HIV infection: risks to health care workers and infection control

The risk for occupational transmission of HIV-1 in the health setting is extremely small. Current data from a number of prospective studies of health care workers sustaining adverse exposure to blood or other body fluids from patients infected with HIV-1 demonstrate that the rate for transmission of infection following a needlestick injury is approximately 0.5%. Similar data regarding the risk for occupational transmission of hepatitis B virus infection, however, indicates that the rate of transmission of infection with this virus following a needlestick injury may be as high as 30% and the risk for transmission of other blood-borne infections is poorly defined. Infection control precautions designed to minimize the risk for HIV-1 infection were recommended by CDC shortly following the first reported case of AIDS in the United States. These measures were implemented for patients diagnosed with or suspected to be infected with HIV-1, determined by history-taking or serologic evaluation. The inability of these mechanisms to accurately identify all infected individuals, coupled with the occurrence of undiagnosed or unrecognized blood-borne infections, emphasizes the need for health care workers to consider all patients as potentially infected with HIV-1 or other blood-borne pathogens. Implementation and enforcement of universal precautions should minimize exposure of health care personnel to blood and body fluids and thus substantially reduce the risk for occupational transmission of HIV-1 and other blood-borne infections in the health care environment.