Risk of infection in health care small Statistics disclose almost no incidents AIDS AND THE DEATH OF A DOCTOR

December 02, 1990|By Holly Selby

An article in Sunday's editions of The Sun stated incorrectly that 5.3 percent of U.S. health-care workers have acquired immune deficiency syndrome, according to Dr. Timothy Townsend, senior director for medical affairs at Hopkins. In fact, Dr. Townsend said that 5.3 percent of Americans with AIDS are health-care workers.

+ The Sun regrets the errors.

The chances of doctors getting AIDS from patients, and vice versa, are remote, federal statistics indicate.

According to Dr. Timothy Townsend, senior director for medical affairs at Hopkins, 5.3 percent of U.S. health-care workers -- including aides, nurses and doctors -- have acquired immune deficiency syndrome. The federal Centers for Disease Control reports that 37 are believed to have contracted it at work.

Most of the health-care workers who have AIDS developed it through sexual contact and intravenous drug use. Only one case in which a patient is believed to have contracted the disease from a health-care provider has been reported.


In that case, the care-giver, David J. Acer, was a Stuart, Fla., dentist, who died of AIDS on Sept 3. Nine months earlier, one of his patients, 22-year-old Kimberly Bergalis, was told she had AIDS after being hospitalized for a form of pneumonia.

In a letter published in the local newspaper after his death, Mr. Acer addressed his former patients, saying he had followed CDC guidelines for health-care workers -- and had worn gloves and a mask while treating patients. And he wrote that he didn't believe the CDC report that he might have transmitted AIDS.

However, he urged his approximately 1,000 patients to be tested for HIV for their "peace of mind."

Guidelines set by the CDC recommend that the question of whether workers infected with HIV can safely continue to do their jobs must be decided on an individual basis and that the #F decision should be made by the worker's personal physician in conjunction with the employee's advisers.

Studies that have tried to establish the risk of doctor-to-patient infection have so far shown no transmission, according to Dr. Townsend, an epidemiologist and senior director for medical affairs at Johns Hopkins Institutions.

One recent study from Nashville, Tenn., reported in the Journal of the American Medical Association in July, arose from a situation similar to the one at Hopkins in which a surgeon recently died of AIDS.

In that case, a surgeon died of respiratory failure due to AIDS in January 1989. A review of his medical history suggested an infection date as early as Jan. 1, 1982.

The Tennessee Department of Health and the Environment wroteto all patients on whom he had operated after that date, offering free counseling and testing. Of the 616 who were tested, only one was positive for HIV, and he was an intravenous drug abuser whose medical history suggested a date of exposure before his contact with the surgeon.

However, the case of Kimberly Bergalis has caused some alarm. Tests of the virus in her blood and that of the practitioner show a similar genetic pattern, which is strong, though not entirely conclusive, evidence that the disease was indeed passed from him to her.

Ms. Bergalis has hired a lawyer, who intends to sue the dentist's estate and the insurance company for whom he was a preferred provider.

'Universal precautions'

The following are "universal precautions" recommended by the federal Centers for Disease Control to be used by hospital workers and health care staffs to prevent transmission of HIV from patient to staff.

These precautions are required at the Johns Hopkins MedicaInstitutions, as well as other medical centers, and apply to all health care staff, says Dr. Timothy Townsend, senior director for medical affairs at Johns Hopkins.

"The concept behind universal precautions is that as a health care worker you don't know who has a blood-borne infection and who hasn't," he says.

"No. 1 on that list is AIDS, but there are other diseases like hepatitis B that can also be transmitted."

* Gloves should be worn whenever a health care worker is going to be in contact with blood or bloody body fluids or infectious body fluids. This includes starting an IV, a vascular catheter, drawing blood or any other basic procedure, Dr. Townsend says.

* Face masks should be worn in any procedure in which blood might spatter.

* Waterproof gowns should be worn in any surgery entailing massive amounts of blood such as heart surgery.

* Protective eyewear should be worn in any major surgery.

* To prevent needle-stick injuries, needles should not be recapped, bent, broken or removed from disposable syringes.

* Sharp instruments should be disposed of in puncture-resistant containers.

* Soiled linen should be handled as little as possible and bagged at the site of contamination. Linens soiled with blood should be transported in plastic bags.

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