In many countries for many years health care workers have become infected with HIV as a result of their work. These infections of health care workers have been reported in the USA as follows:

U.S. Health care workers with documented and possible acquired HIV infection, by occupation reported through June 2000

The main cause of HIV infection in occupational settings is via a percutaneous (i.e. needle stick) injury resulting in exposure to HIV infected blood. Research suggests that infection is rare after a needle stick injury, with a rate of about 3 per 1000 injuries. Although the risk of infection after a needle stick injury is rare, this is still understandably an area of considerable concern for many health care workers.

Surveillance on health care workers in the UK who have been exposed to blood born viruses has been carried out since 1984. By the end of June 2000, the PHLS Communicable Disease Surveillance Centre had received 827 reports of exposures to material from patients with antibody to HIV, Hepatitis C or Hepatitis B. 242 of the health care workers were exposed to HIV. Out of the total of 827 infected 337 were nurses and 262 were doctors. These two groups remain the most frequently exposed¹.

Certain specific factors may mean a needle stick injury carries a higher risk, for example:

A deep injury An injury with a hollow bore needle. Where the source patient has AIDS When the sharp instrument is visibly contaminated with blood When the sharp instrument has been in an artery/vein

If percutaneous exposure occurs, bleeding should be encouraged by pressing around the site of the injury (but taking care not to press immediately on the injury site). It is best to do this under a running water tap.

There are a small number of instances when HIV has been acquired through contact with non-intact skin or mucous membranes. Research suggests that the risk of HIV infection after mucous membrane exposure e.g. splashes of infected blood in the eye, is much less than 1 in 1000. If mucocutaneous exposure occurs, wash the affected area thoroughly with soap and water. If the eye is affected, irrigate thoroughly.

If intact skin is exposed to HIV infected blood, there is no risk of HIV transmission.

Treatment with anti-HIV drugs as soon as possible after an exposure has occurred, in order to reduce the risk of infection, is referred to as Post Exposure Prophylaxis (PEP).

Research evidence seems to suggest that the use of anti-HIV drugs like zidovudine in combination with other anti-HIV drugs if given soon after the injury can reduce the rate of transmission. It is recommended that PEP should commence within 24-36 hours of injury, and preferably within a few hours of exposure².

Although exposure through needle stick injuries can usually be avoided by following good working practices, health care workers should consider the implications of taking PEP. This will help them to make a swift decision in the event of an accident where an injury occurs. In the UK, the Department of Health guidelines for PEP are that most needle stick injuries should be treated with the drug lamivudine (3TC, Epivir) for four weeks. For more serious exposure adding a protease inhibitor is suggested.

Although infection through needlestick injury does not often occur, it can be devasting for the person concerned as the following account sent to AVERT shows:-

I am a lab tech. I worked 11-7 shift for the past 9 and half years. My job includes drawing blood, testing blood and urine samples in a hospital laboratory, and preparing blood transfusions for patients who need blood products. On 12/31/93 at 3.55am I was called to the emergency room to draw blood on an hiv+ drug abuser, it seems she was out of cash but wanted more 'pain meds". The doctors wanted blood tests first to find out what was she sick with. I ended up trying to draw her blood and she became violent, jerking her arm around after I had a needle in her vein and was getting blood out of her arm. She managed to get the dirty needle stabbed into my left thumb. When I saw that needle in my hand I felt a chill go down my spine and dreaded I would become positive too.

Well by march of 1994 I was hiv+. Since then I have tried many of the hiv meds on the market. Many have given me allergic reactions, some have simply been ineffective, others the virus has grown resistant to. It's a month to month battle. So far my t counts are holding and my viral load is between non detected and 10,000. I am married and had a son aged 18months at the time I was infected. He's now 9.5 years old and the pride of my life. How can I ever tell him mom may not be around much longer? On October 28, 2000 we were blessed with the birth of a daughter. Beautiful is her description by anyone who has seen her. Tonight I received the results of her 1 year hiv test. It is positive.

Universal Infection Control Precautions means taking precautions with everybody. If precautions are taken with everyone, health care workers do not have to make assumptions about people's lifestyles and risk of infection. Health care workers should have the right to be able to protect themselves against infection, whether it is HIV or Hepatitis.

The following universal infection control precautions are advised in the UK to help protect health care workers from blood-borne infections including HIV.

The following should be carried out for protection against any infection:

Always wear gloves when handling blood and other body fluids. If you have cuts or other abrasions then cover them with a waterproof plaster. Mop up blood spills using gloves and paper towels and wash with either detergent or a chlorine solution made from NaDCC (sodium dichloroisocyanurate) tablets. For large spillages NaDCC granules should be available. An alternative is to use a 1% solution of sodium hypochlorite. 'Spill Kits' containing the above items may also be available in some districts for use in the community. In instances where NaDCC tablets are not available, diluted household bleach should be used. In hospital settings all linen with blood on it should be sealed in a water-soluble bag. This should then be placed in a red marked bag and labelled according to hospital procedures. Linen contaminated in the community should be washed on a hot wash cycle (approx. 70 degrees). If a machine is not available, contact should be made with the Infection Control Department. In domestic settings pads, sanitary wear and disposable nappies should be (double) wrapped in polythene bags and put in a lidded bin away from children, or put in an incinerator where available. Hands should be washed before and after changing nappies, or disposable gloves should be used. Terry nappies and protective plastic pants should be washed as normal (soaked in a bucket with nappy cleanser, rinsed and washed with hot water and detergent).