Spare post-exposure prophylaxis with round-the-clock HIV testing of the source patient.

After occupational exposures, immediate HIV testing of source patients may avoid the unnecessary use of post-exposure prophylaxis (PEP). Two time periods were compared. Before the availability of 24 h a day immediate testing, PEP was initiated after 12.6% of exposures, compared with 3.7% during the second period. The adjusted relative odds ratio of PEP during the second compared with the first period, was 0.23. The availability of immediate HIV testing limits unnecessary occupational PEP.

The occurrence of percutaneous injuries to health care workers: a cross sectional survey in seven Swiss hospitals.

OBJECTIVES: In 1995, a cross sectional survey was conducted in 7 Swiss hospitals to estimate the incidence of percutaneous injuries among nurses, surgeons, anesthetists and domestic personnel, and to describe the circumstances of these injuries and the reporting process within the hospital. METHODS: An anonymous questionnaire was distributed and filled out on-site in the case of nursing staff and domestic personnel, and was sent by post to physicians (anesthetists and surgeons). Participants were asked to report in detail on percutaneous injuries of the last workday and the last working month (nurses and physicians), and of the last month and the last year for domestic personnel. The overall response rate was 72%, representing a total of 3116 health care workers. RESULTS: The annual incidence rates of percutaneous injury with material contaminated with blood or other biological fluids were calculated by type of worker for the two available units of time. For nurses, the incidence was 0.49 and 2.23, for surgeons 4.28 and 11.05, for anesthetists 2.11 and 3.14, and for domestic personnel 0.11 and 0.17 respectively. Most of the injuries occurred in a "normal" situation (no emergency, no stress, no fatigue) and were described as avoidable. Compliance with universal precautions was not optimal and declaration rates within the hospital rather low (nurses 39.7%, physicians 3.4%, domestic personnel 87.9%). CONCLUSION: Percutaneous injuries with blood-contaminated material are frequent in health care workers, and are not always adequately assessed because of under-reporting of accidents within the hospital. This may result in underestimation of current occupational exposure of health care workers to HIV and other blood-borne viruses.

[HIV infection: feasibility of a seroprevalence study with consent of hospitalized patients]. / Infection VIH: faisabilité d'une étude de séroprévalence avec consentement chez des patients hospitalisés.

A pilot study was carried out in order to evaluate the feasibility of determining the seroprevalence rate of HIV infection and the prevalence of risk factors among selected hospital patients at the Centre Hospitalier Universitaire Vaudois (CHUV). Consent was obtained and only blood already obtained for other purposes was used for testing. Among 850 patients between 16 and 65 years of age and residing in Switzerland who were originally selected at random, only 200 patients were accessible for an interview and for whom blood was available in order to be included in the study. Of these, 165 (83%) accepted their blood to be tested. A seropositive result was identified in 2 patients already aware of their serostatus. The age distribution, diagnosis and behavioral risk factors (when available through the interview) were not different among those accepting the test and the ones refusing. However, foreigners were more likely to refuse the blood test than Swiss nationals, even though none of them came from a country with a high rate of endemicity for HIV infection. Reasons for refusal included the following: lack of risk factors 10 (29%), doubts about confidentiality 6 (17%), blood test already performed 5 (14%), language barrier 4 (11%) and others 10 (29%). We conclude that even though the data in our sample did not suggest that patients refusing the test were at an increased risk of being seropositive, it is unlikely that with such a refusal rate, a reliable measure of seroprevalence could be determined in the population of study with the methods used, especially when one is expecting a relatively low seroprevalence rate.

[364 anonymous screening tests for AIDS at the Vaudois University Hospital Center: who? why?]. / 364 tests anonymes de dépistage du SIDA au Centre Hospitalier Universitaire Vaudois: qui, pourquoi?

From 1 July to 31 December 1988 risk factors for HIV infection were systematically recorded for all individuals tested anonymously at our institution and compared with similar data observed when anonymous testing was introduced (1985-1986). The absolute number of homosexuals and intravenous drug abusers remained stable but their ratio decreased because most tests are now performed in persons with multiple heterosexual partners. More than half of heterosexuals said they used condoms. Tests were positive only in homosexuals and intravenous drug abusers. These data suggest that the ongoing Swiss nationwide educational programmes have been successful in reaching people potentially exposed to HIV. Such campaigns may still prevent the dissemination of HIV infection to the heterosexual population.