[Hepatitis B prevention after occupational exposure]

The course of a programme for protection from hepatitis B after occupational exposure is assessed. Passive/active prophylaxis from hepatitis B was offered to 51 persons but only 28% completed the entire regimen. The programme for vaccination of staff prior to exposure must be intensified and not only this programme but also the protective programme after exposure must include reminders to individuals who do not follow the programme.

An outbreak of psittacosis in Minnesota turkey industry workers: implications for modes of transmission and control

From June through November 1986, an outbreak of psittacosis occurred in turkey industry workers in central Minnesota. A total of 186 suspect cases were identified, and 122 cases (66%) were serologically confirmed. Cases occurred in three turkey processing plants, two rendering plants, one farm, and one "further processing" plant (where meat is removed from previously eviscerated carcasses and consumer products, such as roasts, are made). As in previous outbreaks, workers exposed to the viscera of infected birds were at greatest risk of becoming infected. However, our data showed that 31 (25%) of the confirmed cases occurred in workers at the further processing plant who had contact only with previously eviscerated carcasses. Although the specific source of infection and the mode of transmission in these workers are unclear, the use of gloves and masks by all processing workers during an outbreak might help to limit exposure. Control measures, which focused on identifying and treating ill turkey flocks, were initiated in early September; however, cases continued to occur in turkey industry workers through November. One of the flocks suspected of causing illness appeared healthy and, therefore, was not treated. Chlamydia psittaci infection in this flock was confirmed by culture after the flock had been processed. A rapid test for diagnosing C. psittaci infection in turkey flocks at the time of processing might be useful in preventing exposure of large numbers of workers.

Glove perforation during plastic surgery

Intraoperative perforation of surgical gloves is common. Nine hundred and forty surgical gloves were tested after 100 consecutive plastic surgical operations, each involving a surgeon, a variable number of assistants and a scrub nurse. In the first 52 operations, single gloves were used and 21.5% of the staff were found to have a perforated glove. In the second 48 operations, double gloves were used by all members of the surgical team and the number with perforations (of both inner and outer gloves) was reduced to 9%. Most perforations occurred on the dorsum of the hand and fingers and on the thumb tip, especially in the non-dominant hand. The risk of acquiring AIDS due to glove perforation is low but the consequences of such an event could be lethal.

Human immunodeficiency virus infection in health care workers. A method for estimating individual occupational risk

Physicians and other health care workers are concerned about their occupational risk of acquiring human immunodeficiency virus infection. We have developed an approach that can help health care workers estimate their cumulative risk of infection with human immunodeficiency virus. Illustrations are used to develop a score that reflects an individual's occupational exposures and social behavior. This score is then translated into the probability that the worker is infected.

Do hospital personnel in hyperendemic areas require immunization against hepatitis B virus (HBV) infection? Is vertical transmission of HBV infection common in this group?

Medical personnel working in contact with blood and blood-contaminated body fluids are often considered to be a high-risk group for hepatitis B virus (HBV) infection and, as a result, it is recommended that they should be vaccinated against this infection. To find out if this is necessary in a country hyperendemic for HBV infection and to see if parents transmit the infection to their offspring, a total of 336 volunteer hospital employees, and 103 children of 47 of them, were tested for HBsAg, anti-HBc, anti-HBs, HBeAg and anti-HBe using the radioimmunoassay technique. Of these, 242 (72%) were found to have evidence of past or present HBV infection and only 94 (28%) had no such evidence. The infection prevalence in the 47 parents was 68% comparable to that of the total sample. Only 9 of their 103 children were positive for HBV markers. All tested parents of these positive children were either negative for all markers or positive for anti-HBs. The HBV infection prevalence among this hospital population is not different from that of the general Ethiopian population, and vertical transmission appears unlikely in this group. Therefore, mass vaccination of hospital staff in hyperendemic areas is unnecessary.

An avoidable occupational hazard during mastoid surgery

Conjunctival innoculation is a previously unrecognized hazard for the otologist during mastoid surgery. This experiment assess the spread of droplet contamination during temporal bone dissection. The results suggest that otologists and assistants should wear eye protection during exposure of the mastoid antrum by drilling.

AIDS: the contamination risk in urological surgery

Increasing numbers of patients infected with the Human Immunodeficiency Virus (HIV) will be encountered in surgical practice. The risk of exposure to the virus during urological surgery is unknown. In an attempt to quantify the risk and to identify procedures that require change, 427 consecutive urological operations were prospectively assessed for contamination of the surgeon's skin, face and mucous membranes by potentially infected body fluids. Contamination occurred in 136 procedures (32%), of which 37 of 123 (30%) were open operations and 99 of 304 (33%) were endoscopic. Contamination of the face and eyes accounted for 46% (46 of 99 operations) of the contamination occurring in endoscopic surgery. Attention must be paid to reducing exposure of the surgeons' skin to patients' body fluids. The surgeons' eyes should be protected by modification of urological techniques and equipment to avoid spillage.

[The psychiatric facility and AIDS]

There is still a lack of interest in problems emerging in the institutional treatment of the psychiatric AIDS-patient. The small number of articles dealing with the treatment of the acute ill is reported. None of them regards the risk of HIV-infection for chronic mental ill or mental retarded persons in greater institutions. Ethical, legal, and practical implications of this problem are discussed.

Increased incidence of Campylobacter pylori infection in gastroenterologists: further evidence to support person-to-person transmission of C. pylori

The mode transmission of Campylobacter pylori is still unknown, although several studies have suggested person-to-person transmission. In this study the incidence of active C. pylori infection in an endoscopy staff was compared with that in general practitioners and normal blood donors. Since endoscopy workers are in close contact with patients, many of whom would be likely to have active C. pylori infection, it was likely that there would be an increased incidence of active C. pylori infection in endoscopists if the organism can spread from person to person. The incidence of active C. pylori infection in the group of gastroenterologists was 52%, compared with 21% in an age-matched group of blood donors. This finding was statistically significant (p less than 0.01). In comparison, the incidence of active C. pylori infection in the endoscopy nurses and general practitioners was not statistically different from that in the normal population.

Occupational infection with human immunodeficiency virus (HIV). Risks and risk reduction

As the epidemic of the acquired immunodeficiency syndrome (AIDS) expands, the prevalence of the human immunodeficiency virus (HIV) infection in health care environments will increase and health care workers in many locations are likely to be at increased risk for exposure. The Fifth Annual Advances in Occupational Cancer Conference, held in December 1988 in San Francisco, addressed occupational HIV infection. Symposium participants concluded that the risk of HIV infection for health care workers is low but not zero. Implementation of universal blood and body fluid precautions was agreed to as an appropriate method of preventing exposure to HIV, especially for preventing needlestick accidents. Current standards for hospital waste disposal were judged to be adequate to prevent transmission of HIV, and confidential testing for HIV antibody in health care workers with follow-up counseling was recommended where indicated. It was also agreed that the risk of occupational exposure to HIV does not free health care workers from the responsibility to provide care to infected persons.

AIDS and the minority health care worker

1. Large groups of health care workers, many of whom are among ethnic minorities with potential for occupational exposure to HIV/HBV, are generally underserved in training on prevention of occupational transmission of the viruses. 2. The inadequacy of training for indirect client care personnel appears to be one of the primary reasons for high rates of needlestick injuries and exposure to blood. 3. Training in appropriate infection control techniques can help reduce the uneasiness and fear among health care workers over occupationally-related HIV/HBV transmission.

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

The possibility of transmission of the human immunodeficiency virus (HIV) to health care workers with occupational exposure to infected patients has caused concern since the beginning of the AIDS crisis. This report summarizes both national surveillance data for AIDS among health care workers and the results of prospective studies on the risk of HIV transmission in the health care professions. All the available evidence indicates that HIV infection in health care workers in the United States results primarily from exposure outside the health care setting, and is acquired by one of the conventional routes of transmission. A small number of health care workers have been infected with HIV through occupational exposure. Prospective surveillance studies indicate that the risk of seroconversion after needlestick exposure to HIV-infected blood is about 0.5%. The level of risk associated with exposure of mucous membranes or nonintact skin is far less.

[Hepatitis diseases in health occupations (exemplified by Lower Saxony federal land)]

We analysed the incidence of hepatitis among members of the medical profession (doctors, dental surgeons, nurses and medical assistants) by extracting the relevant figures from the total number of hepatitis cases that had been reported to Lower Saxony Public Health authorities between 1976 and 1986. It was found that the incidence and hence the risk of contracting hepatitis A was two to three times higher in particular for the nursing profession than for the total population and also than for doctors and dental surgeons. Although the incidence of hepatitis B has gone down in recent years, the risk of getting infected is definitely higher for doctors, dentists and nursing staff than it is for the total population. This shows that all necessary precautionary and hygiene measures have not yet been fully observed for the members of professions engaged in health care. All persons active in health have an increased risk of being infected with hepatitis non-A-non-B, compared with the overall population. This enhanced risk of hepatitis A infection for the nursing profession and of hepatitis non-A-non-B infection for all medical staff including doctors and dentists prompts us to demand that these two types of disease should also be included in the list of professional diseases.

Prevention of human immunodeficiency virus infection: our responsibilities as health care professionals

The prevention of human immunodeficiency virus (HIV) infection is a major responsibility of health care professionals. This paper deals with the virus itself--its history and prevalent modes of transmission. The low risk of HIV transmission in health care settings and through casual contact is emphasized. A discussion of prevalence rates in the United States is followed by an explanation of methods to prevent HIV infection through testing, counseling, limiting sexual transmission, screening of blood and blood products, reducing risk among intravenous drug users, avoiding perinatal transmission, practicing safety measures in health care settings, and implementing educational goals.

Emergency department thoracotomy

The best candidates for a community hospital emergency room thoracotomy are those victims who have decompensated following small-caliber gunshot wounds or stab wounds to the chest or abdomen who initially had signs of life in transport to the hospital or in the Emergency Department. Some of these patients can be successfully resuscitated by an emergency physician using the techniques described in this article.

HIV infection: risks to health care workers and infection control

The risk for occupational transmission of HIV-1 in the health setting is extremely small. Current data from a number of prospective studies of health care workers sustaining adverse exposure to blood or other body fluids from patients infected with HIV-1 demonstrate that the rate for transmission of infection following a needlestick injury is approximately 0.5%. Similar data regarding the risk for occupational transmission of hepatitis B virus infection, however, indicates that the rate of transmission of infection with this virus following a needlestick injury may be as high as 30% and the risk for transmission of other blood-borne infections is poorly defined. Infection control precautions designed to minimize the risk for HIV-1 infection were recommended by CDC shortly following the first reported case of AIDS in the United States. These measures were implemented for patients diagnosed with or suspected to be infected with HIV-1, determined by history-taking or serologic evaluation. The inability of these mechanisms to accurately identify all infected individuals, coupled with the occurrence of undiagnosed or unrecognized blood-borne infections, emphasizes the need for health care workers to consider all patients as potentially infected with HIV-1 or other blood-borne pathogens. Implementation and enforcement of universal precautions should minimize exposure of health care personnel to blood and body fluids and thus substantially reduce the risk for occupational transmission of HIV-1 and other blood-borne infections in the health care environment.

Cryptosporidiosis in veterinary students

Cryptosporidiosis was diagnosed in 10 veterinary students. Exposure to the pathogen was associated with direct contact with infected calves and contact with contaminated materials. Affected students had fever (50%), headache (50%), nausea (70%), diarrhea (80%), and vomiting (40%). Clinical signs persisted for 30 hours to 16 days after the onset of clinical signs of disease. Although one student required hospitalization, the remaining students recovered without treatment.

[Risk of AIDS and prevention in the hospital and general practice]

Following an explanation of the most important routes of infection, there are general recommendations for protection against HIV-infection. Part 2 discusses AIDS risks and prophylaxis in the hospitals and in the offices of physicians. This discussion includes both, general aspects and specific medical questions. Both among medical workers and among the general population, HIV-infection can be prevented by adequate measures, sufficient knowledge and determination.

"HIV-infected health care workers"

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