placement of sharps containers. Infect Control Hosp Epidemiol 1992;13:265271.
49.Linnemann CC, Cannon C, DeRonde M, Lanphear B. Effect of educational programs, rigid sharps containers, and universal precautions on reported needlestick injuries in healthcare workers. Infect Control Hosp Epidemiol 1991;12:214219.
50.Weltman AC, Short LJ, Mendelson MH, Lilienfeld DE, Rodriguez M. Disposal related sharps injuries at a New York City teaching hospital. Infect Control Hosp Epidemiol 1995;16:268274.
51. Pub L No. 106430, Needlestick Safety and Prevention Act. (November 6, 2000).
52.Zafar AB, Butler RC, Podgorny JM, Mennonna PA, Gaydos LA, Sandiford JA. Effect of a comprehensive program to reduce needlestick injuries. Infect Control Hosp Epidemiol 1997;18:712715.
53.Dilley JW, Woods WJ, McFarland W. Are advances in treatment changing views about high-risk sex? N Engl J Med 1997;337:501502.
54.Kelly JA, Hoffman RG, Rompa D, Gray M. Protease inhibitor combination therapies and perceptions of gay men regarding AIDS severity and the need to maintain safer sex. AIDS 1998;12:F91F95.
55.Katz MH, Gerberding JL. Postexposure treatment of people exposed to the human immunodeficiency virus through sexual contact or injection drug use. N Engl J Med 1997;336:10971100.
56.Lehman JS, Hecht FM, Wortley P, Lansky A, Stevens M, Fleming P. Are at-risk populations less concerned about HIV infection in the HAART era? Presented at the 7th Annual Conference on Retroviruses and Opportunistic Infections; January 30-February 2, 2000; San Francisco, CA. Abstract 198.
57.Wang SA, Panlilio AL, Doi PA, et al. 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.
58.Henry K, Acosta EP, Jochimsen E. Hepatotoxicity and rash associated with zidovudine and zalcitabine chemoprophylaxis. Ann Intern Med 1996;124:855.
59.Hirsch MS, Brun-Vezinet F, D'Aquila RT, et al. Antiretroviral drug resistance testing in adult HIV-1 infection: recommendations of an international AIDS society-USA panel. JAMA 2000;282:24422444.
60.Short L, Robert L, Chamberland M, et al. Underreporting of needlestick injuries (NSIs) among healthcare workers (HCWs). Infect Control Hosp Epidemiol 1994;15:20.
61.Jagger J. Interview: Patricia Wetzel, M.D. Advances in Exposure Prevention 1994;3:1011.
62.Beekman SE, Fahey BJ, Gerberding JL, Henderson DK. Risky business: using necessarily imprecise casualty counts to estimate occupational risks for HIV-1 infection. Infect Control Hosp Epidemiol 1990;11:371379.
63.U.S. Department of Labor. Employment and Earnings. Washington, DC: Bureau of Labor Statistics; 2001. Available at www.bls.gov/cps/home.htm. Accessed July 26, 2002.
64.Department of Labor, Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries: final rule. Federal Register 2001;66:53185325.
65.Centers for Disease Control and Prevention. Proposed projects. Federal Register 2000;65:4980949810.
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Infection Control & Hospital Epidemiology
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