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undergoing chemotherapy or those with lymphoreticular malignancies, who are at risk, not for
contracting HIV, but for spread of opportunistic infections from the AIDS patient.
The most common form of parenteral exposure to infectious agents in the hospital setting
is needlestick injury. Disposable syringes have the lowest rate of injuries and those devices that
required disassembly have higher rates of injury. Needleless intravenous access can also be
instituted to decrease injuries to health care workers. One third of needlestick injuries are related
to recapping needles. Therefore, attention should be given to usage of needlestick prevention
devices consisting of equipment with shielded or retracting needles along with ongoing training
programs and implementation of procedures that help to avoid these penetrating injuries. Use of
needlestick prevention devices results in a marked reduction in needlestick injuries.[161,1071]
The risk to surgeons from accidental exposure to HIV in the operating room is low, with
a percutaneous injury rate of 1.7% per operative procedure in a hospital with a high HIV
prevalence population.[1072] There is no evidence to suggest a higher rate of HIV infections for
surgeons performing surgery in moderate to high AIDS incidence areas, and the risks for
hepatitis B and hepatitis C are greater.[1073] The potential risk to a patient undergoing an
invasive procedure by a physician infected with HIV is also extremely low, particularly with use
of universal precautions. By contrast, the risk of death from homicide in the United States is 1 in
10 000 per year and from vehicular accident 1 in 7000 per year, and more health care workers
have died from firearms injuries incurred at work than from AIDS.[1074]

OSHA REGULATIONS

The United States Occupational Safety and Health Administration (OSHA) have adopted
standards to be followed to protect workers against exposure to blood-borne pathogens,
particularly hepatitis B virus and HIV.[1075] These rules have as their basis the Centers for
Disease Control (CDC) guidelines for universal precautions for blood borne pathogens. These
rules require that the following standards be followed in the health care delivery setting:

1. Vaccines and post-exposure treatment be made available free of charge to all employees at
risk of exposure on the average of one or more times per month.

2. Routine tasks are to be evaluated for potential exposure, without consideration of protective
equipment, and personnel at risk are to be identified and documented. Standard operating
procedures are recommended.

3. A written control plan be implemented, including:

a. exposure determination
b. proper and appropriate use of safety equipment, work practice and
engineering controls
c. schedule and method of implementation for each provision
d. a summary of education and training procedures
e. review and update of infection control plan as needed to reflect any
changes in policy