Risk of Exposure to HIV-Infected Body Fluids Among Medical Housestaff

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Abstract
To assess the risk of percutaneous and mucosal exposure to HIV-contaminated fluids among medical housestaff and the role of zidovudine (ZDV) postexposure use, 69 residents and fellows were surveyed with a self-administered questionnaire. Twenty-four exposures to HIV-infected fluids (22 needlesticks, 1 mucosal splash, and 1 other injury) were reported in 94 person-years (py) with a rate of 0.25/py. Accidents were common during the first training year (22 of 24; rate 1.26/py). Most occurred while directly caring for patients (23 of 24); blood was involved in 19 cases and CSF in 5. Eighteen reported being tired at the time of accident. Mean on-duty time was 15.1 hours. Accidents occurred during: venipuncture, 6 of 24; needle recapping, 5; blood transfer to test tube, 5; arterial puncture during CPR, 2; other actions, 6. Available baseline (12 of 24) and follow-up (7 of 24) HIV antibody testing were all negative. Six residents elected to take ZDV within 24 hours of exposure; 5 received 600-1200 mg/d for 4-6 weeks, and 1 for 3 days. Gastrointestinal side effects were noted during prolonged ZDV therapy, and diarrhea was frequently seen (3 of 5). Bone marrow suppression did not occur. The rate of exposure to HIV-infected body fluids is high, especially during the first year of training. Serial HIV testing may help define the role of ZDV use in preventing seroconversion after occupational exposure, as a double-blind, placebo-controlled trial appears to be currently precluded.