Nosocomial HIV transmission

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Nosocomial transmission

Ganczak M, Barss P. Nosocomial HIV infection: epidemiology and prevention-a

global perspective. AIDS Rev. 2008;10(1):47-61.

Because, globally, HIV is transmitted mainly by sexual practices and injection

drug use and because of a long asymptomatic period, healthcare-associated HIV

transmission receives little attention even though an estimated 5.4% of global

HIV infections result from contaminated injections alone.

It is an important personal issue for healthcare workers, especially those who

work with unsafe equipment or have insufficient training. They may acquire HIV

occupationally or find themselves before courts, facing severe penalties for

causing HIV infections.

Prevention of blood-borne nosocomial infections such as HIV differs from

traditional infection control measures such as hand washing and isolation and

requires a multidisciplinary approach.

Since there has not been a review of healthcare-associated HIV contrasting

circumstances in poor and rich regions of the world, the aim of this article is

to review and compare the epidemiology of HIV in healthcare facilities in such

settings, followed by a consideration of general approaches to prevention,

specific countermeasures, and a synthesis of approaches used in infection

control, injury prevention, and occupational safety.

These actions concentrated on identifying research on specific modes of

healthcare-associated HIV transmission and on methods of prevention. Searches

included studies in English and Russian cited in PubMed and citations in Google

Scholar in any language.

Medical Subject Headings (MeSH) keywords such as nosocomial, hospital-acquired,

iatrogenic, healthcare associated, occupationally acquired infection and HIV

were used together with mode of transmission, such as “HIV and

haemodialysisâ€. References of relevant articles were also reviewed.

The evidence indicates that while occasional incidents of healthcare-related HIV

infection in high-income countries continue to be reported, the situation in

many low-income countries is alarming, with transmission ranging from frequent

to endemic.

Viral transmission in health facilities occurs by unexpected and unusual as well

as more frequent modes.

HIV can be transmitted to patients and to donors of blood products by specific

vehicles and vectors during blood transfusion, plasma donation, and artificial

insemination, by improperly sterilized sharps, by medical equipment during

activities such as dialysis and organ transplantation, and by healthcare workers

infected by occupational exposure to hazards such as blood-contaminated sharps.

Personal, equipment, and environmental factors predispose to acquisition of

nosocomial HIV and all are pertinent for prevention.

For infection and injury control, poverty is often an underlying determinant.

While sophisticated new tests offer improved HIV detection, increasingly higher

marginal costs limit their feasibility in many settings. Modest investment in

safer equipment and appropriate integrated training in infection control, injury

prevention, and occupational safety should provide greater benefit.

Editors’ note: Nosocomial (from the Greek nosos [disease] and komein [to care

for] and later from the Latin for hospital nosocomium) infections are those that

occur more than 48 to 72 hours after a patient is admitted and were not present

or incubating at entry.

This exhaustive review, the first in 15 years, is essential reading for policy

makers, health personnel, and the public alike. The detailed descriptions of

modes of health care-associated HIV transmission and of virtually all the

documented cases from around the world set the stage for recommended

interventions to eliminate/reduce risk for all countries, with special

priorities for low-income countries. Arguing that prevention begins when

everyone accepts that nosocomial infections are truly avoidable, the authors

call for international action to develop and implement appropriate and efficient

safety equipment, training, and surveillance that are feasible for even remote

areas of low-incomecountries.

http://hivthisweek.unaids.net/2009/04/17/nosocomial-transmission/