Accidental Infection on Rise in Health-Care Field
The number of health-care workers accidentally infected with the AIDS virus is rising, researchers reported here Friday, while the possibility of using drugs such as AZT to protect them remains in question.
Thirty-four cases of occupationally acquired AIDS virus infection have been reported to federal health officials. New studies indicate that many health-care workers are not routinely taking recommended steps to avoid exposure to patients’ blood.
Some hospitals now offer the AIDS drug AZT to health-care workers exposed to contaminated blood and body fluids--an approach based on the hypothesis that, if taken immediately after exposure, the anti-viral drug might prevent infection.
That hypothesis was challenged Friday in papers presented by two researchers at the Sixth International Conference on AIDS, one citing two cases in which AZT failed to stop the infection in Dutch health-care workers, the other citing failure in monkeys.
Dr. Murray B. Gardner of UC Davis reported that three monkeys given AZT before and after inoculation with a monkey version of HIV all became infected. Dr. Giuseppe Ippolito of Italy said the two Dutch cases represent the first reported instances in which AZT has failed to prevent infection in humans.
He suggested, however, that the Dutch cases were unusual because the workers were exposed to unusually large amounts of the virus. In one case, the AZT dose may have been inadequate; in the other, the virus may have been resistant to the drug because the blood came from a patient who had been on AZT for months.
“Even in the best circumstances, we are not going to be able to create a zero-risk environment,” said Dr. Julie Gerberding of UC San Francisco. “ . . . So that looking for an effective post-exposure (treatment) is a very rational and important need for health-care providers.”
Gerberding heads a program at San Francisco General Hospital where health-care workers exposed to blood or body fluids through needle pricks or in other ways are encouraged to report the accidents immediately on a hot line and are offered AZT.
The number of accidents reported to the hospital increased 169% in the first 10 months of the program. The hot line receives about 45 calls a month. Hospital officials have confirmed through blood testing that 12 of those workers were exposed to HIV-contaminated blood. None have become infected.
In a separate presentation, Scott Campbell of the St. Paul-Ramsey Medical Center in St. Paul, Minn. reported that many physicians, nurses and others in that hospital’s emergency room routinely fail to comply with standard recommended protection procedures.
For example, Campbell said, his three-month study found high rates of unsafe handling of needles and numerous instances of failure to wear gloves, gowns, masks and goggles. Health-care workers said there was usually not enough time and to follow guidelines and that gloves interfered with their manual dexterity.
