Prevention of transmission of blood borne pathogens to patients during invasive procedures
Lutz, B.
Aids Information Exchange 8(3): 2-11
1991
ISSN/ISBN: 0891-7426 PMID: 12284144 Document Number: 314976
Whether universal testing of all U.S. health care workers (HCWs) who perform invasive procedures for HIV status is needed to prevent transmission of HIV to patients is discussed, concluding that such testing would create more problems and endanger more patients than lives would be saved. The address was given at the U.S. Conference of Mayors and the U.S. Conference of Local Health Officers in New Orleans, June 1991. 38% of the country's 2000 local health departments offer dentistry and 3% operate public hospitals. Universal body fluid precaution guidelines were adopted in 1987. Using hepatitis B virus (HBV) as an indicator, transmission of blood-bourne pathogens has been significantly curtailed since adoption. Changes that could be made to improve infection control are training, monitoring, enforcement of compliance, and use of safer barrier technologies. CDC could collect data on transmission related to specific procedures, set guidelines for management of infected HCWs, allow HCWs to elect not to perform certain procedures. Patients have the right to be informed of breakdown in the universal precautions, concern of a HCW of potential transmission, and death of a HCW of AIDS. The costs and risks of universal testing of HCWs would include prohibitive monetary costs to test and maintain confidential records of results, loss of services of some HCWs, avoidance by HCWs to treat further HIV infected people, dumping of HIV patients on public facilities and possibly wider misperception by the public that invasive procedures are dangerous. An example is the common fear that giving blood causes AIDS, which reduced numbers of blood donations. CDC estimates that the chance of contracting HIV from invasive procedures is 1:263,000 to 2.6 million from dental surgery and 1:41,000-416,000 from general surgery, based on the past decade, without universal precautions.