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Usefulness of a Rapid Human Immunodeficiency Virus-1 Antibody Test for the Management of Occupational Exposure to Blood and Body Fluid

Published online by Cambridge University Press:  21 June 2016

Michael L. Landrum ,
Clarissa H. Wilson ,
Luci P. Perii ,
Sandra L. Hannibal  and
Robert J. O'Connell
Michael L. Landrum*
Affiliation:
from the Department of Infectious Diseases, San Antonio, Texas
Clarissa H. Wilson
Affiliation:
from the Department of Infection Control, San Antonio, Texas
Luci P. Perii
Affiliation:
from the Department of Infection Control, San Antonio, Texas
Sandra L. Hannibal
Affiliation:
from the Immunology Laboratory, Department of Pathology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas
Robert J. O'Connell
Affiliation:
from the Department of Infectious Diseases, San Antonio, Texas from the Department of Infection Control, San Antonio, Texas
*
759 MDOS/MMII, Wilford Hall Medical Center, 2200 Bergquist Drive, Ste. 1, Lackland Air Force Base, San Antonio, TX 78236., [email protected]
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Abstract

Objective:

To describe the usefulness of the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, PA) in cases of occupational exposure regarding its use with source-patient sera, effects on post-exposure prophylaxis (PEP) use, potential cost savings, and effects on healthcare worker (HCW) stress reaction symptoms.

Design:

Before-and-after analysis.

Setting:

A 269-bed, tertiary-care medical center with adjacent clinics.

Participants:

All source-patients and HCWs experiencing an occupational exposure during the study period.

Methods:

Use of the OraQuick test with patient sera was validated prior to its use for occupational exposures. Exposures from January 1 through July 10, 2003 (enzyme immunoassay [EIA] group) and July 11 through December 31, 2003 (OraQuick group) were retrospectively reviewed and the use and cost of PEP was compared for each group. Randomly selected HCWs from both groups completed a survey to assess their stress reaction symptoms.

Results:

After exclusion, there were 71 exposures in the EIA group and 79 in the OraQuick group. OraQuick results were 100% concordant with the reference standard of EIA and Western blot using patient sera. The mean number of doses ingested per course of PEP was significantly higher for HCWs in the EIA group (3.8; range, 0 to 6) compared with the OraQuick group (1.2; range, 0 to 3; P = .016). Cost analysis revealed a mean savings of $6.62 with the OraQuick test per occupational exposure. Although the survey failed to detect an overall reduction in HCW stress reaction symptoms using OraQuick for source-patient testing, 11 HCWs in the EIA group had repetitive thoughts of the exposure compared with 5 in the OraQuick group (P= .049).

Conclusion:

Because of the reduction in ingested doses of unnecessary PEP and reduced cost of occupational exposure management with their use, rapid HJV-antibody tests should be the preferred method for source-patient testing following an occupational exposure.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 9 , September 2005 , pp. 768 - 774
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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