Efficiency of Human Immunodeficiency Virus Transmission Through Injections and Other Medical Procedures: Evidence, Estimates, and Unfinished Business

To estimate the transmission efficiency of human immunodeficiency virus (HIV) through medical injections and other invasive procedures. We searched our own files and Medline (from 1966-2004, using the keywords ["iatrogenic" or "nosocomial" or "injections"] and "HIV...

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Bibliographic Details
Published in:	Infection control and hospital epidemiology Vol. 27; no. 9; pp. 944 - 952
Main Authors:	Gisselquist, David, Upham, Garance, Potterat, John J.
Format:	Journal Article
Language:	English
Published:	Thorofare, NJ The University of Chicago Press 01-09-2006 Slack
Subjects:	Adult Biological and medical sciences Blood Child Disease Outbreaks Disease transmission Equipment Contamination Global Health HIV HIV infections HIV Infections - epidemiology HIV Infections - transmission Human immunodeficiency virus Humans Infant Infectious Disease Transmission, Patient-to-Professional Injections Injections - adverse effects Medical equipment Medical procedures Medical sciences Medical syringes Miscellaneous Original Article Predisposing factors Public health. Hygiene Public health. Hygiene-occupational medicine Risk Factors Transmission efficiency Virus Infection Efficiency Transmission Retroviridae Human immunodeficiency virus Lentivirus Public health
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Summary:	To estimate the transmission efficiency of human immunodeficiency virus (HIV) through medical injections and other invasive procedures. We searched our own files and Medline (from 1966-2004, using the keywords ["iatrogenic" or "nosocomial" or "injections"] and "HIV") for reports of iatrogenic outbreaks worldwide, except outbreaks traced to receipt of contaminated blood or blood products. We also analyzed information from a case-control study of percutaneous exposures to healthcare workers. Worldwide healthcare settings. EVENTS: We identified 8 iatrogenic outbreaks that met our study criteria; published information from 4 outbreaks was sufficient to estimate transmission efficiency. From the 4 documented iatrogenic outbreaks, we estimated that 1 iatrogenic infection occurred after 8-52 procedures involving HIV-infected persons. Although only 0.3% of healthcare workers seroconvert after percutaneous exposure, a case-control study reported that deep injuries and other risk factors collectively increased seroconversion risk by as much as 50 times. Laboratory investigations demonstrate HIV survival through time and various rinsing regimens. We estimate that the transmission efficiency in medical settings with no or grossly insufficient efforts to clean equipment ranges from 0.5% to 3% for lower risk procedures (eg, intramuscular injections) and from 10% to 20% or more for high-risk procedures. Efforts to clean equipment, short of sterilization, may cut the transmission efficiency by 0%-100%. Procedures that contaminate multidose vials may accelerate transmission efficiency. To achieve better estimates of the transmission efficiency for a range of medical procedures and settings, investigations of iatrogenic outbreaks should be accorded high priority.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0899-823X 1559-6834
DOI:	10.1086/506408