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The Cumulative Probability of Occupationally-Acquired HIV Infection: The Risks of Repeated Exposures During a Surgical Career

Published online by Cambridge University Press:  21 June 2016

W. Paul McKinney  and
Mark J. Young
W. Paul McKinney*
Affiliation:
Divisions of infectious Diseases, the Medical College of Wisconsin, Milwaukee, Wisconsin General Internal Medicine, the Medical College of Wisconsin, Milwaukee, Wisconsin
Mark J. Young
Affiliation:
General Internal Medicine, the Medical College of Wisconsin, Milwaukee, Wisconsin
*
Department of Znternal Medicine, Box 135, Milwaukee County Medical Complex, 8700 West Wisconsin Avenue, Milwaukee, WZ 53226
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Abstract

The cumulative risk of human immunodeficiency virus (HIV) infection over a healthcare career has rarely been estimated, but is more relevant to the description of an occupational hazard than the risk of seroconversion from a single exposure. We describe a model for assessing the individualized risk for HIV infection after multiple potential exposures over many years for surgeons and other operating room personnel, a high-risk group. For the average surgeon operating over a 30-year career on patients with an HIV seroprevalence of 0.01, the cumulative risk is estimated at 1%. The same surgeon operating on patients with a seroprevalence of 0.10 has an estimated cumulative risk of 10%. These risks may vary dramatically depending on the assumed rate of skin punctures during surgery. Healthcare workers need to be aware of the cumulative risk from multiple exposures to infectious blood and body fluids, to follow proposed suggestions for the reduction of percutaneous blood exposures and to assist in developing new technology to further reduce these risks. Failure to protect these professionals could result in the reduction of services for the approximately 1 to 1.5 million HIV-infected persons in the United States.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 11 , Issue 5 , May 1990 , pp. 243 - 247
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1990

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References

1. Link, RN, Feingold, AR, Charap, MH, et al. Concerns of medical and pediatric house officers about acquiring AIDS from their patients. Am J Public Health 1988;78:455–459.10.2105/AJPH.78.4.455Google Scholar
2. Krieger, JN. The acquired immunodeficiency syndrome: prudent precautions for the practicing urologist. J Urol. 1988;139:801–802.10.1016/S0022-5347(17)42644-9CrossRefGoogle ScholarPubMed
3. Carey, JS, Wiener, RS, Guido, LJ, Jones, LD, Leff, A. Routine preoperative screening for HIV JAMA. 1988;260:179–180.10.1001/jama.1988.03410020039012Google Scholar
4. Sautter, RD. Surgeons and AIDS. Wis Med J. 1988;87:8.Google Scholar
5. Frater, RWM. Human immunodeticiency virus and the patient who needs a cardiac operation. Ann Thorac Surg. 1989;47:179–181.10.1016/0003-4975(89)90265-8Google Scholar
6. Johnson, CD, Evans, R, Shanson, DC, Wastell, C. Attitudes of operating theatre staff to inoculation risk cases. Br J Surg. 1989;76:195–197.10.1002/bjs.1800760229Google Scholar
7. Marcus, R, CDC Cooperative Needlestick Surveillance Group. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N Engl J Med. 1988;319:1118–1123.10.1056/NEJM198810273191703Google Scholar
8. Henderson, DK, Fahey, BJ, Saah, AJ, Schmitt, JM, Lane, HC. Longitudinal assessment of risk for occupational/nosocomial transmission of human immunodeticiency virus-type 1 in health care workers. Presented at the 1988 ICAAC Conference, New Orleans, Louisiana. abstract no. 634.Google Scholar
9. Gerberding, JL, Littell, CG. Chambers, HF, et al. Risk of occupational HIV transmission in intensively exposed health-care workers: follow-up. Presented at the 1988 ICAAC Conference, New Orleans, Louisiana.Google Scholar
10. Grady, GF, Lee, VA, Prince, AM, et al. Hepatitis B immune globulin for accidental exposures among medical personnel: final report of a multicenter controlled trial. J Infect Dis. 1978;138:625–638.10.1093/infdis/138.5.625Google Scholar
11. Werner, B, Grady, GF. Accidental hepatitis B surface antigen positive inoculations. Ann Intern Med. 1982;97:367–369.10.7326/0003-4819-97-3-367Google Scholar
12. Pattison, CP, Maynard, JE, Berquist, KR, Webster, HM. Epidemiology of hepatitis Bin hospital personnel. Am J Epidemiol. 1975;101:59–64.10.1093/oxfordjournals.aje.a112071CrossRefGoogle Scholar
13. Roach, PJ, Fleming, C, Hagen, MD, Pauker, SG. Prostatic cancer in a patient with asymptomatic HIV infection: are some lives more equal than others? Med Decis Making. 1988;8:132–144.10.1177/0272989X8800800209Google Scholar
14. Hagen, MD, Meyer, KB, Pauker, SG. Routine preoperative screening for HIV: does the risk to the surgeon outweigh the risk to the patient? JAMA. 1988;259:1357–1359.10.1001/jama.1988.03720090047033Google Scholar
15. Colton, T. Statistics in Medicine. Boston, Mass: Little, Brown and Company; 1974.Google Scholar
16. Furuhashi, M, Miyamae, T. Effect of pre-operative hand scrubbing and influence of pinholes appearing in surgical rubber gloves during operations. Bull Tbkyo Med Dent Univ. 1979;26:73–80.Google Scholar
17. Cruse, PJE, Foord, R. The epidemiology of wound infection. Surg Clin North Am. 1980;60:27–40.10.1016/S0039-6109(16)42031-1Google Scholar
18. Reynolds, RA. Socioeconomic Characteristics of Medical Practice: 1985. Chicago, II: American Medical Association; 1985:80–81.Google Scholar
19. Handsfield, HH, Cummings, MJ, Swenson, PD. Prevalence of antibody to human immunodeficiency virus and hepatitis B surface antigen in blood samples submitted to a hospital laboratory: implications for handling specimens. JAMA. 1987;258:3395–3397.10.1001/jama.1987.03400230055031CrossRefGoogle ScholarPubMed
20. Harris, CM, Rattner, E. The costs of HIV infection. JAMA. 1990;263:1067–1068.10.1001/jama.1990.03440080039014Google Scholar
21. Henderson, DK, Gerberding, JL. Prophylactic zidovudine after occupational exposure to the human immunodeficiency virus: an interim analysis. J Infect Dis. 1989;160:321–327.10.1093/infdis/160.2.321Google Scholar
22. Burke, DS, Redfield, RR, Bjornson, DC, Fowler, AK, Oster, CN. Frequent isolation of HIV-1 from the blood of patients receiving zidovudine (AZT) therapy. N Engl J Med. 1989;321:1682.Google Scholar
23. Hagen, MD, Meyer, KB, Kopelman, RI, Pauker, SG. Human immunodeficiency virus infection in health care workers: a method for estimating individual occupational risk. Arch Intern Med. 1989;149:1541–1544.10.1001/archinte.1989.00390070077010Google Scholar
24. Hinman, F Jr. Scalpel for operations on patients possibly infected with human immunodeficiency virus. Urol. 1988;32:241.10.1016/0090-4295(88)90392-5Google Scholar
25. Matta, H, Thompson, AM, Rainey, JB. Does wearing two pairs of gloves protect operating theatre staff from skin contamination? Br Med J. 1988;297:597–598.10.1136/bmj.297.6648.597Google Scholar
26. Sim, AJW, Dudley, HAF. Surgeons and HIV. Br Med J. 1988;296:80.10.1136/bmj.296.6615.80Google Scholar
27. Bessinger, CD. Preventing transmission of human immunodeficiency virus during operations. Surg Gynecol Obstet. 1988;167:287–289.Google Scholar
28. Gerbert, B, Maguire, V, Badner, V, Altman, D, Stone, G. Why fear persists: health care professionals and AIDS. JAMA. 1988;260:3481–3483.10.1001/jama.1988.03410230099037Google Scholar
29. Brennan, TA. The acquired immunodeficiency syndrome (AIDS) as an occupational disease. Ann Intern Med. 1987;107:581–583.10.7326/0003-4819-107-4-581Google Scholar
30. Aoun, H. When a house officer gets AIDS. N Engl J Med. 1989;321:693–696.10.1056/NEJM198909073211020Google Scholar
31. Heyward, WL, Curran, JW. The epidemiology of AIDS in the U.S. Sci Am. 1988;259:72–81.10.1038/scientificamerican1088-72Google Scholar