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Biomedical subjects

J L Gerberding

Publications and source records attributed to J L Gerberding.

At least 19 recordsLinked to original sources
PubMed1992

Management of occupational exposures to bloodborne pathogens: hepatitis B virus, hepatitis C virus, and human immunodeficiency virus.

Being a health care worker in today's world is not without risks. Accidental exposure to blood carries with it a definite risk of transmission of infection by various bloodborne pathogens, especially the hepatitis B, hepatitis C, and human immunodeficiency viruses. While infectious disease specialists, hospital epidemiologists, and infection control clinicians can develop many important strategies to reduce this risk--aggressive training, utilization of safer needles, identification of high-risk activities, and efficient disposal systems--their overriding responsibility is to design and implement a comprehensive plan for expeditiously and effectively dealing with accidental exposures when they occur. Among other things, the plan must address a number of key issues, including testing, administering postexposure prophylaxis, providing short- and long-term follow-up care, and, particularly, counseling for helping the health care worker deal with the tremendous anxiety associated with the injury. Drs. Julie L. Gerberding of the University of California, San Francisco, and San Francisco General Hospital and David K. Henderson of the National Institutes of Health and the Warren G. Magnuson Clinical Center have both made significant contributions in this area; in this month's AIDS Commentary they discuss the essential elements of such a plan.

HIV Infections↗
PubMed1991

Does knowledge of human immunodeficiency virus infection decrease the frequency of occupational exposure to blood?

Implementation of universal precautions is advocated to prevent exposure to human immunodeficiency virus (HIV) and other bloodborne pathogens. Critics of this approach argue that additional benefit can be derived by identifying and labeling patients known to be infected. Knowledge of HIV infection status could result in a reduced exposure rate by two mechanisms: (a) by motivating improved compliance with universal precautions, or (b) by allowing changes in procedure or technique not feasible for all patients. Compliance with universal precautions may reduce the frequency of some types of exposure but has not been associated with a reduction in the frequency of needlestick exposures in several studies. Despite the perception by some health care workers that awareness of HIV status will result in improved safety, no objective data have demonstrated a direct benefit from testing or identifying infected patients. Health care workers who recognize the presence of occupational HIV risk are apt to be motivated to practice universal infection control precautions and experience little additional benefit from testing individual patients. Health care workers in low prevalence areas may experience less incentive to comply routinely with universal precautions and selectively may be motivated when HIV infection is diagnosed in individual patients. However, routine testing in areas of low HIV prevalence is not likely to be cost effective. Until further research clarifies the efficacy and costs of universal precautions or HIV testing, infection control standards should maximize local autonomy in developing rational policies consistent with institutional needs.

HIV Infections↗
PubMed1991

Reducing occupational risk of HIV infection.

At San Francisco General Hospital and many other institutions in areas of high HIV prevalence, a policy of body substance isolation has proved easier to implement than the CDC's across-the-board recommendations. Prevention of needle-stick injury and use of barrier methods of infection control are emphasized. Preoperative HIV testing is addressed.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Occupational exposure to HIV: frequency and rates of underreporting of percutaneous and mucocutaneous exposures by medical housestaff.

PURPOSE: To study the frequency of work-related exposures to human immunodeficiency virus (HIV)-infected blood and reporting of exposures among medical housestaff. SETTINGS: Three teaching hospitals where HIV infection is prevalent among patients. SUBJECTS: Internal medicine interns and residents in training in 1988-1989. METHODS: In a cross-sectional survey, house officers were asked to complete anonymously a questionnaire reviewing their past percutaneous and mucocutaneous exposure to blood products. RESULTS: Nineteen percent of the respondents (16 of 86) recalled accidental exposure to HIV-infected blood, and 36% (31 of 86) recalled exposure to blood from patients at high risk for having HIV infection. Of the exposures recalled in the 12 months prior to the survey, 81% (47 of 58) of all needlestick injuries and all (nine of nine) needlestick injuries from HIV-infected blood occurred in postgraduate year 1 or 2 trainees. Only 30% (31 of 103) of the needlestick injuries recalled by subjects were reported. The principal reasons for not reporting were time constraints, perception that the percutaneous injury did not represent a significant exposure, lack of knowledge about the reporting mechanism, and concern about confidentiality and professional discrimination. CONCLUSIONS: Medical housestaff are at substantial risk for occupational infection with HIV. A large proportion of internal medicine housestaff recall accidental exposure to blood during medical school and residency, and the majority of exposures were not reported. Hospitals may be able to increase rates of reporting of percutaneous exposures to HIV by developing programs that are easy to access, efficient, and strictly confidential.

Adult↗
PubMed1991

Transmission of HIV in health care workers.

Health care workers may be occupationally exposed to human immunodeficiency virus (HIV). The risk of infection is highest with accidental needlestick and similar percutaneous exposures. Emphasis should be placed on avoiding this type of accident. Strategies to prevent accidents and to manage exposures once they have occurred should be developed in each work environment. It is to be hoped that a combination of better infection control, safer devices and technologies, and postexposure prophylaxis with zidovudine (AZT) or other chemotherapeutic agents will help prevent infection in health care providers caring for HIV-infected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Comparison of conventional susceptibility tests with direct detection of penicillin-binding protein 2a in borderline oxacillin-resistant strains of Staphylococcus aureus.

Six selected strains of Staphylococcus aureus classified as borderline oxacillin-resistant, according to standard disk diffusion and microdilution susceptibility test methods, and seven methicillin-resistant and seven methicillin-susceptible control strains were examined for the presence of penicillin-binding protein 2a (PBP 2a) by fluorography and immunoblotting and for DNA hybridization with a mec-specific probe in a dot blot assay. Oxacillin agar screen tests with and without NaCl supplementation were also performed with all strains. PBP 2a was detected both by fluorography and by immunoblotting in all seven methicillin-resistant control strains and in none of the susceptible controls. PBP 2a was detected in two borderline strains. Results of agar screen tests performed without NaCl supplementation were completely concordant with susceptibility determined by PBP 2a and mec detection methods. Agar screening with NaCl supplementation was less accurate. These findings were confirmed with 20 additional borderline strains. Direct detection methods for the presence of PBP 2a or mec, the gene encoding it, allow accurate and definitive classification of borderline strains. Further efforts to develop a rapid, clinically useful, antibody detection system for PBP 2a are warranted.

Animals↗
PubMed1991

AIDS risk and risk reduction in the radiology department.

As the AIDS epidemic progresses, concern about the risk of occupational transmission of the causative organism, human immunodeficiency virus (HIV), is increasing. In this article, we summarize the risk of occupational acquisition of HIV in the health care setting and specify protocol and equipment that can reduce this risk in the radiology department. Accidental needle-stick injury is the most common form of exposure to infected blood, which is the only body fluid implicated to date in the occupational transmission of HIV. Prospective cohort studies demonstrate a 0.3-0.4% risk of infection for each needle-stick event. The most important instruction to health care workers that can reduce this risk is the following: Do not recap needles. Other risk-reduction measures include the adoption of universal precautions against transmission of infectious disease; sharp-instrument precautions; the use of protective garb to prevent skin and mucous membrane contamination when blood or bloody body fluid may splash; the availability of stable, puncture-resistant disposal containers for sharp instruments; the exclusion of breakable glass syringes; and the accessibility of resuscitation equipment in all rooms in order to avoid direct mouth-to-mouth contact. These and other measures discussed here are designed to prevent exposure of skin or mucous membrane to blood. If exposure does occur, the contaminated area should be washed immediately. A multicenter research protocol to evaluate the effectiveness of zidovudine (AZT) therapy in preventing seroconversion after exposure to HIV-contaminated blood recommends AZT therapy after massive exposure (e.g., injection of measurable quantities of blood) and endorses it for serious parenteral exposure (e.g., deep needle sticks).

Acquired Immunodeficiency Syndrome↗
PubMed1990

Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital.

We undertook an observational study of 1307 consecutive surgical procedures at San Francisco General Hospital to record descriptions of intraoperative exposures to blood and other body fluids, determine the factors predictive of these exposures, and identify interventions that might reduce their frequency. During a two-month period, circulating nurses took note of parenteral and cutaneous exposures to blood and recorded information about all procedures. In a follow-up validation study, 50 additional procedures were observed by the study investigators to determine the accuracy of the data collected by the nurses. A total of 960 gloves used by surgical personnel during the validation study were examined to determine the perforation rate. Accidental exposure to blood (parenteral or cutaneous) occurred during 84 procedures (6.4 percent; 95 percent confidence interval, 5.1 to 7.8 percent). Parenteral exposure occurred in 1.7 percent. The risk of exposure was highest when the procedures lasted more than three hours, when blood loss exceeded 300 ml, and when major vascular and intraabdominal gynecologic surgery was involved. Neither knowledge of diagnosed human immunodeficiency virus (HIV) infection nor awareness of a patient's high-risk status for such infection influenced the rate of exposure. Double gloving prevented perforations of the inner glove and cutaneous exposures of the hand. We conclude that all surgical personnel are at risk for intraoperative exposure to blood. Our data support the practice of double gloving and the increased use of water-proof garments and face shields to prevent mucocutaneous exposures to blood. No evidence was found to suggest that preoperative testing for HIV infection would reduce the frequency of accidental exposures to blood.

Accidents, Occupational↗
PubMed1990

Risky business: using necessarily imprecise casualty counts to estimate occupational risks for HIV-1 infection.

Although the genesis of healthcare worker anxiety regarding occupational risks of HIV-1 infection is clear, the reasons for continued insistence on a meticulous "casualty count" become less clear with time. One could, in fact, argue that the precise number of such infections has become virtually meaningless, because the routes of occupational/nosocomial transmission of HIV-1 and the magnitude of risk for infection following an adverse exposure in the healthcare setting have been well-characterized. Nevertheless, with the substantial limitations of these data clearly in mind, we have summarized the numbers of healthcare workers reported to have HIV-1 infection in each of the above categories in Table 2. The likelihood that an individual case represents true occupational infection decreases as one moves down the table. Having waded through the depths of this literature, we have reached the conclusion that, of the available data, the magnitude of risk for occupational HIV-1 infection remains the single most useful and instructive statistic available. Longitudinal cohort studies of HCWs involved in the day-to-day care of HIV-1-infected patients and in the handling and processing of specimens from such patients provide the best available evidence regarding the magnitude of risk for transmission of this virus in the healthcare setting. Fourteen prospective studies are currently in progress, with approximately 2,000 HCWs enrolled (Table 4). Six HCWs enrolled in these studies have developed serologic evidence of HIV-1 infection following percutaneous exposures, yielding an infection rate per participant of 0.32% and an infection rate per exposure of 0.31%.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1990

Characterization of mechanisms of resistance to beta-lactam antibiotics in methicillin-resistant strains of Staphylococcus saprophyticus.

The resistance mechanisms of methicillin-resistant strains of Staphylococcus saprophyticus were characterized. Penicillin-binding protein (PBP) studies demonstrated an inducible PBP identical to PBP 2a in the membranes of these isolates. The amount of beta-lactamase produced was minimal. PBP 2a is responsible for the methicillin resistance observed in these strains of S. saprophyticus.

Anti-Bacterial Agents↗
PubMed1990

HIV risks in the health care organization.

Health-care workers who sustain an accidental parenteral exposure to HIV are at risk of infection. Although only incomplete data are available to assess the risk, these data are reassuring. The most important lesson for health-care workers in the AIDS era is that nearly all risky exposures can and should be prevented. Greater emphasis on needlestick safety, control of infection in high-risk environments and improved devices and procedures can alleviate the vast majority of hazardous exposures.

Cross Infection↗
PubMed1990

Current epidemiologic evidence and case reports of occupationally acquired HIV and other bloodborne diseases.

Studies in which noninfected persons shared households with human immunodeficiency virus (HIV)-infected family members and friends, and had substantial though non-sexual contact with them revealed no transmissions of the HIV virus. These results suggest a similar low risk for healthcare workers, particularly those who have little or no contact with blood. However, occupational transmission of HIV, when it does occur, is most commonly caused by needlestick injuries. Nurses make up the largest group--nearly 80%--of hospital workers who contract HIV infection on the job. Generally, the risk ratio following an HIV needlestick is 1 in 250. Improper needle disposal, recapping and other ingrained behavior patterns are typical causes of needlestick accidents. Though the focus today is on HIV/acquired immunodeficiency syndrome (AIDS), it is important to realize that hepatitis B accounts for 200 to 300 deaths a year among healthcare workers. Awareness of the risk of needlestick injuries, and the considerable financial and emotional costs they can impose, should justify preliminary expenditures on needlestick prevention programs.

HIV Infections↗