OCCUPATIONAL EXPOSURE TO HIV - FREQUENCY AND RATES OF UNDERREPORTING OF PERCUTANEOUS AND MUCOCUTANEOUS EXPOSURES BY MEDICAL HOUSESTAFF

PURPOSE: To study the frequency of work-related exposures to human immunodeficiency virus (HIV)-infected blood and reporting of exposures among medical housestaff. SETTINGS: Three teaching hospitals where HIV infection is prevalent among patients. SUBJECTS: Internal medicine interns and residents in training in 1988-1989. METHODS: In a cross-sectional survey, house officers were asked to complete anonymously a questionnaire reviewing their past percutaneous and mucocutaneous exposure to blood products. RESULTS: Nineteen percent of the respondents (16 of 86) recalled accidental exposure to HIV-infected blood, and 36% (31 of 86) recalled exposure to blood from patients at high risk for having HIV infection. Of the exposures recalled in the 12 months prior to the survey, 81% (47 of 58) of all needlestick injuries and all (nine of nine) needlestick injuries from HIV-infected blood occurred in postgraduate year 1 or 2 trainees. Only 30% (31 of 103) of the needlestick injuries recalled by subjects were reported. The principal reasons for not reporting were time constraints, perception that the percutaneous injury did not represent a significant exposure, lack of knowledge about the reporting mechanism, and concern about confidentiality and professional discrimination. CONCLUSIONS: Medical housestaff are at substantial risk for occupational infection with HIV. A large proportion of internal medicine housestaff recall accidental exposure to blood during medical school and residency, and the majority of exposures were not reported. Hospitals may be able to increase rates of reporting of percutaneous exposures to HIV by developing programs that are easy to access, efficient, and strictly confidential.