Health care workers infected with the human immunodeficiency virus. The next steps
B. Lo and R. Steinbrook
Program in Medical Ethics, University of California, San Francisco.
The tragedy of five patients who contracted human immunodeficiency virus
(HIV) infection from a seropositive dentist has alarmed the public. The
Centers for Disease Control (CDC) recently revised its recommendations for
preventing the transmission of HIV infection to patients during invasive
procedures. The CDC abandoned a previous plan to list exposure-prone
invasive procedures that HIV-infected health care workers should not
perform. The CDC said "expert review panels" should decide on a
case-by-case basis whether seropositive health care workers may perform
invasive procedures. As of February 1992, the revised recommendations were
under review by the US Department of Health and Human Services. Many issues
remain to be clarified, such as how these panels will operate and whether
decisions will be consistent in similar cases. Disregarding the CDC
guidelines or infection-control precautions may further erode public trust
and lead to draconian restrictions on HIV-infected health care workers.
Physicians and dentists should respond more effectively to public fears
about HIV transmission. The challenge is to protect patients while
respecting the privacy and livelihood of health care workers.
