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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

Published online by Cambridge University Press:  02 January 2015

Ann N. Do ,
Carol A. Ciesielski ,
Russ P. Metler ,
Teresa A. Hammett ,
Jianmin Li  and
Patricia L. Fleming
Ann N. Do*
Affiliation:
Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Carol A. Ciesielski
Affiliation:
Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemiology and Surveillance Branch, Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention
Russ P. Metler
Affiliation:
Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia Office of the Director, Centers for Disease Control and Prevention
Teresa A. Hammett
Affiliation:
Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Jianmin Li
Affiliation:
Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Patricia L. Fleming
Affiliation:
Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-47, Atlanta, GA 30333
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Abstract

Objective:

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 2 , February 2003 , pp. 86 - 96
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Stricof, RL, Morse, DL, HTLVIII/LAV seroconversion following a deep intramuscular needlestick injury. N Engl J Med 1986;314:115.Google Scholar
2.Wormser, GRJoline, C, Duncanson, F. Needle-stick injuries during the care of patients with AIDS. N Engl J Med 1984;310:1461–1462.Google ScholarPubMed
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;33:181–182.Google Scholar
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;319:1118–1123.Google Scholar
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;104:644–647.CrossRefGoogle Scholar
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;156:1–8.Google Scholar
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;318:86–90.CrossRefGoogle ScholarPubMed
8.Chirgwin, K, Rao, TKS, Landesman, SH. HIV infection in a high prevalence dialysis unit. AIDS 1989;3:731–735.Google Scholar
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;265:2826–2830.CrossRefGoogle ScholarPubMed
10.Tokars, JI, Chamberland, ME, Schable, CA, et al. A survey of occupational blood contact and HIV infection among orthopedic surgeons. JAMA 1992;268:489–494.Google Scholar
11.Lifson, AR, Castro, KG, McCray, E, Jaffe, HW. National surveillance of AIDS in health care workers. JAMA 1986;256:3231–3234.CrossRefGoogle ScholarPubMed
12.Centers for Disease Control. Surveillance for occupationally acquired HIV infection: United States, 1981-1992. MMWR 1992;41:823–825.Google Scholar
13.Centers for Disease Control. Recommendations for prevention of HIV transmission in health-care settings. MMWR 1987;36(suppl 2S):3S–18S.Google Scholar
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, 387–388.Google Scholar
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.Google Scholar
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):1–42.Google Scholar
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;18:562–569.Google Scholar
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;90:145–153.Google Scholar
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;19:401–406.Google Scholar
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;46:21–25.Google Scholar
21.Jagger, J. Reducing occupational exposure to bloodborne pathogens: where do we stand a decade later? Infect Control Hosp Epidemiol 1996;17:573–575.Google Scholar
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;337:1485–1490.Google Scholar
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;28:365–383.CrossRefGoogle ScholarPubMed
24.Centers for Disease Control and Prevention. U.S. HIV and AIDS cases reported through June 2001. HIV/AIDS Surveillance Report 2002;13:1–41.Google Scholar
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.Google Scholar
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;31:305–307.Google Scholar
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):1–31.Google Scholar
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;239:295–297.Google Scholar
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;10:1143–1155.Google Scholar
30.Centers for Disease Control. Update: human immunodeficiency virus infections in health-care workers exposed to blood of infected patients. MMWR 1987;36:285–289.Google Scholar
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;336:919–922.Google Scholar
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.Google Scholar
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;118:913–919.Google Scholar
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;172:851–854.Google Scholar
35.Jochimsen, EM. Failures of zidovudine postexposure prophylaxis. Am J Med 1997;102(5B):52–55.Google Scholar
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;23:345–348.Google Scholar
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;19:339–349.Google Scholar
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;13:1687–1695.Google Scholar
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; 338:853–860.Google Scholar
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.Google Scholar
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: 1621–1629.Google Scholar
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;3:549–552.Google Scholar
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; 2000:3052–3054.Google Scholar
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; 321:1621–1625.Google Scholar
45.Chamberland, ME, Ciesielski, CA, Howard, RJ, Fry, DE, Bell, DM. Occupational risk of infection with human immunodeficiency virus. Surg Clin North Am 1995;75:1057–1070.CrossRefGoogle ScholarPubMed
46.Jagger, J. Introducing A.E.P: a new opportunity to make the health care workplace safer. Advances in Exposure Prevention 1994;1:2.Google Scholar
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.Google Scholar
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;13:265–271.Google Scholar
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;12:214–219.Google Scholar
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;16:268–274.Google Scholar
51. Pub L No. 106430, Needlestick Safety and Prevention Act. (November 6, 2000).Google Scholar
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;18:712–715.CrossRefGoogle ScholarPubMed
53.Dilley, JW, Woods, WJ, McFarland, W. Are advances in treatment changing views about high-risk sex? N Engl J Med 1997;337:501–502.Google Scholar
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:F91–F95.Google Scholar
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;336:1097–1100.Google Scholar
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.Google Scholar
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;21:780–785.Google Scholar
58.Henry, K, Acosta, EP, Jochimsen, E. Hepatotoxicity and rash associated with zidovudine and zalcitabine chemoprophylaxis. Ann Intern Med 1996;124:855.Google Scholar
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;282:2442–2444.Google Scholar
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.Google Scholar
61.Jagger, J. Interview: Patricia Wetzel, M.D. Advances in Exposure Prevention 1994;3:10–11.Google Scholar
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;11:371–379.Google Scholar
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.Google Scholar
64.Department of Labor, Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries: final rule. Federal Register 2001;66:5318–5325.Google Scholar
65.Centers for Disease Control and Prevention. Proposed projects. Federal Register 2000;65:49809–49810.Google Scholar