摘要:

SummaryIn a study undertaken to determine compliance with Universal Precautions, we observed 129 personnel performing 1,274 interventions on 151 consecutive critically ill and injured patients in an emergency department setting in July 1988. Barrier precautions were fully adhered to 44.0% of the time. During interventions in patients with profuse bleeding, adherence was only 19.5% in contrast to 44.7% for those who were not bleeding. Adherence was 56.4% during minor interventions but only 16.7% during major procedures. Adherence rates varied among health care providers: residents, 58%; emergency staff physicians, 38%; consultant physicians, 43%; emergency nursing staff, 44%; paramedics, 8%; radiology technicians, 14%; and housekeeping, 91%. In a follow-up questionnaire that ascertained reasons for lack of compliance, 47% of providers indicated that there was not always sufficient time to put on protective material, 33% felt that precautions interfered with skillful performance of procedures, and 23% stated that materials were uncomfortable. Only 2.7% felt that Universal Precautions did not work. Since there is no proven postexposure prophylaxis for human immunodeficiency virus, Universal Precautions must be rigorously followed until such time as they are shown not to be effective or an alternate approach is developed. Strategies to improve compliance and improvements in barrier technology need to be developed.

ISSN:0894-9255    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

SummaryThe prevalence of antibodies to human immunodeficiency virus (HIV) was determined in the relatives, friends, and sex partners of AIDS patients in Haiti and in other unrelated Haitian population groups. Among contacts of AIDS patients, HIV seroprevalence was highest among sex partners of the opposite sex (55%) and lowest among female relatives and friends (9%) of female AIDS patients. Male relatives and friends of male AIDS patients had a seroprevalence rate of 19% and also had a history of multiple heterosexual partners and frequent contact with prostitutes. The HIV seroprevalence rate among unrelated groups of Haitian adults ranged from 2% in rural healthy adults to 22% among tuberculosis patients to a high of 49% among Haitian prostitutes. This seroprevalence pattern suggests that HIV infection is widespread in Haiti and that heterosexual activity plays a major role in transmission.

ISSN:0894-9255    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

SummaryAt Mulago Hospital in Kampala, Uganda, 270 consecutive patients at the dermatology and sexually transmitted disease (STD) clinic were enrolled in a study to evaluate the association of clinical STD syndromes and human immunodeficiency virus (HIV) infection. Female patients became sexually active earlier than male patients and were younger at marriage. Persons with a history of an STD during the preceding 5 years were more likely to be HIV infected (43%) than those without such a history (26%; OR 2.08,95% C.I. 1.17, 3.73). Examination at the time of the visit demonstrated an association between genital ulcers and HIV infection in male and female patients (OR 2.21, 95% C.I. 1.08, 4.53, and OR 8.54, 95% C.I. 1.45, 87.55, respectively) but no association between HIV and urethritis or vaginal discharge. The etiologic fraction for HIV infection of genital ulcers was 0.218. Men with a history of contact with prostitutes were more likely to be HIV infected than those without contact (50% versus 28%, p < 0.05), but once controlled for STDs, this relationship was no longer significant. This study confirms other studies from East Africa that have shown a relationship between genital ulcers and HIV infection. This finding, in the presence of no association between other STD syndromes and HIV infection, suggests that genital ulcers may be truly associated with HIV infection rather than a marker of high-risk activities.

ISSN:0894-9255    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

SummaryIn a previous study on immune responsiveness among asymptomatic human T-cell leukemia virus type I (HTLV-I) carriers, we found that carriers had significantly reduced delayed-type hypersensitivity (DTH) response to purified protein derivative (PPD) skin testing. The association was strongest among persons at least 60 years of age. In order to evaluate this finding further, we evaluated the response to both PPD and phytohemagglutinin (PHA) in an elderly population. Fifty-six consecutive hospitalized patients with nonimmunosuppressive diseases were examined. None had a history of tuberculosis nor evidence of the known HTLV-I-associated diseases. The subjects' ages ranged from 62–93 years (median = 75 years); 43 were women and 13 were men. Twenty-two of the subjects were HTLV-I antibody positive. Among the carriers, there was an increased level of nonreactivity to PPD, the relative risk adjusted for age (RR) being 1.9 (95% confidence interval, 0.62–5.8), as well as to PHA of RR = 2.3 (0.60–9.0). When subjects were cross-classified for response to both skin tests, 15 of 17 carriers were nonreactive to either or both antigens compared to 15 of 25 noncarriers [RR = 5.1 (0.99–25.9) (pvalue, one-sided = 0.026)]. The decline in reactivity to both antigens increased with age, but was consistently lower among the carriers. Among subjects with positive reactions to PPD, the degree of reaction as measured by the size of erythema was reduced among the carriers; however, for PHA responders, the response in carriers appeared to be normal. Among the HTLV-I antibody negative subjects, the size of erythema for both antigens was strongly correlated (p= 0.01). Among the carriers, there was no correlation (p= 0.92). These findings confirm our earlier report of reduced DTH response in older HTLV-I carriers and extends it to nonspecific mitogen challenge, suggesting that the defect in triggering DTH is not related to antigen-specific memory. However, once triggered, the level of erythema to the two antigens is not correlated in carriers.

ISSN:0894-9255    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

SummaryA mathematical model is presented that describes the probability of a subject becoming infected as a result of sharing equipment used for percutaneous injections. This risk is a function of (a) the number of syringes shared by the subject, (b) the probability of a syringe becoming contaminated after being used once by an infective person, (c) the probability of a person becoming infected after using a contaminated syringe once, (d) the number of persons who have previously used each syringe shared by the subject, (e) the prevalence of infectivity in the group from which these previous users are drawn, (f) the number of times each syringe has been used by each previous user, and (g) the number of times the subject uses it. Simulations with the model suggest mainly that (i) when each shared syringe has been used previously by only one person, the number of persons with whom syringes are shared is more important than the number of syringes; (ii) the reverse is true when each shared syringe has previously been used by many persons; and (iii) for an equal number of injections, the “shooting gallery” type of sharing can be much more risky than other kinds of sharing, but this difference decreases as the infection becomes more prevalent.

ISSN:0894-9255    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0894-9255    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0894-9255    

出版商:OVID    

年代:1990

数据来源: OVID