Health care workers and HIV: surveillance of occupationally acquired infection in the United Kingdom.

In the period 1985-1992, 176 significant occupational exposures to HIV were reported to the PHLS Communicable Disease Surveillance Centre. The outcome at three months post exposure was reported for 134 (76%) incidents. Ninety-nine of these involved percutaneous exposure to HIV-infected blood or serum; two resulted in seroconversion, one following the use of zidovudine post exposure. Under-reporting of significant exposures may have been considerable. However, the observed transmission rate, of 2%, is not inconsistent with other estimates. Two other documented seroconversions after occupational exposure have been reported, making a total of four health care workers known to have acquired HIV infection after occupational exposure in the UK. Another six UK health care workers have possible occupationally acquired HIV infections. Five of these probably became infected while working in adverse conditions in Africa; the other while working with HIV-infected patients in the United States and Europe. A summary of current good practice of post exposure management is provided. Practitioners providing post exposure care are asked to contribute to the national surveillance scheme. Initial reporting of significant occupational exposures, and of serological outcome at a minimum of six months post exposure, should be regarded as integral to satisfactory post exposure management.