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Asked in a private interview] about reverse transmission from medical technicians and technologists in the clinical laboratory, Dr. Gershon of Johns Hopkins said the issue was not really relevant to the laboratory setting. Among lab personnel, only phlebotomists perform invasive procedures, she pointed out; even if they cut themselves, their blood is extremely unlikely to reach a portal of entry in the patient. In surgery or dentistry, by contrast, the patient's flesh is readily exposed and potentially available for exposure to HIV; not so with phlebotomy, Dr. Gershon observed.
* Many views. Unthreading the extremes of opinion expressed at the conference would be difficult. To generalize or presume a consensus on any issue would be inappropriate. The Florida dentist who infected his patients clearly was on the minds of all as participants urged a strengthening of CDC guidelines and greatly enhancing biosafety practices in the workplace.
Many studies documented poor compliance with universal precautions throughout the health care disciplines. Ethical issues, such as the patient's right to privacy balanced against the right of the health care worker to be protected against hazards in the workplace, will grow even more intense in years to come. Reverse transmission and the right of the health care provider or patient to know is or her own HIV status will be an explosive topic in health care.
Exposure to HIV in the health care environment is increasing. Both employees and employers are beginning to realize that while the risk remains low, it is not insignificant.
The greatest risk to laboratorians involves needlestick injuries with hollow-bore needles containing blood. The efficiency of this mode of transmission was emotionally demonstrated in a report from an orphanage in Romania, an epidemiologically closed environment. An astonishing 20% of children three years of age or younger had contracted the human immunodeficiency virus through incautious reuse of needles and syringes. [14]
It was estimated that poor biosafety practices had enabled the virus to be transmitted in a highly efficient manner from one or two infected babies to the other children. The power of an infected needlestick must never again be underestimated by any of us.
* At the front. Presentations and interviews at the AIDS conference made it clear that laboratorians are on the front lines in this epidemic. Emphasizing biosafety and protection for the health care worker can overshadow our sensitivity to people who are HIV positive or who ae experiencing the ravages of AIDS.
As health care providers, we must practice and teach universal precautions and demand proper biosafety equipment and engineering in our laboratories. We must never forget our humanity, however, or fail to show compassion for those who are sick. Those are the qualities that historically have set the health care professions apart. We never know if or when we may become the patient on the other end of that positive HIV result.
[1] Chin, J. Epidemiology of HIV disease. Keynote address. June 17.
[2] Fauci, A. Role of biomedical research in the fight against AIDS. Opening Address. June 16.
[3] Stafford, R.S.; Janssen, R.S.; St. Louis, M.E.; et al. Estimate of HIV-1 infection among U.S. hospital patients. June 17.
[4] Kelen, G.D.; Chan, D.W.; and Green, G.B. Seroprevalence of HIV, HTLV, HCV and HBV among emergency department patients and potential risk to health care workers. June 19.
[5] Henry, K.; Collier, P.; O'Boyle-Williams, C.; et al. Observed and self-reported compliance with universal precautions among emergency department personnel at two suburban community hospitals. June 17.
[6] Ippolito, G., and Puro, V. Efficacy of HIV transmission after at-risk exposures in health care settings: The Italian multicentric study. June 17.
[7] Gershon, R.; Curbow, B.; Vlahov, D.; et al. Low compliance with universal precautions among hospital employees despite high perceived risk. June 19.
[8] Korniewicz, D.; Kirwin, M.; Cresci, K.; et al. Barrier protection with gloving: Double versus single. June 19.
[9] Metler, R.; Ciesielski, C.; Marcus, M.; et al. Occupationally acquired HIV infection, United States. June 19.
[10] Tokars, J.I.; Marcus, R.; Culver, D.H.; et al. Zidovudine use and occupational exposure to HIV-infected blood. June 19.
[11] Marianos, D.; Gooch, B.; Furman, L.; et al. HIV transmission and infection control in the office of a dentist with AIDS. June 17.
[12] Cottone, J.A.; Dove, S.B.; Marianos, D.W.; et al. An international dental survey of HIV knowledge/attitudes and infection control procedures. June 19.
[13] Bell, D.M.; Martone, W.J.; Culver, D.H.; et al. Risk of endemic HIV and hepatitis B virus (HBV) transmission to patients during invasive procedures. June 17.
[14] Hersh, B.; Popovici, F.; and Jezek, Z. Risk factors for HIV infection among abandoned romanian children. June 20.
COPYRIGHT 1991 Nelson Publishing
COPYRIGHT 2004 Gale Group
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