Acquired Infections in Health Care Workers
A. Sepkowitz, MD
December 1996 | Volume 125 Issue 11 | Pages 917-928
care workers are at occupational risk for a vast array of
infections that cause substantial illness and occasional
deaths. Despite this, few studies have examined the
incidence, prevalence, or exposure-associated rates of infection
or have considered infection-specific interventions recommended
to maintain worker safety.
the type and frequency of infections, the recommended
interventions, and the costs of protecting health care
workers. Part II of this two-part review focuses on infections
caused by bloodborne organisms, organisms spread through the
oral-fecal route, and organisms spread through direct contact.
It also reviews established interventions for controlling
search and examination of infectious disease and infection
English-language articles and meeting abstracts published
from January 1983 to February 1996 related to occupationally
acquired infections among health care workers were reviewed.
Outbreak- and non-outbreak-associated incidence and prevalence
rates were derived, as were costs to prevent, control, and treat
infections in health care workers.
Occupational transmission to health care workers was
identified for numerous diseases, including infections caused
by bloodborne organisms (human immunodeficiency virus, hepatitis
B virus, hepatitis C virus, Ebola virus), organisms spread through
the oral-fecal route (salmonella, hepatitis A virus), and
organisms spread through direct contact (herpes simplex
virus, Sarcoptes scabiei). Most outbreak-associated attack
rates range from 15% to 40%. Occupational transmission is
usually associated with violation of one or more of three
basic principles of infection control: handwashing,
vaccination of health care workers, and prompt placement of
infectious patients into appropriate isolation.
for occupationally acquired infections is an unavoidable part
of daily patient care. Occupationally acquired infections
cause substantial illness and occasional deaths among health
care workers. Further studies are needed to enhance
compliance with established infection control approaches. As
health care is being reformed, the risk for and costs of
occupationally acquired infection must be considered.
Ann Intern Med.
More than 10 years
have elapsed since the last major consideration of
occupationally acquired infections in health care workers
[1,2]. Since then, much has changed--new infections have been
identified, diagnostic tests for previously recognized diseases
have been improved, the use of molecular epidemiologic techniques
in outbreak investigations has increasingly become routine,
and outpatient and home care have become more common.
The topic of
occupationally acquired airborne infections in health care
workers was addressed in part I of this two-part review .
Infections such as occupationally acquired tuberculosis,
varicella-zoster, measles, and respiratory syncytial virus infections
were considered, as were ethical and historical concerns. Part
II of this review discusses infections caused by bloodborne
organisms (such as human immunodeficiency virus [HIV], hepatitis
B virus [HBV], hepatitis C virus [HCV], cytomegalovirus [CMV],
and Ebola virus), organisms spread through the oral-fecal route
(such as salmonella and hepatitis A virus [HAV]), and organisms
spread through direct contact (such as herpes simplex virus
and Sarcoptes scabiei). It then summarizes known interventions,
including handwashing, vaccination, and prompt placement of
potentially infectious patients into appropriate isolation.
The risks to health care workers inherent in health care delivery
should be considered by planners of health care for the next
Bloodborne transmission Table 1 has received increased attention
with the advent of the acquired immunodeficiency syndrome epidemic
and, more recently, the outbreak of Ebola virus infection.
Although many nonmedical occupational groups are at risk for
diseases caused by organisms transmitted through the airborne
or oral-fecal route, health care workers are one of the few
groups at risk for the transmission of bloodborne pathogens.
In addition to blood-to-blood transmission, some of these
pathogens may be transmitted in saliva, as occurs with CMV
and B virus infection.
Occupationally Acquired Infections Resulting from Bloodborne
risk for transmission of HIV has been the subject of numerous
thorough reviews [9,34-40] and is not considered in detail
here. The rate of seroconversion after exposure ranges from
0.1% to 0.4% [4,5,35]. In general, a large inoculum--including
that from a source case with more advanced disease, a stick
with a large-bore blood-containing needle, or a more severe
injury--is associated with a higher rate of transmission .
transmission has been confirmed in 49 health care workers and
may have occurred in 102 others  Table 2. Percutaneous exposure alone
was the source of transmission for most confirmed cases of
infection (42 persons). The optimal management of health care
workers after exposure remains unknown. A recent
retrospective, case-control study examined risks associated
with transmission in 31 case-patients and 679 controls .
In this analysis, the use of zidovudine was associated with a
79% risk reduction, although zidovudine failure has occurred
. Provisional Public Health Service recommendations
include three antiretroviral drugs (zidovudine, lamivudine,
and indinivir) for high-risk exposures [7,43].
Table 2. Health
Care Workers with Documented and Possible Cases of Occupationally
Acquired HIV Infection in the United States, through 1995*
Hepatitis B virus
was one of the first bloodborne pathogens to be recognized as
an occupational risk among health care workers [44-46]. An
early review  found a preponderance of cases of hepatitis
B among pathologists, laboratory workers, and blood bank
workers, alerting investigators to the risks of exposure to
blood. Subsequent studies confirmed these early observations
[47-63]. In general, the seroprevalence of HBV in health care
workers is twofold to fourfold higher than that of blood donor
controls [47,61]; the highest rates are seen among dentists
[8,47]; physicians [8,47,61,63]; laboratory workers [8,47,63,64];
dialysis workers ; cleaning service employees [51,62]; and
nurses , including emergency department nurses . Widespread
transmission may occur from a single surgical procedure .
Many infections in health care workers are asymptomatic .
surveys, the annual incidence of hepatitis B was 5 to 10
times higher among physicians and dentists than among blood
donors and more than 10 times higher among surgeons, dialysis
workers, persons caring for the mentally handicapped, and laboratory
workers exposed to blood [47,61,66].
The risk for
transmission from a single needlestick varies according to E
antigen status: 1% to 6% for E antigen-negative blood compared
with 22% to 40% with E antigen-positive blood [8-10,67]. However,
transmission of E antigen-negative blood has caused fulminant
hepatitis requiring liver transplantation . Hepatitis delta
virus has been transmitted to a surgeon . The quality-adjusted
loss in life expectancy is similar for persons who receive
needlesticks involving a source patient who has HBV infection
and for persons who receive needlesticks involving a source
patient with HIV infection [70,71]. Not all cases of HBV
transmission are explained by needlesticks, suggesting that
other modes of spread may be possible [8,9,72].
interventions, such as the segregation of dialysis recipients
according to surface antigen status [73,74] and vaccination
[74,75], have effectively reduced occupational acquisition of
HBV. However, the Centers for Disease Control and Prevention
(CDC) calculate that 6500 to 9000 new HBV infections occurred
among health care workers in 1990 . Given the natural
history of HBV infection, 300 to 950 of these health care workers
(5% to 10%) will eventually develop chronic HBV infection that
will lead to death from cirrhosis in 100 to 150 persons and
to fatal hepatocellular carcinoma in 25 to 40 persons . Despite
this, HBV vaccination of health care workers remains incomplete.
In one study, 23% of health care workers were unvaccinated ,
a rate similar to that of anesthesiologists in the United Kingdom
. A three-vaccine series is 88% effective [77,78]; decreased
response is seen among recipients who are older, who smoke,
or who are obese [77,78].
introduction of a test for HCV infection has dramatically
improved our understanding of disease epidemiology. Because
HBV and HCV have similar modes of transmission, it was assumed
that groups of health care workers at increased risk for hepatitis
B also would be at risk for hepatitis C [19,52,60]. This, however,
has not proven to be true for many groups, including dialysis
workers [79-82], laboratory workers , persons who work with
the mentally impaired , and surgical staff . Indeed,
although "occupational exposure" accounts for about 2% of all
cases of hepatitis C , the seroprevalence of HCV among health
care workers is roughly similar to that of the general population
(about 1%) [83,85-89]. Dentists do have increased risk [16,17]:
In one serosurvey , significantly more dentists (1.7%) than
blood donors (0.13%) were seropositive for HCV; the highest
rate of seroprevalence was seen among oral surgeons (9%).
occurs in 1.2% to 10% of nonimmune health care workers who
receive needlesticks from a source patient with hepatitis C
[11-15]. Variation among control populations [90-92],
variation in employee populations [18,93,94], and variation
in the sensitivity of tests for HCV  have contributed to
the lack of consensus about risk [14,18,94]. Optimal management
of a needlestick is unknown, but the administration of immune
globulin is not recommended [18,40].
The prevalence of
CMV infection in the United States varies according to
geography, patient age, and group studied and ranges from 40%
to 95%. The annual community incidence among adults is about
2% . Transmission of CMV may occur through sexual contact
or through contact with infectious blood. Respiratory
secretions, saliva, and urine may also transmit CMV, as shown
by increased rates of CMV infection among day care workers (8%
to 10% per year) [95,96]. Early incidence [97-99] and prevalence
studies , as well as meta-analyses [101,102] and reviews
[103,104], suggested that pediatric health care workers had
elevated risk, similar to that of day care workers. Subsequent
reports [20,21,35,105,106], however, have not shown this risk,
perhaps because many recent studies were done in the era of
universal precautions. Similarly, no increase in CMV infection
among dialysis workers  or renal transplantation workers
 has been found.
molecular epidemiologic techniques have also shown that
health care workers are at low risk for occupational transmission
of CMV [109,110]. No transmission was documented among 188 health
care workers at a pediatric chronic care or neonatal unit in
which many of the patients were heavy CMV shedders .
Molecular analysis of CMV recovered from one of two nurses
who seroconverted showed discordance with CMV taken from a
known occupational contact and concordance with CMV from a
family member with new disease.
Infection and Other Viral Hemorrhagic Fevers
The recent outbreak
of Ebola virus infection in Zaire involved 296 cases and was
associated with a 79% mortality rate [22-24]. At least 90
persons (32%) were health care workers [24,25], a fact that
led the CDC to issue recommendations for the management of
persons with suspected viral hemorrhagic fevers . Among
the recommended practices were use of universal precautions,
use of strict barrier protection, restriction of workers and
visitors, and use of negative-pressure ventilation in the presence
of respiratory symptoms.
In a 1979 outbreak
of Ebola virus infection in Sudan, persons who provided
nursing care were five times more likely to develop disease
than were those who provided no care . In all, 34 cases
of infection occurred and 22 persons died. Similar outbreaks
involving health care workers have been reported with Crimean
hemorrhagic fever-Congo virus infection in Pakistan, where 10
of 17 exposed workers developed disease and 2 died ;
Lassa fever virus infection on an obstetrics ward, where 7 of
26 exposed workers developed disease and at least 1 died
; and Marburg virus infection [114,115]. Ribavirin was
effective as therapy for 3 health care workers with Crimean
hemorrhagic fever-Congo virus .
occupationally acquired infection with B virus (Herpesvirus
simiae) was described in 1932, when a physician died of
encephalomyelitis 3 days after being bitten by a clinically
well rhesus monkey [117,118]. Since that time, more than 24
infections with B virus have occurred in humans, and 18
persons have died . The peak incidence of B virus
infection occurred in 1957-1958, in conjunction with the
production and testing of poliomyelitis vaccines . In
the 1980s, a cluster of four cases (two of which were fatal)
occurred in a research facility in Pensacola, Florida ,
leading to the development of new recommendations for monkey
handlers . Treatment with acyclovir may be effective
[27,29], but the optimal duration of therapy is unknown and
may extend years.
disease is a uniformly fatal neurodegenerative disorder that
has been the subject of extensive epidemiologic investigation
[31,32]. Health care workers are not considered to be a group
at risk , but cases have been reported in two
neurosurgeons [31,32], two histopathology technicians [120,121],
and one pathologist . In none of these cases could a specific
incident that may have led to transmission be recalled. Recent
recommendations stress sterilization of equipment to minimize
the risk .
Epstein-Barr virus infection have seldom been reported.
Transmission of Epstein-Barr virus to 9 of 29 medical staff
(31%) in an obstetrics and gynecology clinic was never explained
. Investigators at a hospital that treated hundreds of
cases of nasopharyngeal carcinoma suggested that nosocomial
spread was a major source of Epstein-Barr virus infection among
health care workers at their institution . Occupationally
acquired cases of syphilis , malaria , and yellow
fever  have been reported.
Enteric pathogens spread in various ways, including through
the ingestion of contaminated food; through direct person-to-person
contact; and through contact with infectious waste, usually
feces Table 3. Insufficient handwashing by health care workers
probably contributes more to the transmission of these pathogens
than to the transmission of bloodborne or airborne pathogens.
Occupationally Acquired Infections Resulting from Oral-Fecal
The number of cases
of salmonellosis has increased steadily since the 1950s, and
food-related outbreaks continue to occur. The effect of
contaminated food was vividly shown by a recent outbreak that
was traced to ice cream and that caused more than 200 000
cases of salmonellosis across 41 states . In general,
institutional disease accounts for 10% to 30% of all cases
[138,154,155]. Hospitals, nursing homes, psychiatric
facilities, pediatric wards, and nurseries are common sites
contamination of mashed potatoes was responsible for a large
outbreak at a hospital in Jordan , where 183 of 619
persons (19.6%) (including 150 hospital employees) developed
disease. Investigation showed that 11 of 61 kitchen workers
(18%) were infected with salmonella; all had been negative on
cultures taken 3 months earlier, suggesting that routine surveillance
cultures may not be useful.
transmission of salmonella occurred in a hospital in Maine
, where several workers who drank tainted eggnog
developed salmonellosis. As the outbreak progressed, at least
eight additional workers who had not drunk eggnog also developed
disease. Person-to-person spread has been suggested by other
studies [159,160], including the report of an outbreak that
involved fasting patients who had recently had gastrectomy and
infants who were not receiving hospital food. In a nursing home
in Tennessee, 8 of 160 employees (5%) developed salmonellosis;
the highest attack rate was seen in laundry workers . Several
laundry workers had no direct contact with infected patients,
suggesting that transmission occurred through contaminated linen.
identified outbreak may be difficult. In Cincinnati, Ohio, 24
of 52 kitchen workers were found to have Salmonella drypool,
which accounted for at least 11 cases of salmonellosis among
staff who ate food that had been prepared at the hospital
. The epidemic was stopped only after 50 of 52 kitchen
workers were treated with trimethoprim-sulfamethoxazole. Because
32% of treated employees developed reactions to drug treatment,
this approach may not be advisable for routine outbreaks. In
one study , the cost of identifying and treating one
salmonella-infected health care worker, including cultures,
antibiotic therapy, and lost work time, was $3500.
The number of cases
of hepatitis A gradually increased in the United States in
the 1980s; incidence peaked in 1989 . Common risk
factors for the acquisition of HAV include contact with an
infected person (26%), employment in or attendance at a day
care center (14%), and use of injection drugs (11%) .
The overall prevalence rate of HAV infection in the United States
is about 38%, similar to rates described in health care workers
(35% to 54%) [164-166]. In one report , the rates of
antibodies to HAV were significantly higher in nurses older
than 30 years of age than in office workers; in another
study, charwomen had the highest rate .
Many outbreaks have
been reported in pediatric or neonatal intensive care units
[130,133-136] and orphanages . A neonate who acquired
HAV through a transfusion spread the organism to 10 of 61
susceptible nurses (16%) . An infected child who had an
immune defect that resulted in an inability to seroconvert to
HAV remained undiagnosed for a protracted period, leading to
transmission of HAV to 15 of 102 staff . Adults with
diarrhea have also transmitted the virus to health care workers
An outbreak of HAV
infection in a burn unit occurred despite the use of
appropriate infection control measures, and HAV was spread to
11 of 59 susceptible nurses (18.6%) . Eating on the
hospital ward was the most important risk factor for
infection. Other nosocomial outbreaks have resulted from the
consumption of contaminated food, including orange juice 
and sandwiches . One outbreak resulted in 66 cases of
clinical or subclinical disease .
administration of immune globulin to persons who have contact
with HAV-infected patients has been used effectively for many
years to prevent secondary cases. Defining which, if any,
health care workers should routinely be vaccinated for HAV is
currently being discussed [137,172].
Given the small
inoculum size required for transmission of shigella ,
the reason for the relative infrequency of nosocomial
shigella infection has been the subject of speculation but remains
obscure . Outbreaks in day care centers have been reported
[153,174]. At a teaching hospital in Kenya , salmonella
accounted for 10% and shigella accounted for 2.5% of 360 cases
of nosocomial diarrhea. In another report , 3 of 32 workers
in a newborn nursery developed shigellosis. All were chronic
nail-biters. The cost of controlling the outbreak was $5000.
been spread to a medical intern and possibly other staff
, a nurse , and a laboratory researcher .
Proper infection control techniques failed to control an
outbreak in Wales, where 5 of 16 nurses developed disease
. This outbreak was perpetuated by severe environmental
contamination; replacement of sinks and hand basin taps with
leg-operated machinery proved to be an effective intervention.
Veterinarians and animal handlers also have an increased risk
for cryptosporidiosis. In one outbreak , cryptosporidiosis
developed in 10 of 20 veterinary students who worked with calves
that had died of the disease. This outbreak was similar to another
calf-related outbreak, in which 12 of 18 animal handlers became
reports have examined the seroprevalence of antibodies to
Helicobacter pylori among health care workers [143-147]. One
found that seroprevalence was higher among endoscopists (69%)
than among internists (40%) . Two other studies [143,147]
found that about 52% of endoscopists and only about 14% to 21%
of blood donors were seropositive for H. pylori [143,147].
Dentists have no increased seroprevalence despite contact
with saliva . These findings suggest that contact with
contaminated equipment, rather than routine patient care or
contact with saliva , is an important mode of
difficile has emerged as an important cause of hospital-acquired
diarrhea and has been cultured from the hands of 14% to 59%
of asymptomatic health care workers during outbreaks [179,180].
However, controversy exists about the potential role of C.
difficile as an occupationally acquired organism [181-183].
Possible nosocomial transmission of fatal C. difficile
infection to an otherwise healthy worker has recently been
reported . Several nursing home outbreaks of infection
with the Norwalk virus (a small, round-structure virus) have
resulted in rates of transmission to staff that range from
30% to 50% [148-152]. In one outbreak, "care attendants" had
an incidence rate of 92% . In an outbreak of Escherichia
coli O157: H7-associated hemorrhagic colitis in a nursing
home , 18 of 137 staff members (13%) developed symptoms;
5 of the 18 had bloody diarrhea. No health care worker
developed the hemolytic-uremic syndrome. Cholera has spread
to staff , but studies done before vaccination found no
risk to personnel on a polio ward .
Eating hospital food
and drinking hospital beverages expose health care workers to
the same risks faced by patients and visitors, as shown by
hospital food-related outbreaks of salmonellosis
[128,158,161], hepatitis A [170,171], yersiniosis ,
campylobacteriosis , cyclospora infection , and
typhoid fever .
Infection may spread to health care workers as a result of direct
contact. Outbreaks of scabies, particularly among nurses and
laundry workers, have been reported from several hospitals
[192-195]. In one hospital , almost 300 health care
workers were affected, including 45 of 200 laundry workers
(22.5%), 126 of 1448 nurses (8.7%), and 32 of 87 health care
workers (36.8%) who had direct contact with patients. The
outbreak cost about $50 000 for days of work missed and for
treatment. In another outbreak , secondary spread to the
spouses of health care workers was seen. A large, sustained
outbreak at an extended-care facility  resulted in the
infection of 26% of the staff, including half of all nurses.
(herpetic whitlow) is an occupational hazard for dentists;
anesthesiologists; dialysis technicians; physiotherapists;
physicians; and nurses [196,197], particularly nurses in intensive
care units [196,198,199]. That dermatologists face risk associated
with laser treatment of warts with lasers has been suggested
[200,201], including a recent study  in which molecular
epidemiologic techniques were used. Tinea corporis may spread
to staff [203,204], further thwarting control efforts.
Specific Groups of Health Care Workers at Risk
Laboratory personnel, veterinarians and animal handlers, pathologists,
surgeons, dentists, anesthesiologists, and laundry workers are
at risk for an array of specific infections Table 4. In addition,
the concerns of pregnant health care workers are considerable
and unique because certain otherwise mild infections may affect
Occupationally Acquired Infections Encountered in Specific Groups of
Health Care Workers*
infections have been extensively studied [205-207]. Collins
 identified 2168 infections and 48 deaths from diseases
ranging from brucellosis and Q fever (the most common) to
rabies and the plauge. The potential danger of working in
laboratories is dramatically illustrated by the fate of Ricketts
(for whom Rickettsia was named), who died of laboratory-acquired
rickettsiosis . Neisseria meningitidis has fatally infected
laboratory workers . Although many clinical health care
workers receive prophylaxis after exposure to N. meningitidis,
studies have not documented the spread of this organism to health
care workers in the clinical setting .
Despite the seemingly limitless number of infections that health
care workers can acquire on the job, the interventions to prevent
transmission are simple, well known, and effective. Compliance
with three practices--handwashing, vaccination, and appropriate
isolation of infected patients--can control transmission
dramatically and cost-effectively.
Handwashing is the
oldest, simplest, and cheapest way to control the nosocomial
spread of infectious organisms. In the 1840s, Semmelweis
introduced the practice of "hygienic hand disinfection" on
obstetric wards in Vienna, decreasing the maternal mortality
rate from 13.7% to 1.3% [241-243]. Since that time, handwashing
has become routine for all persons doing any surgical procedures;
however, workers involved in medical care have notoriously low
rates of handwashing--usually less than 50% [244-248].
have examined the specific aspects of handwashing, including
type of soap [249,250], type of sink , drying method
, and method of scrubbing [243,253-255]. One study
showed that chlorhexidine was both significantly more effective
and more often used than alcohol and soap . Additional
strategies to improve compliance [244,247,251] are necessary
because compliance, not brand of soap or type of sink, remains
the major obstacle to preventing transmission. In addition to
preventing patient-to-patient spread, handwashing may prevent
the acquisition by health care workers of such infections as
those caused by rhinovirus, respiratory syncytial virus, HAV,
adenovirus, and salmonella. Emphasis of this might promote
compliance and lead to an overall reduction of transmission.
about vaccines are updated frequently , but vaccination
of health care workers remains incomplete [257-259]. Indeed,
compliance with HBV vaccination remains appalling: In a
recent survey in an inner-city hospital, 23% of workers were
unvaccinated . Health care workers are often the source
of outbreaks of measles and rubella  and, less commonly,
HBV infection , further emphasizing the need for improved
compliance with vaccination. A demonstration of evidence of
antibodies to vaccine-preventable diseases, including measles,
mumps, rubella, and hepatitis B, is required of employees at
many hospitals. The varicella-zoster virus has recently been
recommended , whereas the role of the HAV vaccine is being
isolation of infected patients is another time-honored
practice . It is the most complicated and potentially expensive
of the three standard interventions. Difficulties arise when
trying to balance the need to protect health care workers against
the realities of cost, as shown by the recent debate surrounding
tuberculosis control . A common sense approach may find
an acceptable middle ground [264,265]. In general, universal
precautions for infections with bloodborne organisms, respiratory
and droplet isolation precautions for infections with airborne
organisms, and contact isolation precautions (or enteric
precautions) for infections caused by organisms spread by the
oral-fecal route are effective and widely used . Updated
guidelines for isolation precautions have recently been
Public attention has recently focused on the risk to patients
posed by infectious health care workers. Transmission of HIV
from an infected dentist to four patients  stirred a national
debate in the United States about mandatory HIV testing of health
care workers. Workers have been the source of many infections
other than HIV infections, including tuberculosis , hepatitis
B , measles, and rubella . Little public concern or
awareness, however, has been directed toward the risk to health
care workers of caring for contagious persons, despite the
continuing illness and occasional death that result from
occupationally acquired diseases.
developments have changed many aspects of occupational risk.
Old diseases that may be spread to health care workers, such
as tuberculosis and diphtheria, have reemerged, forcing the
reexamination of existing infection control policies .
New technology has identified old infections, such as hepatitis
C. This, in turn, has been followed by numerous studies
delineating the natural history and transmission rates of
disease, including risk to health care workers [11-19,79-94].
Seemingly new diseases with undefined risks, such as HIV and
Ebola virus infection, have become evident, leading to
appreciation of risks to health care workers and
recommendations for worker safety [7,26].
confirmation of outbreaks, as well as improved understanding
of transmission [269,270], rely increasingly on molecular
epidemiologic techniques. These techniques have been applied
to investigations of many diseases, including CMV infection
, adenovirus infection [271,272], hepatitis B , hepatitis
C , HIV infection , and tuberculosis [275,276].
Molecular analysis may identify previously undiscerned
outbreaks  or rule out others .
The recent trend
toward an increase in the use of outpatient care has also
changed the risk for occupationally acquired infection, as
well as the groups of health care workers at risk [64,277,278].
In 1867, Simpson expressed his hope that, given the high
concentrations of sick patients, "hospitals should not become
pesthouses, and do more harm than good" . Since that
time, the risk posed to patients and staff by nosocomial
infection has been repeatedly shown. In this regard, the
result of shorter hospitalizations may well be salutary,
although the risk for undetected infection may increase as
patients receive more care away from diagnostic centers.
In summary, daily
patient care presents the health care worker with a real,
although small, risk for infection. Indeed, the cost to
prevent, control, and treat occupationally acquired
infections is considerable, in terms of both dollars spent and
lives affected. This does not imply that working with contagious
persons is a heroic endeavor. Rather, incurring the risk for
occupationally acquired infection is necessary for daily health
care delivery. Indeed, the willingness of health care workers
to accept this risk is, in many ways, as important to health
care as their professional skills. This should be considered
in the coming years as health care delivery in the United States
continues to be reformed.
author thanks Bruce Artim, JD, for research assistance.
Reprints: Kent A. Sepkowitz, MD, Infectious Disease Service,
Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box
288, New York, NY 10021.
Author and Article Information
Sloan-Kettering Cancer Center and New York Hospital-Cornell Medical
Center, New York, New York. For the current author address, see end of
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