NEW YORK--All physicians, regardless of their specialty, must
be prepared to treat HIV-infected patients, according to an expert
from the Centers for Disease Control and Prevention. Although
fears of nosocomial transmission of the virus are not unwarranted,
much can be done to avoid it.
Harold W. Jaffe, MD, associate director for HIV/AIDS at the CDC's
National Center for Infectious Diseases, Atlanta, said that there
has been a reported 0.3% infection rate from percutaneous injuries.
Mucocutaneous exposure, resulting from splashes of infected fluids
to the mouth or eyes, were reported as 0.1%, and there have been
no documented cutaneous transmissions.
Dr. Jaffe spoke at a CME course on the management of the HIV-infected
patient, cosponsored by the Center for Bio-Medical Communication,
Inc. (Dumont, NJ) and AmFAR (American Foundation for AIDS Research).
He said that the principal risk factors for percutaneous transmission
are deep injury and visible blood on a needle, scalpel, or other
surgical instrument. The risk is greatest if the source patient
is terminally ill, since individuals with end-stage HIV infection
tend to have a high viral load in their peripheral blood.
Dr. Jaffe said that the best approach is to employ universal precautions
to avoid exposure with all patients, assuming that the blood of
any patient could contain HIV or other blood-borne pathogens.
Many safety devices to decrease risk are newly available or in
development, he said. Among those currently available are a self-blunting
needle for use with Vacu-tainer collection devices; a hinged recapping
device; blunt surgical suture needles that can be used in some,
but not all, procedures; and a self-sheathing device for butterfly
needles. He cautioned that some of these devices can be used without
activating the safety features.