Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis

In this report, "health-care worker" (HCW) is defined as any person (e.g., an employee, student, contractor, attending clinician, public-safety worker, or volunteer) whose activities involve contact with patients or with blood or other body fluids from patients in a health-care or laboratory setting. An "exposure" that may place an HCW at risk for HIV infection and therefore requires consideration of PEP is defined as a percutaneous injury (e.g., a needlestick or cut with a sharp object), contact of mucous membrane or nonintact skin (e.g., when the exposed skin is chapped, abraded, or afflicted with dermatitis), or contact with intact skin when the duration of contact is prolonged (i.e., several minutes or more) or involves an extensive area, with blood, tissue, or other body fluids. Body fluids include a) semen, vaginal secretions, or other body fluids contaminated with visible blood that have been implicated in the transmission of HIV infection;^(11,12) and b) cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids, which have an undetermined risk for transmitting HIV.⁽¹¹⁾ In addition, any direct contact (i.e., without barrier protection) to concentrated HIV in a research laboratory or production facility is considered an "exposure" that requires clinical evaluation and consideration of the need for PEP.

Although one nonoccupational episode of HIV transmission has been attributed to contact with blood-contaminated saliva,⁽¹³⁾ this incident involved intimate kissing between sexual partners and is not similar to contact with saliva that may occur during the provision of health-care services. Therefore, in the absence of visible blood in the saliva, exposure to saliva from a person infected with HIV is not considered a risk for HIV transmission; also, exposure to tears, sweat, or nonbloody urine or feces does not require postexposure follow-up.*

Human breast milk has been implicated in perinatal transmission of HIV. However, occupational exposure to human breast milk has not been implicated in HIV transmission to HCWs. Moreover, the contact HCWs may have with human breast milk is quite different from perinatal exposure and does not require postexposure follow-up.

* Although exposure to these body substances generally is not considered a risk for occupational HIV transmission, this does not negate the importance of handwashing and appropriate glove use when contacting these body substances. Handwashing and appropriate glove use are part of standard precautions for infection control to prevent transmission of nosocomial and community-acquired pathogens and are required for compliance with the Occupational Safety and Health Administration bloodborne pathogen standard.^(14,15) In addition, postexposure evaluation for hepatitis B (and possibly hepatitis C) should be provided if contact with saliva includes a possible portal of entry (i.e., nonintact skin, mucous membrane, or percutaneous injury).