On-the-Job HIV Infection Now Rare in US Health Care Workers

Every state health department tracks workplace exposure to human immunodeficiency virus (HIV) in health care workers (HCWs) with assistance from the US Centers for Disease Control and Prevention (CDC).

Since 1987, the CDC has recommended the use of universal precautions—renamed “standard precautions” in 1996—to prevent occupational HIV exposures. Since 1996, the agency has also recommended occupational post-exposure prophylaxis with antiretrovirals to prevent infection.

The January 9, 2015, edition of the CDC’s Morbidity and Mortality Weekly Report summarized data related to occupational exposure to HIV in HCWs. Between 1985 and 2013, there were 58 confirmed and 150 possible cases of occupationally acquired HIV reported by paid and unpaid HCWs. Most cases were reported before 1999, with only 1 case reported after 1999.

The 58 confirmed cases were associated with percutaneous puncture or cut (49 cases), mucocutaneous exposure (5 cases), and both percutaneous and mucocutaneous exposure (2 cases). In 2 cases, the cause was unknown.

The authors attributed the abrupt decline in cases to consistent use of standard precautions, better options for needles and sharps disposal, and good post-exposure management. Standard precautions—which assume that all patents have the potential to transmit infectious illness—rely on the use of barrier devices such as gloves, masks, and safety needles that minimize exposure risk.

Preventing exposures to blood and body fluids is critical to preventing occupationally acquired HIV. Nonetheless, occupational HIV exposures occur, and post-exposure prophylaxis has proven to be effective.

The authors declared that documented occupational acquisition of HIV infection in HCWs has become a rarity in the United States. Although the steep decline in cases could represent under-reporting, it is unlikely. Rather, good health hygiene has triumphed.

HCWs and health care organizations must report all cases of suspected occupationally acquired HIV infection to the state health department HIV surveillance staff and the CDC coordinator for Cases of Public Health Importance, Division of HIV/AIDS Prevention, at (404) 639-0934 or (404) 639-2050.