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Infection control in pulmonary and critical care medicine
1Department of Infection Control, Beth Israel Medical Center, New York, New York 10003, USA.
Abstract:
During the routine care of patients, pulmonary and critical care specialist may have significant exposure to respiratory infections and potentially infectious body fluids such as blood and pleural fluid. Bronchoscopy and intensive care services often require close contact with patients and the use of sharp devices required for intravascular catheterization. Rendering such care places physicians at risk for acquiring agents such as human immunodeficiency virus (HIV), hepatitis viruses, and Mycobacterium tuberculosis. As of December 1998, 188 cases of occupational transmission of HIV to health care workers (HCWs) in the United States have been reported to the Centers for Disease Control. Most documented cases of seroconversion involve percutaneous injury involving blood, with the greatest risks being associated with injury from a hollow-bore needle that has been in an infected patient's vein or artery. Because thousands of HIV-infected persons are unaware of their infection, HCWs must consider all patients to be infected with HIV and improve work practices accordingly. Nevertheless, elimination of all exposures is impossible, and postexposure prophylaxis with combination antiretroviral therapy is recommended for persons deemed a high risk of contracting HIV. Pulmonary specialists are at high risk of exposure to tuberculosis; proper precautions include isolation of patients with suspected tuberculosis and the use of DMF-HEPA respirator masks, especially while performing procedures like bronchoscopy. Contaminated bronchoscopes have been implicated in transmission and "pseudoinfection" of tuberculosis and nontuberculous mycobacteria, underscoring the need for rigorous cleaning and disinfection practices.
Insights
Pulmonary specialists face infection risks from patients, including HIV and tuberculosis. Strict adherence to safety protocols and post-exposure prophylaxis are crucial for healthcare worker protection.
Area of Science:
- Medicine
- Infectious Diseases
- Occupational Health
Background:
- Pulmonary and critical care specialists have high exposure risks to respiratory infections and infectious bodily fluids.
- Procedures like bronchoscopy and intensive care services increase contact with patients and sharp devices.
- Healthcare workers (HCWs) are at risk of acquiring infections such as HIV, hepatitis viruses, and Mycobacterium tuberculosis.
Purpose of the Study:
- To highlight the occupational risks faced by pulmonary and critical care specialists.
- To emphasize the importance of universal precautions and post-exposure prophylaxis for HIV.
- To stress the need for rigorous infection control measures for tuberculosis and other mycobacterial infections.
Main Methods:
- Review of reported occupational transmissions of HIV to HCWs.
- Discussion of risks associated with percutaneous injuries from sharp devices.
- Emphasis on standard precautions, patient isolation, and personal protective equipment (PPE).
Main Results:
- As of December 1998, 188 occupational HIV transmissions to HCWs in the US were reported.
- Percutaneous injuries involving hollow-bore needles pose the greatest risk for HIV seroconversion.
- Contaminated bronchoscopes can transmit tuberculosis and nontuberculous mycobacteria.
Conclusions:
- All patients should be considered potentially infectious, necessitating improved work practices.
- Postexposure prophylaxis with antiretroviral therapy is recommended for high-risk HIV exposures.
- Strict adherence to isolation, respiratory protection (DMF-HEPA masks), and rigorous cleaning of equipment is vital for preventing transmission of tuberculosis and other mycobacteria.