title: Health care worker exposure to HIV-1 and HTLV I-II in critically ill, resuscitated emergency department patients.
abstract: OBJECTIVE
  Exposure to HIV-1 is of profound concern to health care workers. HTLV-I and HTLV-II, retroviruses with similar modes of transmission as HIV-1, also cause disease in human beings. Emergency department resuscitations are high-risk situations for such exposure. The purpose was to determine the seroprevalence of HIV-1 and HTLV I-II in patients undergoing ED resuscitations, the magnitude of health care worker exposure, and risk factors associated with infection.
  
  
  METHODS
  Prospective identity-unlinked seroepidemiologic study.
  
  
  METHODS
  ED of a 950-bed private inner-city teaching hospital. Participants included 370 patients undergoing ED resuscitations.
  
  
  METHODS
  Serum was tested for antibodies to HIV-1 and HTLV I-II. Questionnaires were completed by the physician in charge of the ED resuscitations.
  
  
  RESULTS
  Fifteen (4.1%) (95% confidence interval [CI], 2.1% to 6.1%) patients were HIV-1 seropositive, and seven (1.9%) (95% CI, 0.7% to 3.1%) were HTLV I-II positive. Eleven (5.6%) (95% CI, 2.4% to 8.8%) of 197 trauma patients and 11 (6.4%) (95% CI, 2.8% to 10.0%) of 173 medical patients were infected with one of these viruses. Health care workers had direct cutaneous contact with patient blood during 114 (31%) ED resuscitations and with infected patient blood during 11 (3%) ED resuscitations. An additional 11 ED resuscitations involved parenteral exposures, one to HIV-1-infected blood. No factors could be identified that would quickly and reliably predict infection.
  
  
  CONCLUSIONS
  Health care workers must protect themselves in such high-risk situations by strict compliance to mandatory universal precautions.
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan.
authors.forename: C
authors.initials: C
authors.lastname: Lewandowski
authors.forename: A
authors.initials: A
authors.lastname: Ognjan
authors.forename: E
authors.initials: E
authors.lastname: Rivers
authors.forename: H
authors.initials: H
authors.lastname: Huitsing
authors.forename: D
authors.initials: D
authors.lastname: Pohlod
authors.forename: H
authors.initials: H
authors.lastname: Lee
authors.forename: L D
authors.initials: LD
authors.lastname: Saravolatz
mesh_terms: D000293:Adolescent; D000328:Adult; D017977:Deltaretrovirus / Q000276:immunology*; D004636:Emergency Service, Hospital; D005260:Female; D006679:HIV Seropositivity; D015497:HIV-1 / Q000276:immunology*; D015481:HTLV-I Antibodies / Q000302:isolation & purification; D015482:HTLV-II Antibodies / Q000302:isolation & purification; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D011446:Prospective Studies; D012151:Resuscitation; D016036:Seroepidemiologic Studies; D016635:Universal Precautions
chemical_list: D015481:HTLV-I Antibodies; D015482:HTLV-II Antibodies