Updated CDC recommendations for the management of hepatitis B virus-infected health-care providers and students

This report updates the 1991 CDC recommendations for the management of hepatitis B virus (HBV)-infected health-care providers and students to reduce risk for transmitting HBV to patients during the conduct of exposure-prone invasive procedures (CDC. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR 1991;40[No. RR-8]). This update reflects changes in the epidemiology of HBV infection in the United States and advances in the medical management of chronic HBV infection and policy directives issued by health authorities since 1991. The primary goal of this report is to promote patient safety while providing risk management and practice guidance to HBV-infected health-care providers and students, particularly those performing exposure-prone procedures such as certain types of surgery. Because percutaneous injuries sustained by health-care personnel during certain surgical, obstetrical, and dental procedures provide a potential route of HBV transmission to patients as well as providers, this report emphasizes prevention of operator injuries and blood exposures during exposure-prone surgical, obstetrical, and dental procedures. These updated recommendations reaffirm the 1991 CDC recommendation that HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields. The previous recommendations have been updated to include the following changes: no prenotification of patients of a health-care provider's or student's HBV status; use of HBV DNA serum levels rather than hepatitis B e-antigen status to monitor infectivity; and, for those health-care professionals requiring oversight, specific suggestions for composition of expert review panels and threshold value of serum HBV DNA considered "safe" for practice (<1,000 IU/ml). These recommendations also explicitly address the issue of medical and dental students who are discovered to have chronic HBV infection. For most chronically HBV-infected providers and students who conform to current standards for infection control, HBV infection status alone does not require any curtailing of their practices or supervised learning experiences. These updated recommendations outline the criteria for safe clinical practice of HBV-infected providers and students that can be used by the appropriate occupational or student health authorities to develop their own institutional policies. These recommendations also can be used by an institutional expert panel that monitors providers who perform exposure-prone procedures.     

Evaluating the CDC program for HIV counseling and testing.

The Centers for Disease Control is conducting two investigations of the outcomes of HIV counselling and testing services offered persons at high risk for infection with the human immunodeficiency virus (HIV). One investigation is a trial conducted at sexually transmitted disease clinics where an enhanced version of HIV counseling and testing is compared with a standard version. The other investigation is a longitudinal study of the effects of HIV counseling and testing in drug treatment programs that use methadone therapy. In the evaluation, comparisons are being made of different ways of offering HIV counseling and testing and of the effectiveness of the program among persons who know their HIV serostatus and those who do not. The outcome variables include self-reported sexual and drug-using behaviors, together with corroborating laboratory tests, drug treatment compliance, mental health effects, and services utilization. Methodological, practical, and sociopolitical challenges were encountered in the evaluations. Possible solutions to the problems are described. The authors conclude that the designs of the evaluations were appropriate, but that considerable resources are required to carry them out. In settings with low levels of resources, thorough evaluation of the process and an assessment of the immediate outcomes may be the most appropriate evaluation strategy. As HIV counseling and testing are of fundamental importance to national and international HIV prevention efforts, their evaluation is a critical issue.     

北京市医疗卫生机构HIV抗体检测结果分析

目的调查北京市不同地区、不同级别医疗卫生机构HIV抗体筛查情况;了解HIV抗体筛查工作现状、资源分布特点;掌握目前不同地区、不同类型医疗卫生机构HIV抗体筛查人群分布及阳性率特点。方法分层抽样抽取不同地区、级别医疗卫生机构作为调查对象,收集HIV抗体筛查的人群、科室分布情况及阳性率情况。使用Excel电子表格进行数据录入,SPSS11．5软件进行数据分析。既往资料查阅历史记录。结果共抽取4个区,19家具有HIV初筛实验室资质的医疗卫生机构。其中城区9家,近郊区10家。2005年7月-2006年6月共进行HIV抗体筛查86277份,检出HIV／AIDS205例,总检出率0．24％。其中男性阳性率0．37％;女性阳性率0．12％。皮肤性病门诊1．13％;感染科0．76％;其他科室0．06％;妇科0．02％;外科0．005％;不详科室检出率为0．014％。城近郊区0．46％,高于城区0．14％,传染病专科医院1．24％、疾控中心1．45％高于综合医院0．01％。检出HIV／AIDS162例,总检出率0．26％。男性HIV抗体阳性率较女性高;30-40岁年龄组检测阳性率较其他年龄组高;近郊区检测阳性率高于城区;检出率最高的科室为皮肤性病科,阳性率为1．1％,高于既往同类人群检测阳性率。结论医疗机构就诊者HIV抗体阳性率总体上处于低水平;目前医疗卫生机构因职业暴露导致HIV感染的风险较小;通过介入性治疗导致HIV院内交叉感染的风险较小;高危人群人仍是当前HIV抗体筛查的重点人群。     

Transmission of human immunodeficiency virus (HIV) in health-care settings worldwide

Based on the information available, transmission of human immunodeficiency virus (HIV) can and does occur in health-care settings. No cases of such transmission have been reported from an infected health-care worker to a patient. Transmission of HIV from an infected patient to a health-care worker has been documented after parenteral or mucous-membrane exposure to blood. However, this risk is less than 1%, is limited to exposure to blood, and can be further minimized through adherence to routine infection control measures. Patient-to-patient transmission through invasive equipment or through HIV-infected blood, blood products, organs, tissues, or semen also occurs but can be prevented by proper sterilization of instruments and through donor-deferral, donor screening, and heat treatment of Factors VIII or IX to inactivate the HIV. In health-care settings, prevention of HIV transmission requires education of all health-care workers and ancillary staff, provision of necessary equipment, and strict adherence to general infection control practices.     

HIV Testing Among Men at Risk for Acquiring HIV Infection Before and After the 2006 CDC Recommendations

Objectives

Testing for human immunodeficiency virus (HIV) is the key first step in HIV treatment and prevention. In 2006, the Centers for Disease Control and Prevention (CDC) recommended annual HIV testing for people at high risk for HIV infection. We evaluated HIV testing among men with high-risk heterosexual (HRH) contact and sexually active men who have sex with men (MSM) before and after the CDC recommendations.

Methods

We used data from the National Survey of Family Growth, 2002 and 2006–2010, to assess proportions of HRH respondents and MSM reporting HIV testing in the prior 12 months, compare rates of testing before and after release of the 2006 CDC HIV testing guidelines, and examine demographic variables and receipt of health-care services as correlates of HIV testing.

Results

Among MSM, the proportion tested was 37.2% (95% confidence interval [CI] 28.2, 47.2) in 2002, 38.2% (95% CI 25.9, 52.2) in 2006–2008, and 41.7% (95% CI 29.2, 55.3) in 2008–2010; among HRH respondents, the proportion was 23.7% (95% CI 20.5, 27.3) in 2002, 24.5% (95% CI 20.9, 28.7) in 2006–2008, and 23.9% (95% CI 20.2, 28.1) in 2008–2010. HIV testing was more likely among MSM and HRH respondents who received testing or treatment for sexually transmitted disease in the prior 12 months, received a physical examination in the prior 12 months (MSM only), or were incarcerated in the prior 12 months.

Conclusions

The rate of annual HIV testing was low for men with sexual risk for HIV infection, and little improvement took place from 2002 to 2006–2010. Interventions aimed at men at risk, especially MSM, in both nonmedical and health-care settings, likely could increase HIV testing.New infections of human immunodeficiency virus (HIV) occur in the United States at a rate of approximately 50,000 per year, driven mostly by sexual transmission, particularly among men who have sex with men (MSM).¹ In 2010, male-to-male sexual contact accounted for 63% of new HIV infections (78% among males), and heterosexual contact accounted for 25% of new HIV infections (11% among males).^1,2 Although overall incidence has been relatively stable since 2006, among young MSM, particularly young black MSM, new infections continue to increase.^1,3An estimated 14% of adults and adolescents living with HIV infection in the United States are undiagnosed, of whom 11% are males with high-risk heterosexual (HRH) contact and 62% are MSM.⁴ To increase the proportion of HIV-infected people who are aware of their status and link them to treatment and prevention services, the Centers for Disease Control and Prevention (CDC) recommended in 2006 that all people aged 13–64 years be tested at least once for HIV infection and that people at high risk for HIV infection, including men with HRH contact and sexually active MSM,⁵ be tested annually.Using data from multiple waves of a nationally representative survey, we examined the percentage of HRH and MSM respondents who reported having been tested for HIV in the prior 12 months. We compared rates of testing before and after the revised HIV testing guidelines⁵ were released by CDC in 2006. Additionally, because the 2006 CDC guidelines recommended that HIV screening be conducted as part of routine clinical care in all health-care settings,⁵ we examined HIV testing among men stratified by their reported use of health-care services in the prior 12 months and by several sociodemographic variables.     

医疗保健机构手部卫生指南

本指南旨在促进医务人员手部卫生行为的实施,减少医疗保健机构中病原微生物在患者和医务人员间的传播.本指南不推荐用于食品加工或销售行业,也无意取代由FDA颁发的食品行业卫生准则.     

Emerging waterborne infections in health-care settings

Water is used in vast quantities in health-care premises. Many aquatic microorganisms can survive and flourish in water with minimal nutrients and can be transferred to vulnerable hospital patients in direct (e.g., inhalation, ingestion, surface absorption) and indirect ways (e.g., by instruments and utensils). Many outbreaks of infection or pseudoinfection occur through lack of prevention measures and ignorance of the source and transmission of opportunistic pathogens.     

腾冲县戒毒所戒毒人群HIV检测结果分析

[目的]了解腾冲县戒毒人群HIV感染、滴行现况，为在吸毒人群中开展艾滋病防治干预措施提供科学依据。[方法]对2004年～2006年在戒毒所内接受强制戒毒的戒吸人群进行艾滋病病毒抗体检测，并对结果进行统计和分析。[结果]共检测1618人，抗体阳性者114人，感染率7．05％。其中静脉注射吸毒人群371人，阳性74人，阳性率19．95％；口吸1247人，阳性40人，阳性率3．21％。[结论]腾冲县吸毒人群主要以口吸为主。在艾滋病中度流行区，防止HIV在吸毒人群中传播，切实加强对吸毒人群的宣传教育和行为干预是一项不容忽视的工作。     

2006--2009年杭州市萧山区艾滋病自愿咨询检测人群特征分析

目的：分析杭州市萧山区疾病预防控制中心（cDc）艾滋病（HIV）自愿咨询检测（VCT）人群特征,为制定艾滋病防治策略,预防HIV传播提供科学依据。方法：对2006年1月至2009年12月来萧山区CDC门诊寻求VCT服务的人群资料进行统计分析。结果：前来咨询者共3618人,接受检测人数3594人,以青壮年为主,男性多于女性,初中文化程度者所占比例较大;职业分布主要以商业服务人员为主;咨询检测原因主要为异性性接触。共发现HIV抗体阳性者40人,检出率1．1％。结论：杭州市萧山区CDC门诊VCT高危人群相对集中,主要为：青壮年、已婚、受教育水平中等、商业服务者。咨询的主要原因为异性性接触。