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Health workers in the US who perform ‘invasive’ procedures must be tested
for HIV infection, according to new legislation in Congress. Those who are
infected must either stop performing such procedures or inform their patients
beforehand.

A more Draconian measure is also pending in Congress. If this is passed,
any health worker who, knowingly infected, performs an invasive procedure
without telling the patient would risk 10 years in jail and a $10 000 fine.

The effect of the first bill is to enforce guidelines issued last week
by the government’s Centers for Disease Control in Atlanta, Georgia. State
boards that license health care workers would censure those who do not comply.
The CDC’s guidelines have the support of the leading medical and dental
associations and AIDS activists.

The flurry of restrictions comes amid continuing headlines about a dentist
in Florida who infected five of his patients with HIV. The government emphasises
that infected health workers could carry out most medical treatments without
any risk to patients. ‘However, for more invasive procedures, these guidelines
should be followed carefully,’ says Louis Sullivan, secretary of health
and human services.

Invasive procedures, says the CDC, are those that make patients prone
to exposure to the health worker’s blood. These are procedures where a worker
might be cut or injured and shed blood that would come into contact with
a patient’s body cavity, subcutaneous tissues or mucous membranes. An example
would be using a finger to manipulate a needle tip in a body cavity, or
the presence of a surgeon’s or dentist’s fingers along with a sharp instrument
in a ‘poorly visualised or highly confined anatomic site’.

The CDC has studied such procedures in four hospitals. Almost 7 per
cent of procedures in general surgical, cardiac, gynaecological, orthopaedic
and trauma services resulted in an injury that broke the skin.

However, examinations of almost 900 patients of three surgeons and a
dental student who were infected with HIV found only one patient, a known
intravenous drug user, to be infected. About 10 other investigations of
the patients of infected health workers are going on now in the US, according
to the American Medical Association.

The CDC suggests that hospitals and clinics set up professional advisory
boards to which infected workers would report their condition. The board
could allow the worker to continue invasive procedures, but patients would
have to be informed in each case. The CDC also urges stricter adherence
to universal guidelines – the use of gloves, hand-washing, protective barriers,
and handling of needles – to prevent the spread of HIV.

In January, the AMA urged doctors at risk of HIV infection to be tested.
The AMA said infected doctors should refrain from activities with ‘identifiable
risk of transmission’. But the Service Employees International Union, representing
health care workers, opposes the CDC guidelines and the Congressional bills.