Biomedical subjects
A J Behrman
Publications and source records attributed to A J Behrman.
Trends in bloodborne pathogen exposure and follow-up at an urban teaching hospital: 1987 to 1997.
Health care workers (HCWs) risk occupational exposure to bloodborne pathogens. Effective postexposure treatment and testing depend on compliance with follow-up, but compliance rates are poorly understood. We examined trends in exposure and follow-up at a large teaching hospital after interventions to improve compliance. We reviewed exposures from October 1987 to September 1988 (group 1) and July 1996 to June 1997 (group 2). Data were analyzed for HCW demographics, source patient characteristics, and follow-up outcomes. We found that group 2 source patient serologic data were obtained more often. Group 1 source patients were more likely to be positive for the human immunodeficiency virus (HIV). Group 2 HCWs were more likely to be immune to hepatitis B virus, to agree to HIV testing, and to comply with follow-up. Follow-up rates remained suboptimal, even after high-risk exposures. Non-licensed HCWs were less likely to accept postexposure testing than physicians or nurses in group 2. General and targeted interventions to improve compliance and follow-up are still needed.
Lipid abnormalities in a healthcare worker receiving HIV prophylaxis.
Healthcare workers (HCWs) worldwide risk occupational exposure to HIV and other blood-borne pathogens. Post-exposure prophylaxis (PEP) may decrease the risk of seroconversion after occupational or sexual exposure. Current guidelines recommend immediate PEP with at least 2 drugs following HIV exposure. In high-risk exposures, the guidelines recommend the use of a protease inhibitor (PI) as well as 2 reverse transcriptase inhibitors. Protease inhibitors have been associated with dyslipidaemias, other metabolic abnormalities and lipodystrophy syndromes in AIDS patients. We report a case of new transient lipid abnormalities in a HCW receiving PEP after HIV exposure. HIV medications may produce occult metabolic abnormalities in HIV-negative individuals receiving PEP. This risk should be considered during follow-up evaluation for PEP.
The mask. TB-preventive masks compared.
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Prophylaxis after sexual exposure to HIV.
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Tuberculosis exposure and control in an urban emergency department.
STUDY OBJECTIVE: To measure tuberculosis (TB) conversion rates among staff of an urban emergency department compared with other hospital employees (OHEs) and to evaluate the effectiveness of new TB control measures. METHODS: A prospective interventional cohort study was performed in an academic adult 1,000-bed urban hospital, with more than 6,000 employees, and an annual ED census of 43,000. As part of a hospital-wide program, all employees were screened for tuberculin reactivity (Siebert purified protein derivative [PPD] of tuberculin) annually during a 3 1/2-year period. Additional information collected on each employee included country of birth, ethnicity, history of bacille Calmette-Gúerin (BCG) vaccination, length and site of employment, and age. At the end of the second year, TB control measures including construction of a new ED facility with TB respiratory isolation rooms, nonrecirculated air, and droplet shields for registrars were implemented. Relative risk (RR) and 95% confidence intervals (CIs) were calculated. RESULTS: During the first screening cycle, PPD status was obtained on 5,697 hospital employees, 88 of whom worked primarily in the ED. Baseline status was 81% PPD- (induration <5 mm), 9% PPD+ (induration > or =10 mm), and 10% refused skin testing. ED staff did not differ from OHEs with regard to PPD status, age, ethnicity, BCG history, foreign birth, residing in a county with high TB prevalence, or length of employment. During the second cycle, 6 of 50 (12%) previously PPD- ED staff and 51 of 2,514 (2%) previously PPD OHEs converted to PPD+ status (RR=5.9; 95% CI 2.7,13.1). After implementing TB control measures, the conversion rate during the third year dropped to 0 for ED staff, whereas the OHEs had a conversion rate of 1.2% during that cycle. CONCLUSION: TB conversion rates were 5.9 times greater in ED staff members than OHEs before engineering controls were implemented. The ED TB conversion rate fell dramatically in the year following new TB controls. Many EDs are high-risk sites for TB exposure and may benefit from similar measures.
Long-term prognosis of hepatitis C virus infection.
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