Risk of Exposure to HIV-lnfected Body Fluids Among Medical Housestaff By Mario C. Raviglione, M.D., Rugger o Batían, M.D., Gregg Garner, D.O., Hiram Cortes, M.D., Jeffrey Sugar, M.D., and Angelo Taranta, M.D. Abstract To assess the risk of percutaneous and mucosal exposure to HIV-con- taminated fluids among medical housestaff and the role of zidovudine (ZDV) postexposure use, 69 residents and fellows were surveyed with a self-admin- istered questionnaire. Twenty-four exposures to HIV-infected fluids (22 needlesticks, 1 mucosal splash, and 1 other injury) were reported in 94 person-years (py) with a rate of 0.25/py. Accidents were common during the first training year (22 of 24; rate 1.26/py). Most occurred while directly caring for patients (23 of 24); blood was involved in 19 cases and CSF in 5. Eighteen reported being tired at the time of accident. Mean on-duty time was 15.1 hours. Accidents occurred during: venipuncture, 6 of 24; needle recapping, 5; blood transfer to test tube, 5; arterial puncture during CPR, 2; other actions, 6. Available baseline (12 of 24) and follow-up (7 of 24) HIV antibody This study was presented in part at the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy, Atlanta, GA, Octo- ber 21-24,1990. 52 testing were all negative. Six residents elected to take ZDV within 24 hours of exposure; 5 received 600-1200 mg/d for 4- 6 weeks, and 1 for 3 days. Gastrointestinal side effects were noted during prolonged ZDV therapy, and diarrhea was frequent- ly seen (3 of 5). Bone marrow suppression did not occur. The rate of exposure to HIV-infected body fluids is high, especially during the first year of training. Serial HIV testing may help define the role of ZDV use in preventing seroconversion after occupa- tional exposure, as a double-blind, place- bo-controlled trial appears to be currently precluded. Introduction The impact of the AIDS epidemic on the health care system has led to serious concern about the risk of HIV transmis- sion to health care workers (HCW). Par- enteral exposure has been associated with HIV transmission,12 and the risk of infec- tion is thought to be 0.3-0.4 per hundred exposure.13 Although low, this risk is not negligible, and strategies to prevent occu- pational exposure as well as to prevent establishment of infection after exposure by means of ZDV prophylaxis have been proposed.4 6 For instance, at the National Institutes of Health Clinical Center ZDV is used at the dose of 200 mg every 4 hours for 6 weeks, whereas at San Fran- cisco General Hospital the recommended dose is 200 mg 5 times daily for 4 weeks.1 In 1989, our hospital had an average daily census of 76 patients with HIV infec- tion. Since this is a high number, we have surveyed our medical residents and fel- lows to evaluate rate of exposure to HIV- infected blood or body fluids, and extent of use and safety of ZDV prophylaxis. Methods Setting The study was conducted in April 1990 at Cabrini Medical Center, a community teaching hospital in Manhattan and a referral center for the treatment of patients with HIV-related conditions. The hospital has 497 beds of which about 250 are occupied by Internal Medicine patients. Approximately one third of these patients were infected with HIV at the time of the survey. Subjects Eighty-two medical residents and fel- lows enrolled into our program of Inter- nal Medicine and related subspecialties during the academic year 1988-1989 were invited to participate in the study. Resi- dents and fellows are instructed to follow universal precaution guidelines when handling blood or body fluids from any patient.5 The duration of risk of exposure for each trainee was calculated on the basis of the standard training program in Internal Medicine. This excluded vacation months or rotations which did not involve direct patient care. Questionnaire For purposes of surveillance, a self- administered questionnaire was distribut- ed by the Chief Residents (R.B., G.G., J.S.)