Recommendations for Prevention of HIV Transmission in Health-Care Settings [MMWR Vol. 36. No. 2S]

August 21, 1987 - Supplement

hand-suturing equipment might be used to perform tissue approximation; electrocautery devices rather than scalpels might be used as cutting instruments; and, even
though uncomfortable, gowns that totally prevent seepage of blood onto the skin of
members of the operative team might be worn. While such modifications might
further minimize the risk of HIV infection for members of the operative team, some of
these techniques could result in prolongation of operative time and could potentially
have an adverse effect on the patient.
Testing programs, if developed, should include the following principles:
* Obtaining consent for testing.
* Informing patients of test results, and providing counseling for seropositive
patients by properly trained persons.
* Assuring that confidentiality safeguards are in place to limit knowledge of test
results to those directly involved in the care of infected patients or as required
by law.
* Assuring that identification of infected patients will not result in denial of
needed care or provision of suboptimal care.
* Evaluating prospectively 1) the efficacy of the program in reducing the incidence of parenteral, mucous-membrane, or significant cutaneous exposures of
health-care workers to the blood or other body fluids of HIV-infected patients
and 2) the effect of modified procedures on patients.
Testing of Health-Care Workers
Although transmission of HIV from infected health-care workers to patients has not
been reported, transmission during invasive procedures remains a possibility. Transmission of hepatitis B virus (HBV)-a blood-borne agent with a considerably greater
potential for nosocomial spread-from health-care workers to patients has been
documented. Such transmission has occurred in situations (e.g., oral and gynecologic
surgery) in which health-care workers, when tested, had very high concentrations of
HBV in their blood (at least 100 million infectious virus particles per milliliter, a
concentration much higher than occurs with HIV infection), and the health-care
workers sustained a puncture wound while performing invasive procedures or had
exudative or weeping lesions or microlacerations that allowed virus to contaminate
instruments or open wounds of patients (33,34).
The hepatitis B experience indicates that only those health-care workers who
perform certain types of invasive procedures have transmitted HBV to patients.
Adherence to recommendations in this document will minimize the risk of transmission of HIV and other blood-borne pathogens from health-care workers to patients
during invasive procedures. Since transmission of HIV from infected health-care
workers performing invasive procedures to their patients has not been reported and
would be expected to occur only very rarely, if at all, the utility of routine testing of
such health-care workers to prevent transmission of HIV cannot be assessed. If
consideration is given to developing a serologic testing program for health-care
workers who perform invasive procedures, the frequency of testing, as well as the
issues of consent, confidentiality, and consequences of test results-as previously
outlined for testing programs for patients-must be addressed.

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