Occupationally Acquired HIV Infection Among Health Care Workers — United States, 1985–2013

Occupationally Acquired HIV Infection Among Health Care Workers — United States, 1985–2013 M. Patricia Joyce, MD1, David Kuhar, MD2, John T. Brooks, MD1 (Author affiliations at end of text) Case investigations of human immunodeficiency virus (HIV) infection in health care workers (HCWs) possibly acquired by exposure to HIV in the workplace are conducted by state health department HIV surveillance staff members with assistance from CDC. Since 1991, reports of occupationally acquired HIV in HCWs have been recorded by the National HIV Surveillance System following a standardized case investigation protocol. HCWs are defined as all paid and unpaid persons working in health care settings with the potential for exposure to infectious materials (e.g., blood, tissue, and specific body fluids) or contaminated medical supplies, equipment, or environmental surfaces. HCWs can include but are not limited to physicians, nurses, dental personnel, laboratory personnel, students and trainees, and persons not directly involved in patient care (e.g., housekeeping, security, and volunteer personnel). In 1987, CDC recommended the use of “universal precautions,” which became a part of “standard precautions” in 1995, to prevent occupational HIV exposures. Since 1996, occupational postexposure prophylaxis with antiretrovirals to prevent infection has been recommended. A confirmed case of occupationally acquired HIV infection requires documentation that seroconversion in the exposed HCW is temporally related to a specific exposure to a known HIV-positive source. An HCW should immediately report an exposure event to a supervisor or facility-designated person in accordance with the institution’s infection control procedures. The serostatus of the source patient and of the exposed HCW should be documented at the time of the exposure and, exposed HCWs should be counseled on risk and offered postexposure prophylaxis as appropriate. A possible case of occupationally acquired HIV infection is defined as an infection in an HCW whose job duties might have exposed the HCW to HIV but who lacks a documented workplace exposure. If the HIV status of the source patient is unknown or the HCW’s seroconversion after exposure was not documented as temporally related, occupational acquisition of HIV infection is possible but cannot be confirmed. During 1985–2013, 58 confirmed and 150 possible cases of occupationally acquired HIV infection among HCWs were reported to CDC; since 1999, only one confirmed case (a laboratory technician sustaining a needle puncture while working with a live HIV culture in 2008) has been reported (1; Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, unpublished data, 2014) (Figure). Among the 58 confirmed cases, the routes of exposure resulting in infection were: percutaneous puncture or cut (49 cases), mucocutaneous exposure (five), both percutaneous and mucocutaneous exposure (two), and unknown (two). A total of 49 HCWs were exposed to HIV-infected blood, four to concentrated virus in a laboratory, one to visibly bloody fluid, and four to unspecified body fluids. Occupations of the HCWs with confirmed or possible HIV infection have varied widely (Table). CDC recommends the use of standard precautions to prevent exposure of HCWs to potentially infectious body fluids when working with any patient, whether known to be infected with HIV or not (2). HCWs should assume that body fluids from all patients are infectious even if the patients are not known to be infected with HIV. Proper implementation of standard precautions (e.g., use of safety devices and barriers such as gloves and goggles) minimizes exposure risk. To prevent unintentional puncture injuries, CDC recommends a comprehensive prevention program consistent with requirements of the Occupational Safety and Health Administration’s bloodborne pathogens standard.* Medical devices engineered for sharps† protection (e.g., needleless systems) should be used. Used devices such