Recommendations to Reduce the Risk of Occupational
HIV Transmission After an Exposure Incident

by Sindy M. Paul, M.D., M.P.H., Linda Berezny, R.N., and Carol Lamond, R.N., M.S.

Abstract

HIV infection is an occupational risk for health care workers.  To assist these health care workers, the United States Public Health Service (PHS) issued updated recommendations for post-exposure chemoprophylaxis in a Recommendations and Reports supplement to the Morbidity and Mortality Weekly Report (September 30, 2005, Vol. 54, No. RR-9).

Introduction

The transmission of bloodborne pathogens is an occupational hazard for health care workers.  Nationally, as of December 31, 2002, 57 health care workers had become HIV infected as a result of an occupational exposure.  Twenty-six of these workers have developed AIDS.  The 57 health care workers include: 24 nurses, 19 laboratory technicians, 6 physicians, 2 surgical technicians, 2 housekeeping/maintenance workers, 1 dialysis technician, 1 respiratory therapist, 1 health aide/attendant, and 1 embalmer/morgue technician.  The most common route of exposure for occupational HIV transmission is percutaneous.  Forty-eight of the seroconversions occurred as a result of a percutaneous exposure, 5 occurred through a mucocutaneous exposure (mucous membrane and/or skin exposure), 2 occurred due to a combined percutaneous and mucocutaneous exposure, and for two, the route of exposure was unknown.¹

The purpose of this paper is to describe the updated recommendations from the CDC for medical intervention to reduce the risk of occupational HIV transmission after an exposure incident.  Changes from the 2001 recommendations include:

• Modification and expansion of the list of antiretroviral medications that can be considered for use as PEP
• Emphasis on prompt management of occupational exposures,
• Selection of tolerable regimens,
• Attention to potential drug interactions involving drugs that could be included in HIV PEP regimens and other medications,
• Consultation with experts for post-exposure management strategies (especially determining whether an exposure has actually occurred) and selection of HIV PEP regimens,
• The use of HIV rapid testing, and counseling and follow-up of exposed personnel.

In addition to HIV, health care workers should be evaluated for potential hepatitis B and hepatitis C transmission after an exposure incident.

In order to reduce or eliminate the hazards of occupational exposure to blood or other potentially infectious materials (OPIM), the federal Occupational Safety and Health Administration (OSHA) promulgated the “Occupational Exposure to Bloodborne Pathogens” Standard (29 CFR 1910.1030) in 1991.² The Standard requires that the employer must implement an exposure control plan for the worksite with details on employee protection measures.  The Plan must also describe how an employer will use a combination of engineering controls (including the use of safer needle devices) and work practice controls; ensure the use of personal protective clothing and equipment; provide training, medical surveillance, hepatitis B vaccinations, and warning signs and labels, among other provisions.