THE RISKS OF OCCUPATIONAL EXPOSURE AND INFECTION BY HUMAN-IMMUNODEFICIENCY-VIRUS, HEPATITIS-B VIRUS, AND HEPATITIS-C VIRUS IN THE DIALYSIS SETTING

Background: The dialysis setting has been recognized as a high-risk en vironment for transmission to both patients and health care personnel of blood-borne infections, such as hepatitis B virus, hepatitis C viru s, and HIV. Methods: A seroprevalence survey of HIV, hepatitis B virus , and hepatitis C virus infection among 1002 patients and a subsequent 1-year surveillance study of percutaneous injuries and skin and mucou s membrane contaminations were carried out among 527 health care worke rs in nine Italian dialysis units. The risks of occupational acquisiti on of HIV, hepatitis B virus, and hepatitis C virus infections among h ealth care workers were calculated according to a deterministic model. Results: HIV antibody, hepatitis B surface antigen, and hepatitis C a ntibody prevalences among patients were 0.1%, 5.1%, and 39.4%, respect ively. A total of 67 percutaneous injuries, 29 mucous membrane contami nations, and 271 skin contaminations were reported by health care work ers. The risk of acquiring infection was calculated to be 4000 and 800 0 times lower for HIV than for hepatitis B and C, respectively. Conclu sions: The risks of infection with HIV, hepatitis B, and hepatitis C f or health care workers at dialysis units differ greatly and depend on the demographic profile and medical history of patients undergoing dia lysis. To minimize the risk of exposure to HIV and other blood-borne p athogens, efforts must continue to increase compliance with universal precautions. Needle designs incorporating safety features and improvem ents in dialysis equipment design are also needed to avoid potential e xposure.