Bloodborne Pathogens In the Workplace

Abstract

Occupationally acquired infections from bloodborne pathogens have been recognized since 1949, when a laboratory worker was reported to have been infected with “serum hepatitis” in a blood bank. In the early 1970s, serological tests became available for the diagnosis of infection with hepatitis A and hepatitis B viruses. Seroprevalence studies were then able to document the distinct epidemiology of these two viruses and the extent of transmission to healthcare workers. For example, Skinhoj reported subsequent increases in occurences of laboratory-acquired hepatitis and found a sevenfold higher rate of hepatitis in laboratory workers when compared with the general population. With the development of diagnostic tests for other bloodborne agents (e.g., human immunodeficiency virus (HIV-1) and hepatitis C virus), studies continued to show that occupational infections with bloodborne pathogens were occurring. The potential occult infectivity of blood has been emphasized with the documentation of 54 occupationally transmitted infections with the human immunodeficiency virus (HIV-1) in the United States. Since the first occupational transmission was reported in 1984, healthcare and laboratory administrators, as well as those in the public sector, have reexamined the infection control aspects of their work practices and have begun to analyze and develop equipment and procedures to minimize exposures. Because infection with HIV and other bloodborne pathogens is not always clinically apparent, and the infectious potential of blood and other body fluids is not always known, the Centers for Disease Control (CDC) recommended “universal blood and body fluid precautions” in 1987. This approach emphasizes that blood and body fluid precautions should be consistently used for all patients and their clinical specimens and tissues. The “universal precautions” strategy has formed the foundation for federal guidelines through the CDC and regulations from the Occupational Safety and Health Administration (OSHA). Both organizations recognize that this practical approach to safety will not only minimize the risk of occupationally acquired HIV-1 infection but will also serve to protect against occupational infection with other bloodborne pathogens such as hepatitis B, hepatitis C, human T-cell leukemia viruses I and II, HIV-2, and, to a large extent, prions (agents causing Creutzfeldt–Jakob disease). The risks to healthcare and laboratory workers are dynamic because of the availability of vaccines, antiviral treatment, and recognition of new agents and interactions with old ones. It is the purpose of this chapter to provide an overview of the epidemiology, risk of transmission, and the recommended or regulated strategies to prevent occupational transmission of HIV and other bloodborne pathogens. Keywords: Human Immunodeficiency virus 1; Environmental survival; Epidemiology; Occupational HIV-1 transmission; Risk assessment; Hepatitis B; Hepatitis C; Retroviruses; Prevention; Precautions; Postexposure management