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

August 21, 1987 - Supplement

Health-Care Workers with AIDS
As of July 10, 1987, a total of 1,875 (5.8%) of 32,395 adults with AIDS, who had been
reported to the CDC national surveillance system and for whom occupational
information was available, reported being employed in a health-care or clinical
laboratory setting. In comparison, 6.8 million persons- representing 5.6% of the U.S.
labor force-were employed in health services. Of the health-care workers with AIDS,
95% have been reported to exhibit high-risk behavior; for the remaining 5%, the
means of HIV acquisition was undetermined. Health-care workers with AIDS were
significantly more likely than other workers to have an undetermined risk (5% versus
3%, respectively). For both health-care workers and non-health-care workers with
AIDS, the proportion with an undetermined risk has not increased since 1982.
AIDS patients initially reported as not belonging to recognized risk groups are
investigated by state and local health departments to determine whether possible risk
factors exist. Of all health-care workers with AIDS reported to CDC who were initially
characterized as not having an identified risk and for whom follow-up information
was available, 66% have been reclassified because risk factors were identified or
because the patient was found not to meet the surveillance case definition for AIDS.
Of the 87 health-care workers currently categorized as having no identifiable risk,
information is incomplete on 16 (18%) because of death or refusal to be interviewed;
38 (44%) are still being investigated. The remaining 33 (38%) health-care workers
were interviewed or had other follow-up information available. The occupations of
these 33 were as follows: five physicians (15%), three of whom were surgeons; one
dentist (3%); three nurses (9%); nine nursing assistants (27%); seven housekeeping
or maintenance workers (21%); three clinical laboratory technicians (9%); one
therapist (3%); and four others who did not have contact with patients (12%).
Although 15 of these 33 health-care workers reported parenteral and/or other
non-needlestick exposure to blood or body fluids from patients in the
10 years preceding their diagnosis of AIDS, none of these exposures involved a
patient with AIDS or known HIV infection.
Risk to Health-Care Workers of Acquiring HIV in Health-Care
Settings
Health-care workers with documented percutaneous or mucous-membrane exposures to blood or body fluids of HIV-infected patients have been prospectively
evaluated to determine the risk of infection after such exposures. As of June 30, 1987,
883 health-care workers have been tested for antibody to HIV in an ongoing
surveillance project conducted by CDC (9). Of these, 708 (80%) had percutaneous
exposures to blood, and 175 (20%) had a mucous membrane or an open wound
contaminated by blood or body fluid. Of 396 health-care workers, each of whom had
only a convalescent-phase serum sample obtained and tested >90 days postexposure, one-for whom heterosexual transmission could not be ruled out-was
seropositive for HIV antibody. For 425 additional health-care workers, both acute- and
convalescent-phase serum samples were obtained and tested; none of 74 health-care
workers with nonpercutaneous exposures seroconverted, and three (0.9%) of 351

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