Arnow P M, Chou T, Shapiro R, Sussman E J
Department of Medicine, University of Chicago Hospitals, IL 60637.
Public Health Rep. 1993 May-Jun;108(3):273-8.
The spread of human immunodeficiency virus (HIV) from a Florida dentist with acquired immunodeficiency syndrome (AIDS) to several of his patients has generated considerable concern about the risk of HIV transmission during dental treatment. Accordingly, self-reporting of HIV infection and subsequent AIDS by a dentist at our medical center prompted notification and testing of patients at risk. Key features of the notification and testing process were (a) only patients who had undergone procedures deemed to pose appreciable risk of exposure to the dentist's blood were notified, (b) the identity of the dentist was shielded by not including in notification letters any identifying information other than the name of the medical center, and (c) patients' blood specimens were tested promptly for HIV antibodies and results were reported immediately to each patient to minimize the period of anxiety. HIV antibody testing was requested by 41 of the 88 patients to whom notification letters were sent, and all 41 were HIV negative after having undergone 395 procedures by the HIV-infected dentist. Review of the 88 patients' medical and dental records showed that at least 77 had received treatment by other health care providers at the medical center so that they would not be able to ascertain which provider had HIV infection. None of the patients who were notified by the medical center subsequently queried the dentist concerning possible HIV infection. Our experience demonstrates that look-back investigations can be conducted by institutions in a manner that substantially protects the identity of health care workers with HIV infection, minimizes the number of patients discomfitted, and avoids excessive utilization of personnel time. Even greater protection of the identity of health care workers with HIV infection presumably can be achieved when notification is undertaken by a public health agency.
一名患有获得性免疫缺陷综合征（艾滋病）的佛罗里达州牙医将人类免疫缺陷病毒（HIV）传播给了他的几名患者，这引发了人们对牙科治疗期间HIV传播风险的极大关注。因此，我们医疗中心一名牙医自行报告感染HIV及随后患上艾滋病，促使对有风险的患者进行通知和检测。通知和检测过程的关键特点是：（a）仅通知那些接受过被认为有明显接触牙医血液风险的治疗的患者；（b）在通知信中不包含除医疗中心名称以外的任何识别信息，以保护牙医的身份；（c）迅速对患者的血液样本进行HIV抗体检测，并立即将结果报告给每位患者，以尽量缩短焦虑期。在收到通知信的88名患者中，有41人要求进行HIV抗体检测，在接受了这位感染HIV的牙医的395次治疗后，所有41人HIV检测均为阴性。对这88名患者的医疗和牙科记录进行审查发现，至少有77人曾在该医疗中心接受过其他医护人员的治疗，因此他们无法确定是哪位医护人员感染了HIV。医疗中心通知的患者中，没有一人随后就可能感染HIV的问题询问过这位牙医。我们的经验表明，机构可以以一种能大幅保护感染HIV的医护人员身份、尽量减少感到不安的患者数量并避免过度占用人员时间的方式进行追溯调查。如果由公共卫生机构进行通知，大概能对感染HIV的医护人员的身份提供更大的保护。
