OCCUPATIONAL BLOOD CONTACT AMONG PREHOSPITAL PROVIDERS

Study objective: To assess the nature and frequency of blood contact ( BC) among emergency medical service (EMS) workers. Design: During an 8 -month period, we interviewed EMS workers returning from emergency tra nsport calls on a sample of shifts. We simultaneously conducted an HIV seroprevalence survey among EMS-transported patients at receiving hos pitals served by these workers. Setting: Three US cities with high AID S incidence. Participants: EMS workers. Results: During 165 shifts, 2, 472 patients were attended. Sixty-two BCs (1 needlestick and 61 skin c ontacts) were reported. Individual EMS workers had a mean of 1.25 BCs, including .02 percutaneous exposures, per 100 patients attended. The estimated annual frequency of BC for an EMS worker at the study sites was 12.3, including .2 percutaneous exposures. For 93.5% of the BCs, t he HIV serostatus of the source patients was unknown to the EMS worker . HIV seroprevalences among EMS-transported patients at the three rece iving hospital emergency departments were 8.3, 7.7, and 4.1 per 100 pa tients; the highest rates were among male patients 15 to 44 years old who presented with pneumonia. Conclusion: EMS personnel regularly expe rience BCs, most of which are skin contacts. Because the HIV serostatu s of the patient is usually unknown, EMS workers should practice unive rsal precautions. Postexposure management should include a mechanism f or voluntary HIV counseling and testing of the patient after transport and transmittal of the results to the EMS.