Chris Miller, PHD
The most recent data (as of June 30, 1996) indicate that there have been 548,102 cases of AIDS reported to health authorities in the United States, and 343,000 have died. Many more cases of HIV infections (infected with HIV but not having AIDS) have occurred. The actual number of HIV infections is unknown mainly because only 26 states have laws requiring the confidential reporting of confirmed HIV infection cases. Estimates for the United States in 1992 were 650,000 to 900,000 cases.
Non-occupational behaviors or experiences were identified as likely leading to the infection of the majority of health care workers with HIV infection or AIDS (of which there are at least 9,000). The experiences might include sexual experiences with those of unknown HIV status, drug abuse involving injections, or transfusions.
Only a small number of health care workers have identified possible occupational exposures as a mode of infection. As of June 30, 1996, the Centers for Disease Control and Prevention had received reports of 51 health care workers with documented occupationally acquired HIV disease. Of these HIV-positive individuals, 21 have developed AIDS. Another 108 health care workers exist with possible occupationally acquired HIV disease.
A documented occupationally acquired HIV infection is defined as:
- Being HIV negative.
- Having an occupational exposure to body fluids.
- Becoming HIV positive.
- Not admitting to having high-risk behaviors or related experiences other than the occupational exposure.
A possible occupationally acquired HIV infection is the same as a documented case except the HIV status of the person was not determined at the time of the occupational exposure. As a result, there is a chance that the person was already HIV positive at the time of occupational exposure.
Documented occupational cases. Of these 51 cases, 20 are nurses, 19 are laboratory technicians, six are physicians, three are dialysis or surgical technicians, and the others are a respiratory therapist, health aide, and a housekeeper. No dental workers are listed in this group.
Forty-four of these 51 workers (86 percent) had percutaneous (through the skin) injuries with contaminated sharps. Five had sprays or splashes on mucous membranes or skin, one had percutaneous and mucoctaneous exposures, and one had an unknown route of exposure.
The documentation notes that 32 of these cases of occupational HIV infection occurred before 1992. So 19 new cases have been reported in the last four years.
Possible occupational cases. Of these 108 possible cases, 27 are nurses, 16 are laboratory technicians, 15 are physicians, 12 are health aides or attendants, 10 are EMTs or paramedics, 10 are technicians or therapists, seven are dental workers, seven are housekeepers, three are embalmers, and one is in another health care occupation.
Be cautious, especially with sharps
Of the 200,000 to 300,000 dental workers in the United States, CDC has reports on only seven possible cases of occupational HIV infection. Such cases are indeed rare, and, as described in previous RDH issues, it takes more than just exposure to pathogens for harmful infections to actually occur.
Nevertheless, it is important to continue to use proper barrier techniques to prevent the spread of bloodborne agents, including the hepatitis viruses B, C, D, and G. For example, invisible breaks in the skin of ungloved hands serve as a route of entry into the body and a route of exit from the body. Protective eyewear, masks, and face shields provide protection to the mucous membranes of the eyes, mouth, and nose.
Unfortunately, there is less protection available against sharps injuries. Although proper use of sharps containers, some needle-recapping devices, and heavy utility gloves when directly handling sharp, contaminated instruments provides some protection, most prevention of sharps injuries must come from using safe work practices such as:
* Use a safe needle-recapping procedure.
* Look before reaching for an instrument.
* Look before placing a sharp item back on a tray.
* Don?t pass an anesthetic syringe containing an exposed needle.
* Avoid having to sharpen contaminated scalers during patient care (prepare extra sterile scalers for each patient).
* Use cotton pliers or tongs to Opick upO contaminated sharps such as scalpel blades, burs, files, broaches, and glass.
Chris Miller is director of Infection Control Research and Services and professor of oral biology at Indiana University.