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1991.07.15 :  AIDS -- Health Care Worker Guidelines 

Contact:  Bill Grigg (PHS) 202/245-6867, h-301/652-1864
Don Berreth (CDC) 404/639-3286
July 15, 1991
     
     HHS Secretary Louis W. Sullivan, M.D., today announced new
guidelines which say that any health care workers with HIV should
not perform "exposure-prone" medical procedures in which blood
contact might occur.
     Emphasizing that there is no risk of transmitting HIV (the
AIDS virus) in the great majority of medical treatments, the
guidelines are aimed at those procedures in which blood exposure
could cause transmission, either to a patient from a health care
worker or to a health care worker from a patient.  The guidelines
were drafted by the Centers for Disease Control in Atlanta, one
of the U.S. Public Health Service agencies within HHS.
     The new guidelines say that dentists, physicians and other
health care workers who perform exposure-prone procedures should
find out their HIV and hepatitis B status.  Any who are infected
with HIV or the most virulent form of hepatitis B should not
carry out such procedures unless they have obtained permission
and guidance from special review committees which will require,
at minimum, that potential patients be informed of the workers'
HIV or hepatitis B status.
     In addition, the guidelines emphasize the need for all
physicians to follow carefully the "Universal Precautions"
against infection, including such actions as thorough
sterilization of equipment, careful handling and disposal of
needles and other sharp instruments and the wearing of gloves
when appropriate.
     "Patients deserve accurate information and they deserve the
best measures to protect them from disease transmission," HHS
Secretary Louis W. Sullivan, M.D., said in announcing the new
guidelines.  
     "In the overwhelming number of medical encounters, we simply
don't need to be worried about AIDS or hepatitis B transmission,
and it is important for both patients and workers to understand
that fact," Secretary Sullivan said.  "However, for more invasive
procedures, these guidelines should be followed carefully.
     "The guidelines state first that all health care workers
performing invasive procedures should follow the universal
precautions, both to protect patients and to protect workers
themselves," the Secretary said.  "In addition, health care 
workers who perform exposure-prone procedures should closely 
monitor their HIV and hepatitis B status and should stop
performing such procedures if they find they have either
infection.
     "Only if an expert panel has approved and provided
individualized guidance should an infected health care worker
perform an exposure-prone procedure.  The absolute concern of
these review panels should be the safety of the patient.  And, in
every case, the infected health care worker must inform any
patient who is to undergo an exposure-prone procedure."
     As used in the guidelines, "exposure-prone" procedures are
those in which the worker might be cut or injured and his or her
blood contact a patient's body cavity, subcutaneous tissues or
mucous membranes.  While the guidelines call for specialty groups
to develop lists of these procedures, examples include abdominal,
gynecological and heart surgery, and root canals and tooth
extractions.
     There was extensive public and professional input into the
development of the new guidelines, CDC Director William Roper,
M.D., said.  "It is important that they be made widely available
so that the American people can have the benefit of our best 
guidance on these issues."
     Although the states, not the federal government, regulate
the practice of medicine, the federal guidelines are expected to
strongly influence professional standards and requirements.  The
guidelines:
     -- Seek enhanced teaching and scrupulous use of recommended
"Universal Precautions," including sterilization of equipment and
the careful handling and disposal of needles and other sharp
instruments.  Gloves should be worn by all health practitioners
while performing invasive procedures and whenever they come in
contact with blood or body fluids.

     --  Advise health care workers who perform exposure-prone
invasive procedures to get tested for HIV (the AIDS virus) and
for the hepatitis B virus.  If infected with HIV or the most
virulent form of hepatitis B, they should refrain from performing
these procedures unless they have sought counsel from an expert
review panel and have been advised under what circumstances, if
any, they may continue to perform these procedures.  Such
circumstances would include notification of prospective patients
before doing exposure-prone invasive procedures.

     -- Promote increased use of the hepatitis B vaccine for
health care workers likely to be exposed to blood.

     -- Encourage research to identify modifications for medical,
surgical and dental procedures and for equipment to reduce the
risk of injuries to health care workers that might result in
exposure of patients.

     The guidelines were drafted by CDC after two days of public
hearings in Atlanta and a 30-day public comment period.  The
recommendations were then reviewed by other components of the
PHS.  Further comments on the guidelines may be made to the CDC.
     James O. Mason, M.D., who as HHS assistant secretary for
health heads the Public Health Service, said, "We must get across
to the public that in most medical situations there's no more
risk from a potentially HIV-infected nurse or doctor than from a 
lawyer, cab driver or teacher.  AIDS will not be transmitted by 
most medical activities, from an electrocardiogram to the
treatment of pneumonia to the radiation of a tumor.  However,
when surgery is performed, patients need to know that they will
be protected by their dentists and physicians scrupulously
following the Universal Precautions and recommended infection
controls -- such as the sterilization of equipment, use of gloves
and proper care of sharp instruments.
     "These Universal Precautions," Dr. Mason said, "guard the
patient and they guard against the health care worker becoming
infected and becoming a potential transmitter to other patients."

     Transmission to patients has been shown only in one unusual
cluster of five patients of a dentist in Florida.     

     The most virulent form of hepatitis B is identified by the
presence of "e" antigen.  It is up to 100 times as infectious as
HIV, and has occurred when there was poor compliance with
infection control procedures during exposure-prone invasive
procedures.  Hepatitis B can kill but is not as uniformly fatal
as AIDS.    

     CDC will distribute the new recommendations as a supplement
to its Morbidity and Mortality Weekly Report.  The
recommendations will be distributed widely to physicians,
dentists, nurses, professional schools and other interested
parties.  They may be obtained by calling the AIDS Hotline, 1-
800-342-AIDS.

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