Occupational Exposure to HIV in an Urban University Hospital Setting

In response to the potential transmission of the human immunodeficiency virus in a hospital setting, an occupational exposure assessment program was established at a New York City university hospital in 1990. During the first year, 322 potential exposures to blood or body secretions in 313 health care workers (HCWs) were reported. Exposures occurred most frequently on the surgical service (36%), and in patients' rooms (37%). Nurses accounted for 53% and physicians 25% of reported exposures. A percutaneous injury was reported by 78% of HCWs. Human error was responsible for the exposure in 54% of HCWs and was associated with a break in universal precautions in one-third. The immune status for HIV antibody, hepatitis B antigen and hepatitis C antibody was positive in 11%, 3% and 9% in source patients, respectively. However, the immune status for these potential nosocomially transmitted pathogens was not determined in 12%-26% of source patients. Based on the source patients HIV antibody status and the extent of injury, zidovudine was recommended to 39 HCWs; 12 refused prophylaxis. HIV seroconversion was not documented in those HCW who returned for follow-up testing. A similar assessment program for medical students rotating on the surgical service revealed that two-thirds were exposed to blood or body fluids while in the operating room. Only 16% of sharps injuries were self-inflicted, whereas 66% were caused by another HCWs, usually a surgical attending or houseofficer. These data underscore the necessity for institutional programs regarding management of HCWs potentially exposed to HIV. Such programs not only provide an indispensable service to the exposed HCW and medical student, but also a means by which infection control policies and educational programs may be monitored and implemented.