A look-back investigation of patients of an HIV-infected physician. Public health implications.

BACKGROUND: Transmission of the human immunodeficiency virus (HIV) to five patients receiving care from an HIV-infected dentist in Florida has recently been reported. Current data indicate that the risk of HIV transmission from health care workers to patients is low. Despite this low risk, programs to notify patients of past exposure to an HIV-infected health care worker are being conducted with increasing frequency. METHODS: We recently conducted an investigation of all the patients cared for by an HIV-infected family physician during a period when he had severe dermatitis caused by Mycobacterium marinum on his hands and forearms. After reviewing the patients' records, we notified 336 patients who had undergone one or more procedures (digital examination of a body cavity or vaginal delivery) placing them at potentially increased risk of HIV infection. The patients were offered tests for HIV infection and counseling. RESULTS: Of the 336 patients, 325 (97 percent) had negative tests for HIV antibody, 3 (1 percent) refused testing, 1 (less than 1 percent) died of a cause unrelated to HIV infection before notification, and the HIV-antibody status of 7 (2 percent) remained unknown. The direct and indirect public health costs of this investigation were approximately $130,000. CONCLUSIONS: The results of this investigation raise important questions about the risk of HIV transmission from health care workers to patients and the usefulness of HIV look-back programs, particularly in the light of recently published recommendations from the Centers for Disease Control. We propose that before a look-back investigation is undertaken, there should be a clearly identifiable risk of transmission of the infection, substantially higher than the risk requiring limitation of an HIV-infected health care worker's practice prospectively.

Interhospital transportation. Monitoring sterility of instrument packs.

The Minneapolis-St Paul area is currently experiencing an increase in health care mergers among hospitals. As new facilities are acquired, whether through merger or the building of satellite hospitals, economic considerations often instigate the consolidation of certain departments and services. Thus, hospitals are confronted with a new set of management problems. One such problem might be determining if the probability of contamination increases when a sterile pack is transported from the central sterile supply department of one hospital to the operating room of another hospital. This study indicates that interhospital transport of surgical packs, using a specially designed transfer system, can be accomplished without compromising the sterile status to a significantly greater degree than that associated with transport within a hospital. Many more samples would have to be assayed before these results could be considered conclusive. This study proposes a simple, reproducible, microbiologically sensitive and statistically satisfactory test to monitor the sterile integrity of surgical packs. In the past, different sterility monitoring methods proposed have required either special equipment, specially trained personnel, or complicated procedures. The assay method described here can be easily used by central sterile supply department personnel to monitor the sterile status of transported or stored surgical packs.