Management of occupational exposures to bloodborne pathogens: hepatitis B virus, hepatitis C virus, and human immunodeficiency virus.

Being a health care worker in today's world is not without risks. Accidental exposure to blood carries with it a definite risk of transmission of infection by various bloodborne pathogens, especially the hepatitis B, hepatitis C, and human immunodeficiency viruses. While infectious disease specialists, hospital epidemiologists, and infection control clinicians can develop many important strategies to reduce this risk--aggressive training, utilization of safer needles, identification of high-risk activities, and efficient disposal systems--their overriding responsibility is to design and implement a comprehensive plan for expeditiously and effectively dealing with accidental exposures when they occur. Among other things, the plan must address a number of key issues, including testing, administering postexposure prophylaxis, providing short- and long-term follow-up care, and, particularly, counseling for helping the health care worker deal with the tremendous anxiety associated with the injury. Drs. Julie L. Gerberding of the University of California, San Francisco, and San Francisco General Hospital and David K. Henderson of the National Institutes of Health and the Warren G. Magnuson Clinical Center have both made significant contributions in this area; in this month's AIDS Commentary they discuss the essential elements of such a plan.