Nosocomial HIV Infection: Epidemiology and Prevention – A Global Perspective

Because, globally, HIV is transmitted mainly by sexual practices and intravenous drug use and becauseof a long asymptomatic period, healthcare-associated HIV transmission receives little attentioneven though an estimated 5.4% of global HIV infections result from contaminated injections alone.It is an important personal issue for healthcare workers, especially those who work with unsafeequipment or have insufficient training. They may acquire HIV occupationally or find themselvesbefore courts, facing severe penalties for causing HIV infections. Prevention of blood-borne nosocomialinfections such as HIV differs from traditional infection control measures such as hand washingand isolation and requires a multidisciplinary approach.Since there has not been a review of healthcare-associated HIV contrasting circumstances in poorand rich regions of the world, the aim of this article is to review and compare the epidemiology ofHIV in healthcare facilities in such settings, followed by a consideration of general approaches toprevention, specific countermeasures, and a synthesis of approaches used in infection control, injuryprevention, and occupational safety.These actions concentrated on identifying research on specific modes of healthcare-associated HIV transmissionand on methods of prevention. Searches included studies in English and Russian cited in PubMedand citations in Google Scholar in any language. MeSH keywords such as nosocomial, hospital-acquired,iatrogenic, healthcare associated, occupationally acquired infection and HIV were used together with modeof transmission, such as “HIV and hemodialysisâ€?. References of relevant articles were also reviewed.The evidence indicates that while occasional incidents of healthcare-related HIV infection in high-incomecountries continue to be reported, the situation in many low-income countries is alarming, withtransmission ranging from frequent to endemic. Viral transmission in health facilities occurs by unexpectedand unusual as well as more frequent modes. HIV can be transmitted to patients and to donorsof blood products by specific vehicles and vectors during blood transfusion, plasma donation, andartificial insemination, by improperly sterilized sharps, by medical equipment during activities such asdialysis and organ transplantation, and by healthcare workers infected by occupational exposure tohazards such as blood-contaminated sharps. Personal, equipment, and environmental factors predisposeto acquisition of nosocomial HIV and all are pertinent for prevention. For infection and injurycontrol, poverty is often an underlying determinant. While sophisticated new tests offer improved HIVdetection, increasingly higher marginal costs limit their feasibility in many settings. Modest investmentin safer equipment and appropriate integrated training in infection control, injury prevention, and occupationalsafety should provide greater benefit.