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

August 21, 1987 - Supplement

with percutaneous exposures seroconverted. None of these three health-care workers
had other documented risk factors for infection.
Two other prospective studies to assess the risk of nosocomial acquisition of HIV
infection for health-care workers are ongoing in the United States. As of April 30,
1987, 332 health-care workers with a total of 453 needlestick or mucous-membrane
exposures to the blood or other body fluids of HIV-infected patients were tested for
HIV antibody at the National Institutes of Health (10). These exposed workers
included 103 with needlestick injuries and 229 with mucous-membrane exposures;
none had seroconverted. A similar study at the University of California of 129
health-care workers with documented needlestick injuries or mucous-membrane
exposures to blood or other body fluids from patients with HIV infection has not
identified any seroconversions (11 ). Results of a prospective study in the United
Kingdom identified no evidence of transmission among 150 health-care workers with
parenteral or mucous-membrane exposures to blood or other body fluids, secretions,
or excretions from patients with HIV infection (12).
In addition to health-care workers enrolled in prospective studies, eight persons
who provided care to infected patients and denied other risk factors have been
reported to have acquired HIV infection. Three of these health-care workers had
needlestick exposures to blood from infected patients (13-15). Two were persons
who provided nursing care to infected persons; although neither sustained a
needlestick, both had extensive contact with blood or other body fluids, and neither
observed recommended barrier precautions (16,17). The other three were healthcare workers with non-needlestick exposures to blood from infected patients (18).
Although the exact route of transmission for these last three infections is not known,
all three persons had direct contact of their skin with blood from infected patients, all
had skin lesions that may have been contaminated by blood, and one also had a
mucous-membrane exposure.
A total of 1,231 dentists and hygienists, many of whom practiced in areas with
many AIDS cases, participated in a study to determine the prevalence of antibody to
HIV; one dentist (0.1%) had HIV antibody. Although no exposure to a known
HIV-infected person could be documented, epidemiologic investigation did not
identify any other risk factor for infection. The infected dentist, who also had a history
of sustaining needlestick injuries and trauma to his hands, did not routinely wear
gloves when providing dental care (19).
Precautions To Prevent Transmission of HIV
Universal Precautions
Since medical history and examination cannot reliably identify all patients infected
with HIV or other blood-borne pathogens, blood and body-fluid precautions should
be consistently used for all patients. This approach, previously recommended by CDC
(3,4), and referred to as 'universal blood and body-fluid precautions" or "universal
precautions," should be used in the care of all patients, especially including those in
emergency-care settings in which the risk of blood exposure is increased and the
infection status of the patient is usually unknown (20).

5S