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Biomedical subjects

J L Gerberding

Publications and source records attributed to J L Gerberding.

At least 37 records · Page 2Linked to original sources
PubMed1997

Accidental exposures to blood and body fluids among health care workers in dental teaching clinics: a prospective study.

The authors evaluated accidental exposures to blood and body fluids reported to a hotline or to health officials at four dental teaching clinics. The authors used a standard questionnaire to solicit and record data regarding each exposure. During a 63-month period, 428 parenteral exposures to blood or body fluids were documented. Dental students and dental assistants had the highest rates of exposure. Syringe needle injuries were the most common type of exposure, while giving injections, cleaning instruments after procedures and drilling were the activities most frequently associated with exposures.

Accidents, Occupational↗
PubMed1996

Prophylaxis for occupational exposure to HIV.

Effective prophylaxis for infection with the human immunodeficiency virus (HIV) is important for health care providers at risk for exposure to infected blood. The average risk from percutaneous exposure is approximately 0.3%, but exposures involving a high titer of HIV or a large volume of infections material are apt to be much riskier. A convergence of indirect evidence strongly suggests that chemoprophylaxis with zidovudine after exposure to HIV may be efficacious. Treatment with zidovudine after percutaneous exposure appears to reduce the odds of infection by almost 80%. Zidovudine prophylaxis effectively prevents perinatal HIV transmission, and treatment during acute retroviral infection may attenuate HIV disease. Reports of "aborted" HIV infection among health care providers who have been stuck with contaminated needles suggest that antiretroviral treatment in the window of opportunity after exposure to HIV could prevent virus propagation and allow local cutaneous host defenses to clear the infection. Although efficacy has not been shown in controlled clinical trials, these data support a potential benefit from treatment after exposure. It is difficult to define the optimal regiment that should be used for prophyaxis, given the emergence of antiretroviral resistance among source patients. Current recommendations favor the use of zidovudine plus lamivudine for 4 weeks. Use of indinavir or other protease inhibitors is advised when the source patient is likely to harbor resistant virus or when exposure is especially hazardous.

Antiviral Agents↗
PubMed1995

Are universal precautions realistic?

In concluding whether universal precautions are necessary, it certainly appears that we need something to reduce the significant problem of HIV transmission to health-care providers. As occupational risk goes, it exceeds the occupational risk of a number of other high-risk professions. Unfortunately, we do not know if universal precautions are effective. We also do not know the true compliance rate in use of universal precautions, nor whether they have an impact on transmission even if effectively used. What are the alternatives? They are not great, but some have not been adequately explored or implemented. Re-engineering around needle use in the hospital is clearly the most likely area to produce concrete results, because needlesticks are overwhelmingly the greatest source of infection, but this has not been encouraged to the degree it could be, even with systems already developed. Universal testing does not appear to be a viable alternative, for numerous reasons already discussed. Finally, are universal precautions more important for other pathogens than HIV? I would say yes. Hepatitis B, hepatitis C, and nosocomial infections are more important both as public health issues and as health-care provider prevention issues. If universal precautions are effective in reducing any of these, they are worthwhile.

HIV Infections↗
PubMed1995

Hand protection.

The traditional purpose of surgical gloves is to prevent transmission of pathogens (usually bacterial) from surgeon to patient. Yet the hand is also the most common site of injury and blood contamination among operating room personnel. Thus, gloves also can protect against transmission of pathogens from patient to surgeon. This article focuses on the value of gloves for hand protection. The current data on such protection derive exclusively from studies that use glove leak and contamination as outcome measures. There are no data that measure protection in terms of actual disease transmission.

Gloves, Protective↗
PubMed1995

Effect of testing method on apparent activities of antiviral disinfectants and antiseptics.

This study was designed to evaluate the independent effects of various test methods on the activities of antiviral chemical germicides. The activities of germicides against MS2 and phi 6 bacteriophages in a new porcine tissue carrier model were compared to those obtained by four other methods (suspension, glass carrier, tile carrier, and fingerpad tissue carrier tests). After a 1-min contact followed by neutralization (and elution off the carriers), the residual virus in the treated samples was quantified and the amount was compared with that in the saline controls. Antiviral activity was highly dependent on the test method for both viruses and was always greatest in suspension tests and lowest in tissue carrier tests. Results obtained for hydrophilic MS2 with the porcine tissue carrier were comparable to those from fingerpads, but lipophilic phi 6 was subject to spontaneous inactivation on human skin and proved unsuitable for fingerpad testing. These data indicate that the activities of germicides in tests with nonbiological substrates may overestimate antiviral antiseptic activity on skin surfaces. Products intended for use as antiviral antiseptics or hand-washing agents should be evaluated in a tissue carrier system. The porcine tissue carrier model provides a safe, inexpensive, accurate, and reproducible method for testing the activities of antiseptics.

Animals↗
PubMed1994

Incidence and prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and cytomegalovirus among health care personnel at risk for blood exposure: final report from a longitudinal study.

In a 10-year dynamic cohort study, 976 health care providers were followed a mean of 1.9 years to evaluate the risk of human immunodeficiency virus (HIV) transmission, delayed seroconversion, and seronegative latent infection following occupational exposures. The seroprevalence and incidence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and cytomegalovirus (CMV) infection were also measured, with annual serologic testing for viruses and postexposure HIV tests. One of 327 percutaneous exposures (0.31%; confidence interval, 0.008%-1.69%) and 0 of 398 mucocutaneous exposures to HIV-infected blood transmitted HIV. Neither delayed seroconversions nor seronegative latent infections were detected. The baseline seroprevalences of HBV, HIV, HCV, and CMV infection were 21.7%, 0, 1.4%, and 43.4%, respectively. Corresponding incidence density rates were 3.05, 0.055, 0.08, and 2.48 (per 100 person-years). Despite infection control precautions and availability of hepatitis B vaccine, these health care providers remain at risk for acquiring bloodborne viral infections.

Blood↗
PubMed1993

Procedure-specific infection control for preventing intraoperative blood exposures.

Contemporary intraoperative infection control must address the risk of infection transmission to both patients and their providers. The patient must be protected from intraoperative wound contamination and exposure to blood-borne pathogens during procedures. Providers must be protected from injuries and mucocutaneous exposure to the patient's blood. Procedure-specific infection control precautions, or similar strategies that address this bidirectional potential for infection transmission, may prove successful in accomplishing improved safety for all.

Blood-Borne Pathogens↗