Table of Contents > Allergies > Healthcare workers exposed to HIV/AIDS Print

Healthcare workers exposed to HIV/AIDS

Image

Also listed as: WAS
Related terms
Background
Author information
Bibliography
Diagnosis
Risks of transmission
Management immediately after exposure
Post-exposure prophylaxis (pep)
Non-occupational post exposure prophylaxis (npep)
Policies for healthcare facilities
Universal precautions to prevent exposure

Related Terms
  • Antibodies, auto recessive, B-cells, bone marrow, bone marrow transplant, CBC, genetic disorder, immune system, immunodeficiency, inherited disorder, inherited immunodeficiency, leukocytes, leukemia, lymphoma, lymphocytes, malignancy, platelets, pneumonia, red blood cells, T-cells, thrombocytes, thrombocytopenia, tumor, WASP, white blood cells, Wiskott Aldrich syndrome, Wiskott-Aldrich syndrome protein, X-linked.

Background
  • Wiskott-Aldrich syndrome (WAS) is an inherited, immunodeficiency disorder that occurs almost exclusively in males. The recessive genetic disorder is caused by a mutation in the WAS (Wiskott-Aldrich syndrome) gene, which is an X-linked trait. The gene mutation leads to abnormalities in B- and T-lymphocytes (white blood cells), as well as blood platelet cells. In a healthy individual, the T-cells provide protection against viral and fungal infection, the B cells produce antibodies, and platelets are responsible for blood clotting to prevent blood loss after a blood vessel injury.
  • Individuals diagnosed with WAS suffer from recurrent infections, eczema and thrombocytopenia (low levels of platelets).
  • Before 1935, patients only lived an average of eight months. Today, patients usually live an average of eight years, according to a recent case study. The cause of death is usually attributed to extensive blood loss. However, cancer (especially leukemia) is common and often fatal among WAS patients.
  • The only possible cure for WAS is a bone marrow transplant. However, if a patient's family member is not a possible match for a bone marrow donation, patients may have to wait years for a potential donor. Other aggressive treatments may also increase a patient's life expectancy. For instance, one study found that patients who underwent splenectomy (removal of the spleen) lived to be more than 25 years old. The spleen may harbor too many platelets, and cause a decrease in the number of platelets in circulation. Antibiotics, antivirals, antifungals, chemotherapeutic agents, immunoglobulins and corticosteroids have also been used to relieve symptoms and treat infections and cancer associated with WAS.
  • Researchers estimate that about four people per one million live male births develop the disease in the United States.
  • The syndrome is named after Dr. Robert Anderson Aldrich, an American pediatrician who described the disease in a family of Dutch-Americans in 1954, and Dr Alfred Wiskott, a German pediatrician who discovered the syndrome in 1937. Wiskott described three brothers with a similar disease, whose sisters were unaffected.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Binder V, Albert MH, Kabus M, et al. The genotype of the original Wiskott phenotype. N Engl J Med. 2006 Oct 26;355(17):1790-3.
  2. Jin Y, Mazza C, Christie JR, et al. Mutations of the Wiskott-Aldrich Syndrome Protein (WASP): hotspots, effect on transcription, and translation and phenotype/genotype correlation. Blood. 2004 Dec 15;104(13):4010-9. Epub 2004 Jul 29.
  3. Natural Standard: The Authority on Integrative Medicine. .
  4. St. Jude Children's Research Hospital. Inherited Immunodeficiencies: Wiskott-Aldrich Syndrome (WAS). .
  5. U.S. Immune Deficiency Foundation. The Wiskott Aldrich Syndrome. .

Diagnosis
  • WAS is diagnosed when the mutated gene is identified. Some individuals may experience physical symptoms and a blood test may detect thrombocytopenia. Gene testing is also available for possible carriers of the disease and for fetuses.
  • Amniocentesis: Amniocentesis may be performed to detect genetic abnormalities in the fetus. This procedure is performed at about 15-18 weeks gestation. During the procedure a long, thin needle is inserted into the pregnant woman's abdominal wall to the uterus. A small amount of fluid is removed from the sac surrounding the fetus. The fluid is then analyzed for genetic abnormalities. There is a slight risk of infection or injury to the fetus, and a chance of miscarriage.
  • CBC: A complete blood count (CBC) test is usually conducted to determine how many and what types of cells are in the blood. Patients who have WAS will have a low platelet count and weak immune response. Healthy individuals have anywhere from 150,000 to 450,000 platelets per microliter of circulating blood in the body. The risk of bleeding increases as the number of platelets decreases. When there are less than 10,000 platelets per microliter of circulating blood, the condition is considered severe, and internal bleeding may occur.
  • Chorionic villus sampling: During chronionic villus sampling (CVS), a small piece of tissue (chorionic villi) is removed from the uterus during early pregnancy to screen the fetus for genetic defects. Depending on where the placenta is located, CVS can be performed through the cervix (transcervical) or through the abdomen (transabdominal). The risks of infections or fetal damage are slightly higher than the risks of amniocentesis. Fetal loss occurs about two percent of the time.
  • DNA test: The DNA from a sample of blood can be analyzed for a mutation in the WAS gene. This test can confirm a diagnosis and will also help the healthcare provider predict how severe the form of the disease will be. In addition, if the specific WAS gene mutation is identified in an affected child, that child's mother can be tested to confirm that she is a carrier.

Risks of transmission
  • Most cases of HIV transmission in occupational settings occur after exposure to HIV-infected blood by a percutaneous injury on the skin. This is most commonly caused by needles, medical instruments, or bites that break the skin. Researchers estimate that about 0.3-1% of healthcare workers who were exposed to the virus via a needle stick or puncture develop HIV.
  • The virus can also be transmitted if blood from an HIV patient's open sore or wound comes into contact with an open sore or wound on the healthcare provider.
  • There are a small number of instances when HIV has been acquired through contact with mucous membranes (like the eyes). For instance, if an HIV patient's blood splashes into a healthcare worker's eye, there is a chance of transmission. Research suggests that the risk of HIV infection after mucous membrane exposure is less than 1 out of 1,000.

Management immediately after exposure
  • Healthcare workers who are exposed or suspect they were exposed to HIV should follow the protocol of their healthcare facilities.
  • First Aid should be provided immediately after the injury. Wounds and areas of skin that were exposed to body fluids should be washed thoroughly with soap and water. Mucous membranes (like the eyes) that were exposed to the virus should be flushed with water.
  • The exposure should be evaluated for potential to transmit HIV infection, based on the severity of exposure (how much bodily fluid the person came into contact with) and specific bodily fluid that the individual was exposed to.
  • The exposed healthcare worker should be tested for HIV infection if he/she consents to testing. However, it generally takes about two to eight weeks for the body to produce antibodies to the virus, which is needed for an accurate test result. It may take some patients three months or longer to develop the antibodies. Therefore, a protocol called post exposure prophylaxis (PEP) should be provided within 72 hours of exposure if the individual was exposed to an HIV-infected patient or if it is strongly suspected that the patient is HIV-positive.
  • The patient who is suspected of having HIV should only be tested after obtaining informed consent. Testing should also include appropriate counseling and care referral. The test results must remain confidential.
  • Exposure risk reduction education should occur with counselors who are evaluating the events that preceded the exposure.
  • An exposure report should be made and sent to the U.S. Centers for Disease Control and Prevention (CDC).

Post-exposure prophylaxis (pep)
  • Post-exposure prophylaxis (PEP) is short-term antiretroviral treatment that is administered to reduce the likelihood of HIV infection after potential exposure. Healthcare facilities should provide treatment to personnel as part of a universal precautions program that is designed to reduce staff exposure to infectious hazards at work.
  • It is estimated that PEP can reduce the rate of infection among exposed healthcare workers by as much as 79%. According to the World Heath Organization (WHO), availability of PEP to healthcare workers will help increase staff motivation to work with HIV-infected patients, and may help to retain staff who are worried about the risk of HIV exposure at work.
  • PEP should begin as soon as possible after exposure. While there is no time limit in most country recommendations, treatment is most effective when it is initiated within two to four hours of exposure. Combination therapy, usually with two or three antiretrovirals, is recommended because it has shown to be more effective than a single agent.
  • The specific regimen and dosage depends on the patient's overall health, severity of exposure, availability of antiretrovirals, and known or possible cross-resistance to different drugs. In general, the recommended combination therapy is 250-300 milligrams of zidovudine (Retrovir®) twice daily with 150 milligrams of lamivudine (Epivir®) twice daily. If a third drug is needed, 800 milligrams of indinavir (Crixivan®) three times daily or 600 milligrams of efavirenz (Sustiva®) once daily (not recommended for pregnant women) is recommended.
  • Treatment should last a minimum of two weeks and no longer than four weeks. Healthcare workers should have access to one month's worth of antiretroviral therapy.
  • There are many side effects of antiretroviral treatment, including dizziness, confusion, fatigue, headache, difficulty sleeping, nausea, vomiting, and diarrhea. Studies have shown that about 22% of those receiving PEP stopped taking the medications before the four-week course is completed because of the side effects. Treatment is less effective if discontinued prematurely.
  • Long-term side effects may cause serious medical problems, including changes in metabolism like abnormal lipid and glucose metabolism, which may cause changes in the body shape due to loss and/or accumulation of body fat.

Non-occupational post exposure prophylaxis (npep)
  • In January 2005, the U.S. Department of Health and Human Services (DHHS) announced that non-occupational post exposure prophylaxis (nPEP) should be available to all individuals who are exposed to HIV, not just healthcare workers.
  • While the DHHS does not recommend for or against the use to nPEP, it encourages healthcare providers and patients to weigh the risks and benefits with individual patients who may have been exposed to HIV in the last 72 hours. When the risk of transmission is negligible or when patients seek care more than 72 hours after a substantial exposure, nPEP is not recommended because it is not usually effective. The sooner treatment is started, the more likely it will prevent HIV transmission.
  • However, healthcare providers might wish to consider prescribing nPEP for patients who seek care more than 72 hours after substantial exposure if the benefit of treatment outweighs the risks for side effects from treatment.
  • Treatment should last a minimum of two weeks and no longer than four weeks. Treatment is less effective if discontinued prematurely.

Policies for healthcare facilities
  • Institutional guidelines: Institutional guidelines for post-exposure prophylaxis (PEP) should be well established in all healthcare facilities. HIV testing, counseling, and antiretrovirals must be available. All healthcare facilities should train personnel on proper infection control procedures and on the importance of reporting occupational exposures to HIV. These facilities should also develop a system to monitor reporting and management of occupational exposures.
  • Safety devices: Effective safety devices that can help prevent injuries from needles and other sharp objects used in the hospital should be available. For instance, some needles have built-in safety controls that help reduce the risk of needlestick injuries before, during, or after use. Proper and consistent use of such safety devices should be evaluated.
  • Monitor the effects of PEP: More data are needed about the safety and efficacy of PEP regimens, especially those regimens that include new antiretrovirals. Improved communication about potential side effects before PEP is started and close follow-up of healthcare workers who are receiving treatment are needed to increase compliance with the PEP.

Universal precautions to prevent exposure
  • Universal precautions are precautions that are taken with all patients. Healthcare personnel should assume that the blood and body fluids from all patients are potentially infectious. Since everyone is treated the same, healthcare providers do not have to make assumptions about the risks of infection.
  • The U.S. Centers for Disease Control and Prevention (CDC) recommends that healthcare providers routinely use barriers (like gloves and/or goggles) when contact with blood or body fluids is possible.
  • If the skin comes into contact with blood or other body fluids, the area should be washed thoroughly with soap and water.
  • Mucous membranes (like the eyes) that were exposed to the virus should be flushed with water.
  • Cuts, sores, or breaks on the exposed skin of both the caregiver and patient should be covered with bandages.
  • Needles and other sharp instruments should be used only when medically necessary and handled appropriately.
  • Medical instruments and other contaminated equipment should be disinfected.
  • Safety devices that have been developed to help prevent needlestick injuries should be used whenever possible. For instance, some needles have built-in safety controls that reduce the risk of needle stick injury before, during or after use. If used properly, these types of devices may reduce the risk of exposure to HIV.
  • Many skin injuries in healthcare settings are related to the disposal of sharp medical equipment. Strategies for safer disposal, including safer design of disposal containers and placement of containers, are currently being developed.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

62 Marshall St
Rochester, NY 14607
585-454-2667
585-454-0343 (fax)
Email Our Store
Driving Directions

  STORE HOURS
 Mon8:00am-8:00pm
 Tue8:00am-8:00pm
 Wed8:00am-8:00pm
 Thu8:00am-8:00pm
 Fri8:00am-8:00pm
 Sat9:00am-7:00pm
 Sun10:00am-7:00pm
 

Co-op Connections

Follow us on Instagram!

Follow us on Twitter!

Join our Facebook community!

Email newsletter sign up

Email Newsletter Archive
Click here>>

Download The Rutabaga Rap

Rutabaga Rap Archive
Click here>>

About Our Co-op

Current Job Openings
See current openings>>

Top 10 Reasons for Shopping
Learn more>>

Why become an owner?
Learn why>>

Owner Application
Download (pdf)>>

All About Co-ops
Learn more>>

Our Board of Directors
Learn more>>

Global Ends Policy
Learn more>>

Bylaws
Learn more>>

Advertise in Our Newsletter
Learn more>>

Job Application
Download (pdf)>>

Discover your local co-op!