Intended for healthcare professionals

Education And Debate

Commentary: The government has mismanaged cases of HIV infected health care workers

BMJ 1996; 312 doi: (Published 04 May 1996) Cite this as: BMJ 1996;312:1152
  1. Cris Swinhoe, senior registrar in anaestheticsa
  1. a Department of Surgical and Anaesthetic Sciences, Royal Hallamshire Hospital, Sheffield S10 2JF

    Pell and colleagues' account of their three cases raises several issues: firstly, the risk to patients; secondly, the management of a case of a health care worker becoming infected; and, thirdly, the duty of a health care worker whose lifestyle puts himself or herself at risk of HIV infection.

    Quantifying the risk to patients of treatment by an infected health care worker is impossible, but common sense suggests that it is close to zero. This suggests that no action should be taken when a health care worker is found to be HIV positive. Nevertheless, the failure of the chief medical officer to state this has rendered such a stance impossible. Instead incident teams and helplines have fuelled the belief of the media and the public that there is a risk. Indeed, if a patient who was treated by an infected health care worker requests testing and is found to be HIV positive, the press and public are more likely to blame the health care worker even though another route is much more likely.

    Pell and colleagues criticise as inadequate the current recommendation that health care workers whose lifestyle is likely to put them at risk of HIV should consult an occupational health physician. But what lies between that an compulsory testing of all health care workers? There is no satisfactory course of action that would not discriminate against certain groups.

    The risk from health care workers is very low. So why not do nothing? Five years ago the media and the public might have accepted this approach. This is no longer possible, however, and as a result sensational publicity will continue to surround health care workers who are found to be HIV positive, causing additional distress to them and their relatives and undue anxiety to the patients they have treated. The departments of health must accept responsibility for this unfortunate situation.

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