Grande Gimenez Marino C, El-Far F, Barsanti Wey S, Servolo Medeiros E A
Hospital Epidemiology Committee, Federal University at São Paulo, SP 05016-000, Brazil.
Braz J Infect Dis. 2001 Oct;5(5):235-42. doi: 10.1590/s1413-86702001000500001.
The first report of occupational acquisition of HIV appeared in 1984, and, by June, 1997, the Centers for Disease Control and Prevention (CDC) had reported 52 documented cases of sero-conversion following occupational exposure to HIV-1 by health care workers of those cases. 47 (90.3%) were exposed to blood. The most frequent type of accident reported was percutaneous needlestick injury. Prospective studies have estimated that the risk of HIV transmission following percutaneous exposure to infected blood is 0.3% (Confidence Interval 95% = 0.2% to 0.5%). Following a mucous membrane exposure, the risk is 0.09% (CI 95% = 0.006% to 0.5%). The risk of hepatitis B acquisition ranges from 6% to 30%, and hepatitis C acquisition, 3% to 10%. Since 1992, the São Paulo Hospital s Hospital Infection Prevention and Control Service (SPCIH) has notified and treated all workers exposed to accidents involving biological materials. In the last six years, we have handled approximately 1,300 cases of reported accidents, of which 90% were percutaneous, most involving needlesticks. Such cases were frequently caused by the inadequate disposal and recapping of needles. In these accidents, 20% of the source patients were HIV positive, 10% were hepatitis C positive, and 7.6% were hepatitis B positive. This review summarizes the guidelines for a standardized response when dealing with accidents involving health care workers. Transmission of hepatitis B and HIV can be reduced if adequate preventive measures are taken in advance. If proper prophylaxis is not being done, it should be initiated immediately.
1984年首次报告了职业性感染艾滋病毒的病例。到1997年6月，美国疾病控制与预防中心（CDC）已报告了52例医护人员在职业暴露于HIV-1后血清转化的确诊病例。其中47例（90.3%）接触了血液。报告的最常见事故类型是经皮针刺伤。前瞻性研究估计，经皮接触受感染血液后感染艾滋病毒的风险为0.3%（95%置信区间=0.2%至0.5%）。黏膜暴露后的风险为0.09%（95%置信区间=0.006%至0.5%）。感染乙型肝炎的风险为6%至30%，感染丙型肝炎的风险为3%至10%。自1992年以来，圣保罗医院医院感染预防与控制服务部门（SPCIH）已对所有接触涉及生物材料事故的工作人员进行了通报和治疗。在过去六年中，我们处理了约1300例报告的事故，其中90%是经皮的，大多数涉及针刺伤。此类事故频繁是由于针头处理不当和重新盖帽所致。在这些事故中，20%的源患者艾滋病毒呈阳性，10%丙型肝炎呈阳性，7.6%乙型肝炎呈阳性。本综述总结了处理医护人员事故时标准化应对措施的指南。如果提前采取充分的预防措施，乙型肝炎和艾滋病毒的传播可以减少。如果未进行适当的预防，应立即开始。
