Occupational human immunodeficiency virus exposure among residents and medical students: an analysis of 5-year follow-up data.

BACKGROUND Findings of a needlestick survey at our institution yielded an estimate that 1 case of occupationally acquired human immunodeficiency virus (HIV) among the approximately 1100 residents and third- and fourth-year medical students would potentially occur every 2 to 3 years, and also revealed types of exposures, circumstances, rates of reporting, and reasons for not reporting. OBJECTIVE The present study is a 5-year follow-up study to investigate changes in these parameters. METHODS A self-administered, anonymous 2-page questionnaire covering occupational exposures and other risk factors was distributed to medical students in classes, and to residents in grand rounds and required conferences. The response rate was 71%. RESULTS The incidence of needlestick accidents dropped dramatically over 5 years (1994-1995 vs 1989-1990), especially for surgical residents. Because the proportion of known sources positive for HIV increased over the same period, estimates of occupational HIV risk remain essentially the same, with a projection that 1 student or resident would be expected to experience an occupationally acquired HIV infection approximately every 2 years. The nonoccupational risk for this population, in contrast, seems to be lower than in their age group as a whole. CONCLUSIONS While the decrease in overall occupational exposures (especially for surgical residents) coupled with slight increases in rates of exposure documentation and use of universal precautions constitute positive findings, the increased proportion of exposure sources who are HIV positive leads to an unchanged estimate of occupational HIV risk for residents and students. Study findings therefore support the continued need for educational efforts aimed at prevention, along with timely dissemination of advances in approaches to postexposure prophylaxis.