HIV testing of asymptomatic patients in U.S. hospitals

The human immunodeficiency virus (HIV) epidemic and the prevalence of HIV-positive persons in the population has provoked marked anxiety among hospital staffs of acquiring nosocomially transmitted HIV infections. A national telephone survey of key staff in a sample of 561 acute-care hospitals was undertaken to describe the extent of asymptomatic HIV testing of patients, and variations between hospitals in testing practices. The interviews with the chiefs of medicine and surgery and the directors of nursing confirm the high level of anxiety among staff members about acquiring HIV from patients. In three of four hospitals, one or more of the three key clinical staff report asymptomatic testing of at least some patients. In 16.4% of the hospitals where asymptomatic testing is undertaken, one or more staff report that patients are either sometimes or never informed before testing and 38% are not counselled before testing. In 4.2% of the hospitals in which testing identified seropositive patients, infected persons are not always notified; one or more staff interviewed in 25.2% of the hospitals report that seronegative patients may not always be notified of results; likewise, 33.1% of the hospitals do not always include positive test results in hospital records, and 37.7% sometimes or always transfer seropositive patients to another hospital. A major finding is that there is a lack of congruence between the reports of the three different staff members interviewed in each hospital. These conclusions consider the likelihood of developing uniform practices between and within hospitals.