Occupational human immunodeficiency virus exposure among residents and medical students - An analysis of 5-year follow-up data

Background: Findings of a needlestick survey at our institution yielded an estimate that 1 case of occupationally acquired human immunodeficiency viru s (HIV) among the approximately 1100 residents and third- and fourth-year m edical students would potentially occur every 2 to 3 years, and also reveal ed types of exposures, circumstances, rates of reporting, and reasons for n ot reporting. Objective: The present study is a 5-year follow-up study to investigate cha nges in these parameters. Methods: A self-administered, anonymous 2-page questionnaire covering occup ational exposures and other risk factors was distributed to medical student s in classes, and to residents in grand rounds and required conferences. Th e response rate was 71%. Results: The incidence of needlestick accidents dropped dramatically over 5 years (1994-1995 vs 1989-1990), especially for surgical residents. Because the proportion of known sources positive for HIV increased over the same p eriod, estimates of occupational HIV risk remain essentially the same, with a projection that 1 student or resident would be expected to experience an occupationally acquired HIV infection approximately every 2 years. The non occupational risk for this population, in contrast, seems to be lower than in their age group as a whole. Conclusions: While the decrease in overall occupational exposures (especial ly for surgical residents) coupled with slight increases in rates of exposu re documentation and use of universal precautions constitute positive findi ngs, the increased proportion of exposure sources who are HIV positive lead s to an unchanged estimate of occupational HIV risk for residents and stude nts. Study findings therefore support the continued need for educational ef forts aimed at prevention, along with timely dissemination of advances in a pproaches to postexposure prophylaxis.