In this study on occupational risks of HIV infection among 99 Dutch medics working in AIDS endemic areas, 61% reported percutaneous exposures during an average stay of 21 months. The mean number of injuries was lower among physicians (2.0 versus 3.9 per year) and higher among nurses (1.9 versus 1.2) than in previous research conducted in 1987-1990 among Dutch medics returning from Africa. But the reduction of exposures among physicians might be explained by the fact that the number of procedures they carried out was less in the later study. Also among nurses a shift of tasks was seen. On the basis of an estimated HIV prevalence in the patient population of 19%, a chance of transmission per accident of 0.3%, and 1.9 percutaneous exposures per year, the mean occupational risk of HIV infection per year can be estimated at 0.11% per person. Besides length of stay and number of activities, characteristics of the work setting were associated with the frequency of different kinds of injuries. From the analysis of 109 extensive descriptions of recent accidents, it appeared that the majority of the injuries occurred during routine activities and were self-inflicted. Injuries with hollow needles usually occurred after the actual medical act (e.g. during recapping). Carelessness (e.g. due to fatigue) or being in a hurry (e.g. because of an emergency) were also often the cause of percutaneous injuries, as were the poor quality of the equipment, lack of professional skills, or a combination of these factors. Prevention activities are still important to reduce the frequency of occupational exposures. But they will not eliminate them totally; from the descriptions of recent exposures it was clear that some of the injuries occurred in spite of precautions.
PIP: By the end of 1995, a total of 79 occupationally acquired HIV cases had been documented worldwide among health care workers. As part of a larger study on the sexual and occupational risks of HIV among Dutch expatriates, 99 medical professionals (48 physicians and 51 nurses, midwives, or anesthesia assistants) who had worked in AIDS-endemic areas were identified. 96% of physicians and 92% of nurses had last worked in sub-Saharan Africa--typically in rural areas or refugee camps. When tested upon return to the Netherlands, none of these health care professionals was HIV-infected. However, 71% of physicians and 51% of nurses experienced at least one percutaneous exposure (mean number, 2.0 and 1.9, respectively) during an average stay abroad of 2.3 and 1.2 years, respectively. 235 of the 337 accidents described involved solid needles. Given an estimated HIV prevalence in the patient population of 19%, an HIV transmission per accident of 0.3%, and 1.9 percutaneous exposures per year, the occupational HIV risk per health worker per year in countries with high HIV prevalence can be estimated as 0.11%. Most injuries occurred during routine acts and tended to be self-inflicted as a result of negligent needle disposal, recapping errors, cleaning materials for reuse, carelessness due to fatigue, or rushing. Accidents with solid needles were significantly more likely to occur if more procedures were performed, the stay abroad was longer, co-workers were local, and management consisted of local personnel. Worry about occupational exposure to HIV was reported to occur sometimes in 68% of physicians and nurses, regularly in 12%, and often in 6%. HIV prevention programs for health workers should address not only how to prevent occupational exposure, but also how to prepare for the emotional responses to exposure and the consequences this may have for sexual behavior.