Risk of transmission of the human immunodeficiency virus to health care workers exposed to HIV-infected patients: a review

Expert consensus statement on the science of HIV in the context of criminal law

INTRODUCTION

Globally, prosecutions for non-disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting. This includes instances in which no harm was intended, HIV transmission did not occur, and HIV transmission was extremely unlikely or not possible. This suggests prosecutions are not always guided by the best available scientific and medical evidence.

DISCUSSION

Twenty scientists from regions across the world developed this Expert Consensus Statement to address the use of HIV science by the criminal justice system. A detailed analysis of the best available scientific and medical research data on HIV transmission, treatment effectiveness and forensic phylogenetic evidence was performed and described so it may be better understood in criminal law contexts. Description of the possibility of HIV transmission was limited to acts most often at issue in criminal cases. The possibility of HIV transmission during a single, specific act was positioned along a continuum of risk, noting that the possibility of HIV transmission varies according to a range of intersecting factors including viral load, condom use, and other risk reduction practices. Current evidence suggests the possibility of HIV transmission during a single episode of sex, biting or spitting ranges from no possibility to low possibility. Further research considered the positive health impact of modern antiretroviral therapies that have improved the life expectancy of most people living with HIV to a point similar to their HIV-negative counterparts, transforming HIV infection into a chronic, manageable health condition. Lastly, consideration of the use of scientific evidence in court found that phylogenetic analysis alone cannot prove beyond reasonable doubt that one person infected another although it can be used to exonerate a defendant.

CONCLUSIONS

The application of up-to-date scientific evidence in criminal cases has the potential to limit unjust prosecutions and convictions. The authors recommend that caution be exercised when considering prosecution, and encourage governments and those working in legal and judicial systems to pay close attention to the significant advances in HIV science that have occurred over the last three decades to ensure current scientific knowledge informs application of the law in cases related to HIV.

An 'Academic Detailing' Intervention To Decrease Exposure to HIV Infection among Health-care Workers

This intervention aimed to decrease health-care workers' experience of automatic pilot (mindless functioning) when performing high risk procedures. An academic detailing visit resulted in a significant increase in compliance with safety guidelines and a decreased incidence of other unsafe practices among 80 health care workers of two hospital units. The effects of mindlessness on health behaviour may be far reaching and the model described in this paper can be used to develop appropriate interventions.

Análise comparativa da proporção de óbitos segundo causas, de dentistas na cidade de São Paulo

Descreve-se a mortalidade proporcional de dentistas residentes na cidade de São Paulo, entre 1980 e 2000, segundo causas de óbito, em busca de possíveis indicações de risco atribuíveis ao trabalho, com dados levantados na Fundação Sistema Estadual de Análise de Dados. A análise comparativa usou informações análogas para médicos e engenheiros. O estudo dos diferenciais de óbito segundo causa básica indicou a ausência de alterações significantes, apontando risco potencial de óbito aumentado para dentistas em relação a médicos e engenheiros. Os óbitos de dentistas não apresentaram piores indicadores para categorias globais e específicas de doenças infecciosas, neoplasias, suicídio, doenças do sistema nervoso central e do aparelho circulatório. Foi observada indicação de excesso sistemático de óbitos de engenheiros por causas externas em geral, por acidentes de trânsito, quedas acidentais e demais acidentes em particular. Registrou-se a ausência de discrepâncias significantes que apontassem para risco diferencial atribuível ao trabalho de dentistas. Essa observação sugere que a Odontologia pode ser considerada uma profissão segura, ao menos no que diz respeito à exposição a riscos sistemáticos de óbito.

The usefulness of the modified extra-oral vacuum aspirator (EOVA) from household vacuum cleaner in reducing bacteria in dental aerosols

AIMS AND OBJECTIVES

Currently, as a preventive measure against air contamination caused by dental procedures, dust-collecting aspirators such as an extra-oral vacuum aspirator (EOVA) are coming into general use. In this study, we tested the ability of a modified EOVA that uses a household vacuum machine.

DESIGN AND SETTING

The study was conducted in two parts. First, the modified EOVA was tested for its ability to eliminate an Escherichia coli aerosol generated in a manikin. Second, the device was tested for its ability to remove the aerosol generated by dental treatment procedures, scaling and drilling a tooth, on human subjects.

RESULTS

There was a statistically significant reduction in both the E. coli aerosol and the oral bacterial aerosol during dental treatment procedures.

CONCLUSION

The modified EOVA machine is highly effective in preventing air contamination by dental procedures. Its main advantages are that it can easily be modified for use with any dental unit and it is relatively inexpensive.

Virucidal activity of an oral fluid human immunodeficiency virus-1 antibody preservative

Diagnosis of human immunodeficiency virus-1 (HIV-1) infection requires the collection of either serum or oral fluid that is subsequently tested for the presence of antibodies to HIV-1. The effective use of oral fluid for the detection of HIV antibodies is contingent on stabilization of immunoglobulins in the sample through the use of preservatives. Oral fluid preservatives also contain agents that can disrupt and inactivate viruses. This study demonstrates the virucidal activity of a commercially available oral fluid preservative against HIV-1 using a sensitive 28-day cell culture assay designed to detect infectious virus. The results demonstrate that a 5-log reduction in viral titer is obtained when equal volumes of HIV-1 viral stocks and the preservative are mixed. The data provide strong evidence that preserved oral fluid samples from infected individuals are noninfectious for HIV-1.

Structural features of latex gloves in dental practice

The aim of this study was to define from a morpho-structural point of view, using scanning electron microscopy, the features of various types of disposable latex gloves commonly used in Italian dental practice (Biogel D, Trend, Pagni, J&J, Latechnics, Pehasoft, Bantex). None of the brands examined was free from morphological flaws; however, while in some of these only slight depressions were found (Biogel D, Trend), in others (Latechnics, Bantex) there was a marked lack of homogeneity in the latex structure or real holes (Pehasoft). This study emphasizes the current difficulties faced by dentists in the search for safe working conditions.

The management of sharps in the emergency department: is it safe?

In this study, we observed the management of sharps by health care workers including physicians, nurses, technicians, and students in the Emergency Department of the University of California-San Diego Medical Center. Twenty-eight percent of 418 observed sharp utilizations were managed in such a way that excess risk was conferred to the user, another person, or both. Twenty-seven percent conferred excess risk to the user and 12% to another person. Twenty percent of 322 recappable needles were recapped using a two-handed technique; 64% were disposed of uncapped. Four sharps (1%) were inadvertently thrown in the trash. Of the 418 observed sharp utilizations, none resulted in a puncture wound, although the four that were thrown in the trash represent a very high risk of injury to others. Physicians were observed handling the highest percentage of sharps in manners associated with excess risk while technicians and students managed sharps with the least risk. Among sharps used on patients who were IV drug abusers with unknown HIV status, 29% (n = 28) were handled with excess risk to the user, another person, or both. Of 24 sharps used on known HIV-infected patients, there were no practices observed that subjected either the user or another person to excess risk.