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September 02, 1983 / 32(34);450-1
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                                                                                      Acquired Immunodeficiency Syndrome (AIDS): Precautions for Health-Care Workers and Allied Professionals                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
                                                                                      Acquired immunodeficiency syndrome (AIDS) was first recognized in 1981. The epidemiology of AIDS is consistent with the hypothesis that it is caused by a transmissible infectious agent (1-3). AIDS appears to be transmitted by intimate sexual contact or by percutaneous inoculation of blood or blood products. There has been no evidence of transmission by casual contact or airborne spread, nor have there been cases of AIDS in health-care or laboratory personnel that can be definitely ascribed to specific occupational exposures (4).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
                                                                                      CDC has published recommended precautions for clinical and laboratory personnel who work with AIDS patients (5). Precautions for these and allied professionals are designed to minimize the risk of mucosal or parenteral exposure to potentially infective materials. Such exposure can occur during direct patient care or while working with clinical or laboratory specimens and from inadvertent or unknowing exposure to equipment, such as needles, contaminated with laboratory personnel who work with AIDS patients (5). Precautions for these and allied professionals are designed to minimize the risk of mucosal or parenteral exposure to potentially infective materials. Such exposure can occur during direct patient care or while working with clinical or laboratory specimens and from inadvertent or unknowing exposure to equipment, such as needles, contaminated with potentially infective materials. Caution should be exercised in handling secretions or excretions, particularly blood and body fluids, from the following: (1) patients who meet the existing surveillance definition of AIDS (1); (2) patients with chronic, generalized lymphadenopathy, unexplained weight loss, and/or prolonged unexplained fever when the patient's history suggests an epidemiologic risk for AIDS (1,2); and (3) all hospitalized patients with possible AIDS.  
                                                                                      These principles for preventing AIDS transmission also need to be adopted by allied professionals not specifically addressed in the previous publications but whose work may bring them into contact with potentially infective material from patients with the illnesses described in the above three groups.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
                                                                                      The following precautions are recommended for those who provide dental care, perform postmortem examinations, and perform work as morticians when working with persons with histories of illnesses described in the above three groups: DENTAL-CARE PERSONNEL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
                                                                                       1. Personnel should wear gloves, masks, and protective eyewear when performing dental or oral surgical procedures.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
                                                                                       2. Instruments used in the mouths of patients should be sterilized after use (5-9).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
                                                                                      PERSONS PERFORMING NECROPSIES OR PROVIDING MORTICIANS' SERVICES                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
                                                                                       1. As part of immediate postmortem care, deceased persons should be identified as belonging to one of the above three groups, and that identification should remain with the body.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
                                                                                       2. The procedures followed before, during, and after the postmortem examination are similar to those for hepatitis B. All personnel involved in performing an autopsy should wear double gloves, masks, protective eyewear, gowns, waterproof aprons, and waterproof shoe coverings. Instruments and surfaces contaminated during the postmortem examination should be handled as potentially infective items (5-7).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
                                                                                       3. Morticians should evaluate specific procedures used in providing mortuary care and take appropriate precautions to prevent the parenteral or mucous-membrane exposure of personnel to body fluids. These and earlier recommendations outline good infection control                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
                                                                                      and laboratory practices and are similar to the recommendations for prevention of hepatitis B. As new information becomes available on the cause and transmission of AIDS, these precautions will be revised as necessary. Reported by AIDS Activity, Div of Host Factors, Div of Viral Diseases, Hospital Infections Program, Center for Infectious Diseases, Office of Biosafety, CDC                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
                                                                                      References                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
                                                                                       1. CDC. Update on acquired immune deficiency syndrome (AIDS)--United States. MMWR 1982;31:507-8, 513-4.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                       2. Jaffe HW, Choi K, Thomas PA, et al. National case-control study of Kaposi's sarcoma and Pneumocystis carinii pneumonia in homosexual men: Part 1, epidemiologic results. Ann Intern Med 1983;99:145-51.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
                                                                                       3. Francis DP, Curran JW, Essex M. Epidemic acquired immune deficiency syndrome: Epidemiologic evidence for a transmissible agent. (guest editorial) JNCI 1983;71:1-4.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
                                                                                       4. CDC. An evaluation of acquired immunodeficiency syndrome (AIDS) reported in health-care personnel--United States. MMWR 1983;32:358-60.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
                                                                                       5. CDC. Acquired immune deficiency syndrome (AIDS): precautions for clinical and laboratory staffs. MMWR 1982;31:577-80.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                       6. Simmons BP, with Hooton TM, Mallison GF. Guidelines for hospital environmental control. Infect Control 1981; 2:131-46.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
                                                                                       7. CDC guidelines on infection control. Guidelines for hospital environmental control (continued). Infect Control 1982;3:52-60.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
                                                                                       8. Garner JS, Simmons BP. CDC guideline for isolation precautions in hospitals. Infect Control 1983;4:245-325.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
                                                                                       9. Cooley RL, Lubow RM. AIDS: an occupational hazard? J Am Dent Assoc 1983;107:28-31.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
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