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CDC Guidelines on HIV or HBV-Positive Health Care Professionals Performing Exposure-Prone Invasive Procedures

Published online by Cambridge University Press:  29 April 2021

Extract

The Centers for Disease Control published its long awaited guidelines for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients on July 12, 1991. The guidelines recommend voluntary HIV and HBV testing of all health care workers performing exposure-prone invasive procedures. Special safeguards are applicable to any worker who is infected with HIV or the most virulent form of hepatitis B—i.e., hepatitis B e antigen positive (HBeAg). HIV or HBsAg-positive health care workers should not carry out exposure-prone invasive procedures unless an expert panel has approved and provided individualized guidance, and the patient is informed about the HCW's serological status.

Characteristics of exposureprone procedures include digital palpitation of a needle tip in a body cavity or the simultaneous presence of the worker's fingers and a sharp instrument in a poorly visualized or confined anatomic site.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 1991

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References

CDC, “Recommendations for Preventing Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures,” MMWR 1991; 40 (No.RR-8):19.Google Scholar
The presence of HBeAg in serum is associated with high levels of circulating virus and therefore with greater infectivity of hepatitis-B-surface-antigen (HBsAg)-positive individuals.Google Scholar
The review panel should include experts who represent a balanced perspective. Such experts might include all of the following: a) the HCW's personal physician(s), b) an infectious disease specialist with expertise in the epidemiology of HIV and HBV transmission, c) a health professional with expertise in the procedures performed by the HCW, and d) state or local public health official(s). If the HCW's practice is institutionally based, the expert review panel might also include a member of the infection-control committee, preferably a hospital epidemiologist. HCWs who perform exposure-prone procedures outside the hospital/institutional setting should seek advice from appropriate state and local public health officials regarding the review process. Panels must recognize the importance of confidentiality and the privacy rights of infected HCWs.Google Scholar
Gostin, L., “The HIV-Infected Health Care Professional: Public Policy, Discrimination & Patient Safety,” Law, Medicine & Health Care 1991; 18:303310.Google Scholar
Feldblum, C.R., “A Response to Gostin, The HIV-Infected Health Care Professional: Public Policy, Discrimination, and Patient Safety,’” Law, Med. & Health Care 19:12, 1991.Google Scholar
Centers for Disease, “Update: Transmission of HIV Infection During Dental Procedures—Florida,” MMWR 1991;40:377381.Google Scholar
Rogers, D.E. Gellini, B.G., “AIDS and Doctors: The Real Dangers,” N.Y. Times, July 16, 1991, A19.Google Scholar
Mishu, B. Shaffner, W. Horan, J.M. Wood, L.H. Hutcheson, R.H. McNabb, P.C., “A Surgeon with AIDS: Lack of Evidence of Transmission to Patients,” JAMA 264:467470, 1990; Armstrong, F.P. Miner, J.C. Wolfe, W.H., “Investigation of a Health Care Worker with Symptomatic Human Immunodeficiency Virus Infection: An Epidemiologic Approach,” Milit. Med. 152:414-418, 1987; Porter, J.D. Cruickshank, J.G. Gentle, P.H. Robinson, R.G. Gill, O.N., “Management of Patients Treated by Surgeon with HIV Infection,” Lancet 335:113-114, 1990; Sacks, J.J., “AIDS in a Surgeon,” New Eng. J. Med. 313:1017-1018 (letter), 1985.Google Scholar
Lettau, L.A. Smith, J.D. Williams, S.D. et al, “Transmission of Hepatitis B with Resultant Restriction of Surgical Practice,” JAMA 255:934937, 1986; Hadler, S.C. Sorley, D.L. Acree, K.H. et al, “American Outbreak of Hepatitis B in a Dental Practice,” Annals of Int. Med. 95:133–138, 1981.Google Scholar
Centers for Disease Control, “Estimates of the Risk of Endemic Transmission of Hepatitis B Virus and Human Immunodeficiency Virus to Patients by the Percutaneous Route During Invasive Surgical and Dental Procedures,” (Draft, January 30, 1991).Google Scholar
Hagen, M.D. Meyer, K.B. Parker, S.G., “Routine Pre-Operative Screening for HIV: Does the Risk to the Surgeon Outweigh the Risk to the Patient?” JAMA 259:1357–59, 1988; Gostin, L.,“HIV-Infected Physicians and the Practice of Seriously Invasive Procedures,” Hastings Cen. Rep. 19:32-39, 1989.Google Scholar
Cruse, P. Ford, R., “The Epidemiology of Wound Infection,” Surgical Clinics of North America 60:2740, 1980.Google Scholar
Wong, E.S. Stotka, J.L. Chinchilli, V.M. et al, “Are Universal Precautions Effective in Reducing the Number of Occupational Exposures Among Health Care Workers? A Prospective Study of Physicians on a Medical Service,” JAMA 265:11231128, 1991; Panlilio, A.L. Foy, D.R. Edwards, J.R. et al, “Blood Contacts During Surgical Procedures,” JAMA 265(12):1533–1537, March 27, 1991.Google Scholar
Baraff, L.J. Talan, D.A., “Compliance with Universal Precautions in a University Emergency Department,” Ann. Emerg. Med. 18:654657, 1989.Google Scholar
CDC, op cit., p. 2.Google Scholar
E.g., Gerberding, J.L. Littell, C. Tarkington, A. et al, “Risk of Exposure of Surgical Personnel to Patients Blood During Surgery at San Francisco General Hospital,” N. Engl. J. Med. 322:17881793, 1990; Hassain, S.A. Latid, A.B. Choudary, A.A., “Risk of Surgeons: A survey of Accidental Injuries During Operations,” Br. J. Surg. 75:314–6, 1988.Google Scholar
Estate of Behringer v. Medical Center, No. L88–2550 (N.J. Sup. Ct., April 25, 1991).Google Scholar
ACLU AIDS Project, “HIV in the Health Care Setting: Infected Health Care Workers and Patients,” (March 1991).Google Scholar