Zeroing in on the appropriate management of occupational exposures to HIV-1.

Transmission of human immunodeficiency virus type 1 (HIV-1) in the healthcare setting continues to be a concern for the healthcare community. Although in the tenth year of the HIV epidemic in the United States we have learned a great deal about some aspects of the occupational risks associated with the provision of care for HIV-l-infected individuals, we still lack several important pieces of information regarding these risks. While several prospective clinical studies have provided information regarding the magnitude of risk for HIV-l infection associated with percutaneous or mucous membrane exposures to body fluids containing HIV-l,’ we have yet to gain much insight into factors associated with occupational injuries that influence risks for infection. For example, most of the instances of documented occupational/nosocomia1 transmission of HIV-l described in the literature have resulted from inadvertent occupational exposures to what might be called “hot” needles (i.e., healthcare worker infections resulting from parenteral exposures to needles [or other sharp objects] that had been removed from HIV-l-infected patients or from specimens containing blood from such patients only moments prior to the exposure1.l Such exposures are also likely to