RESUMO
In response to the potential transmission of the human immunodeficiency virus in a hospital setting, an occupational exposure assessment program was established at a New York City university hospital in 1990. During the first year, 322 potential exposures to blood or body secretions in 313 health care workers (HCWs) were reported. Exposures occurred most frequently on the surgical service (36%), and in patients' rooms (37%). Nurses accounted for 53% and physicians 25% of reported exposures. A percutaneous injury was reported by 78% of HCWs. Human error was responsible for the exposure in 54% of HCWs and was associated with a break in universal precautions in one-third. The immune status for HIV antibody, hepatitis B antigen and hepatitis C antibody was positive in 11%, 3% and 9% in source patients, respectively. However, the immune status for these potential nosocomially transmitted pathogens was not determined in 12%-26% of source patients. Based on the source patients HIV antibody status and the extent of injury, zidovudine was recommended to 39 HCWs; 12 refused prophylaxis. HIV seroconversion was not documented in those HCW who returned for follow-up testing. A similar assessment program for medical students rotating on the surgical service revealed that two-thirds were exposed to blood or body fluids while in the operating room. Only 16% of sharps injuries were self-inflicted, whereas 66% were caused by another HCWs, usually a surgical attending or houseofficer. These data underscore the necessity for institutional programs regarding management of HCWs potentially exposed to HIV. Such programs not only provide an indispensable service to the exposed HCW and medical student, but also a means by which infection control policies and educational programs may be monitored and implemented.
RESUMO
In recent years, emerging microbial pathogens associated with infectious diarrhea have caused significant morbidity and mortality. Although sporadic cases of infectious diarrhea have occurred worldwide in the past, recent outbreaks in the United States traced to contaminated water or food have raised concerns about the safety of the water supply and the adequacy of surveillance of the food supply and foodborne diseases. In 1993, Cryptosporidium parvum, an important cause of unrelenting diarrhea and severe weight loss in AIDS patients, was associated with the largest outbreak of infectious diarrhea caused by contaminated municipal water that has ever been reported in the U.S. During the early summer of 1996, a major outbreak of Cyclospora cayetanensis that infected approximately 1,500 persons in 20 states, Washington, D.C. and two Canadian provinces was reported from North America. The suspected food vehicle in this outbreak was contaminated raspberries imported from Guatemala. In addition to these coccidian protozoa,Escherichia coli 0157:H7, first recognized in 1982 as a cause of hemorrhagic colitis, has recently been responsible for a multi-state outbreak in the U.S. due to contamination of commercial ground beef, and an outbreak in Japan that infected over 9,500 persons, two-thirds of whom were children. The contaminated food vehicle in the latter outbreak, although suspected to be radish sprouts, remains unknown. These recent massive outbreaks underscore the importance of a well-established public health infrastructure and an effective surveillance system for the early identification and reporting of infected patients that will lead to appropriate epidemiologic investigations and the rapid detection of contaminated vehicles.
