Usefulness of a rapid human immunodeficiency virus-1 antibody test for the management of occupational exposure to blood and body fluid.
OBJECTIVE
To describe the usefulness of the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, PA) in cases of occupational exposure regarding its use with source-patient sera, effects on post-exposure prophylaxis (PEP) use, potential cost savings, and effects on healthcare worker (HCW) stress reaction symptoms.


METHODS
Before-and-after analysis.


METHODS
A 269-bed, tertiary-care medical center with adjacent clinics.


METHODS
All source-patients and HCWs experiencing an occupational exposure during the study period.


METHODS
Use of the OraQuick test with patient sera was validated prior to its use for occupational exposures. Exposures from January 1 through July 10, 2003 (enzyme immunoassay [EIA] group) and July 11 through December 31, 2003 (OraQuick group) were retrospectively reviewed and the use and cost of PEP was compared for each group. Randomly selected HCWs from both groups completed a survey to assess their stress reaction symptoms.


RESULTS
After exclusion, there were 71 exposures in the EIA group and 79 in the OraQuick group. OraQuick results were 100% concordant with the reference standard of EIA and Western blot using patient sera. The mean number of doses ingested per course of PEP was significantly higher for HCWs in the EIA group (3.8; range, 0 to 6) compared with the OraQuick group (1.2; range, 0 to 3; P = .016). Cost analysis revealed a mean savings of dollar 6.62 with the OraQuick test per occupational exposure. Although the survey failed to detect an overall reduction in HCW stress reaction symptoms using OraQuick for source-patient testing, 11 HCWs in the EIA group had repetitive thoughts of the exposure compared with 5 in the OraQuick group (P = .049).


CONCLUSIONS
Because of the reduction in ingested doses of unnecessary PEP and reduced cost of occupational exposure management with their use, rapid HIV-antibody tests should be the preferred method for source-patient testing following an occupational exposure.
Landrum
Michael L
ML
Department of Infectious Diseases, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas 78236, USA. michael.landrum@lackland.af.mil
Wilson
Clarissa H
CH
Perri
Luci P
LP
Hannibal
Sandra L
SL
O'Connell
Robert J
RJ
D015492:AIDS Serodiagnosis / Q000379:methods*; D015153:Blotting, Western; D001826:Body Fluids; D016009:Chi-Square Distribution; D003365:Costs and Cost Analysis; D005260:Female; D015483:HIV Antibodies / Q000032:analysis*; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control; D015497:HIV-1; D006282:Health Personnel; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D008297:Male; D016273:Occupational Exposure; D012463:Saliva / Q000821:virology*; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
D015483:HIV Antibodies