In the 1990s, tragic cases of healthcare workers who acquired AIDS and hepatitis on the job helped propel the movement for sharps safety. The evidence now shows the success of safer devices, standard precautions and post-exposure prophylaxis: In the past 15 years, only one health care worker developed HIV in a confirmed occupational exposure, according to a report from the Centers for Disease Control and Prevention.1

Twelve other healthcare workers had HIV infections that were possibly occupationally linked, CDC says.

The improvement in HIV treatment often means lower viral loads for patients and better post-exposure prophylaxis for healthcare workers, says David Kuhar, MD, medical officer with CDC’s Division of Healthcare Quality Promotion. But healthcare workers must report their exposures and receive prompt evaluation and follow up, he says.

“It remains critical to report these injuries and take them seriously, and not just [out of concern] for HIV,” he says. “There’s also risk for infection with other bloodborne pathogens.”

The only recent confirmed case of occupationally acquired HIV involved a technician in a research laboratory who sustained a needlestick with an HIV-positive culture in 2008. The technician did not take antiviral medications for post-exposure prophylaxis, says M. Patricia Joyce, MD, medical officer and epidemiologist with CDC’s Division of HIV/AIDS Prevention.

“We don’t know all the factors and decisions that were made in the clinical management of this case,” she says. But Joyce adds that testing, evaluation and follow up need to be done in a timely manner.

Nurses at high risk

Between 1985 and 2000, 57 healthcare workers had documented cases of occupationally acquired HIV. Twenty-four (42%) of them were nurses and 16 (28%) were laboratory technicians. Some 88% of the incidents involved hollow-bore needles.2

Of the 12 cases since 2003 that were deemed to have a possible occupational link, five were clinical lab technicians, two were nurses, and one was a non-surgical physician, Joyce says. “Nurses are among the highest risk [groups] both for the confirmed and the possible [cases],” she says.

Joyce also notes that hospice nurses and health aides have potential exposure to blood and body fluids and also are at risk of HIV and other bloodborne pathogens.

The small number of occupationally acquired HIV cases shows the effectiveness of precautions, safer devices and prophylaxis. But that shouldn’t be interpreted as evidence that there’s less risk of getting HIV from a needlestick or other exposure, say Joyce and Kuhar.

“We don’t know how many people were at risk and because they followed [recommended protocols] and took post-exposure prophylaxis didn’t get infected,” says Joyce.

References

  1. Joyce MP, Kuhar D and Brooke JT. Notes from the field: Occupationally acquired HIV infection among health care workers — United States, 1985–2013. MMWR 2015; 63:1245-1246/
  2. Do AN, Ciesielski CA, Metler RP, et al. Occupationally acquired human immunodeficiency virus (HIV) infection: National case surveillance data during 20 years of the HIV epidemic in the United States. Infect Control Hosp Epidemiol 2003; 24:86-96.