Nurseweek/Healthweek | Epidemiology society splits with CDC on policy for HIV-positive employees

Epidemiology group splits with CDC on policy for HIV-infected employees

posted 6-4-97

The Society for Healthcare Epidemiology of America (SHEA) has recommended that healthcare workers infected with HIV follow guidelines that differ from those the national Centers for Disease Control and Prevention (CDC) issued in 1991.

The CDC requirement that HIV-infected practitioners report their infection status to prospective patients is "unwarranted," according to the new SHEA guidelines, which were published in a position paper in the May issue of Infection Control and Hospital Epidemiology.

"The magnitude of risk for provider-to-patient HIV transmission may never be known with precision," the position paper says. SHEA says that research conducted in the years since the highly publicized case of reported HIV-transmission by a Florida dentist to a patient has proved that such risks are minimal. "The additional experience gained over the past five years [since the Florida case] provides reassuring evidence that this risk is extremely small," says the organization.

SHEA looked at numerous studies of patients treated by HIV-infected practitioners. They found only one case of possible HIV transmission: A recent report from France of an HIV-infected orthopedist suggests transmission.

The case of the Florida dentist prompted passage of federal legislation requiring states to implement the 1991 CDC guidelines or their equivalent. Most states adopted their own versions of the CDC guidelines, and few states actually require notification of patients about an infected provider’s status, according to the position paper.

The SHEA paper reports that the CDC guidelines have led to legal action against HIV-infected healthcare workers, yet "virtually all of these suits are filed because of the possibility that patients may have been unnecessarily exposed to infection, not because they have been infected with bloodborne pathogens."

HIV-infected healthcare workers should not be restricted from any patient care activity, SHEA says, but workers should take the precaution of double-gloving.

The SHEA report also issued guidelines for healthcare workers infected with the hepatitis B or C virus and other bloodborne pathogens. Due to low transmission rates of hepatitis C, healthcare workers should double-glove while performing procedures, but need not be restricted in patient care, the report says. In the case of hepatitis B virus, SHEA advises more caution, given higher rates of transmission.

The position paper was written by the AIDS/TB committee of SHEA.