Transmission of human immunodeficiency virus (HIV) in health-care settings worldwide

Abstract

Based on the information available, transmission of human immunodeficiency virus (HIV) can and does occur in health-care settings. No cases of such transmission have been reported from an infected health-care worker to a patient. Transmission of HIV from an infected patient to a health-care worker has been documented after parenteral or mucous-membrane exposure to blood. However, this risk is less than 1%, is limited to exposure to blood, and can be further minimized through adherence to routine infection control measures. Patient-to-patient transmission through invasive equipment or through HIV-infected blood, blood products, organs, tissues, or semen also occurs but can be prevented by proper sterilization of instruments and through donor-deferral, donor screening, and heat treatment of Factors VIII or IX to inactivate the HIV. In health-care settings, prevention of HIV transmission requires education of all health-care workers and ancillary staff, provision of necessary equipment, and strict adherence to general infection control practices.

PIP: The findings of a project initiated in 1988 by the World Health Organization's Global Program on AIDS on HIV transmission in health care settings indicate that strict adherence to infection control practices can greatly reduce the already minimal risk. There have been no cases reported of transmission from health workers with HIV infection to patients; 66 UK patients operated on by a UK surgeon with AIDS and 615 patients of a US surgeon with AIDS tested over 90 days after exposure were seronegative. On the other hand, prospective studies from the US, UK, France, Martinique, and Italy have identified 18 seroconversions in health care workers who had parenteral or mucus membrane exposure to blood from an HIV-infected patient. The majority (13) of these 18 cases involved needlestick injuries or cuts with a sharp object. Always problematic is the determination of whether infection in health care workers was occupationally acquired or a result of other high-risk activities. Patient-to-patient transmission of HIV infection has been the most commonly reported phenomenon and can occur through HIV-infected blood products, organs, tissues, and semen or contaminated equipment. HEre, the risk can be substantially reduced by proper instrument sterilization, use of disposable needles, screening of potential donors, and heat treatment of Factors VIII or IX.