Recent reports of health care workers being exposed to the AIDS virus have heightened concerns of doctors and nurses who take care of AIDS patients.

Although most studies show that the chances of becoming infected in the hospital are remote, the increase in AIDS cases underscores the need for special precautions in handling blood and other body fluids where the virus may be present.

"Obviously, the risk of infection with health care workers is not zero," said Dr. Martin Favero, a branch chief in the Centers for Disease Control's hospital infection program, but "we think it is very low."

Those with the greatest risk are emergency medical technicians riding ambulances, nurses and doctors in operating rooms and emergency rooms, and technicians analyzing blood and tissue samples.

Two weeks ago, a study in the Johns Hopkins Hospital emergency room found that 16 percent of the patients between the ages of 25 and 34 who were treated for bloody, traumatic injuries proved to be infected with the virus -- and none of them showed outward signs of illness.

More recently, the CDC reported that three health care workers became infected by the AIDS virus after infected blood was splashed on their skin.

"There is a healthy fear, particularly in ICU nurses who have what I would say is a significant exposure to AIDS patients and their bodily fluids," said Sharon Boone, nursing coordinator for an intensive care unit at Georgetown University Hospital. "A lot of nurses believe that the jury is still out on the issue of how the AIDS virus is spread, especially because of the {CDC} report that just came out."

For years, there have been hospital guidelines to prevent the transmission of a number of blood-borne diseases such as hepatitis B, said Favero. The threat of AIDS has refocused attention on these precautionary measures.

The guidelines, which recommend that health care workers use rubber gloves, gowns, masks, hoods, booties and even goggles to erect physical barriers between themselves with the blood of their patients, seem to be working. Although thousands of health care workers have treated thousands of AIDS patients and those infected with the virus, only nine are known to have become infected.

In one study, CDC has been following more than 1,000 health care workers who were cut, stabbed with instruments or splashed with blood from AIDS patients. Only one became infected with the AIDS virus, "indicating that the risk of transmission during these exposures is very low," according to the CDC.

The risk of a health worker becoming infected after being stuck with an AIDS contaminated instrument is 0.2 percent, Favero said. The risk could be as high as 0.8 percent or nearly zero. Either way, he said, "it is below 1 percent."

Since the risk is so low, "health care workers can and should be expected to treat patients with {AIDS virus} infections," Favero said.

But not everyone in the medical community agrees.

Two heart surgeons in Milwaukee have decided they will no longer operate on patients shown to be infected with the AIDS virus -- despite the fact that Wisconsin has only recorded 113 cases of the disease.

In mid-March, Dr. W. Dudley Johnson, a heart surgeon and pioneer of coronary artery bypass surgery, disclosed that he had refused to perform bypass surgery on two patients after discovering they were infected with the AIDS virus.

After Johnson's announcement, Dr. Terence Schmahl, chief of cardiac and thoracic surgery at St. Luke's Hospital in Milwaukee, where 1,400 bypasses are done each year, disclosed that he, too, had adopted a policy of refusing to operate on those testing positive to HIV exposure.

Johnson justified his decision not to operate on AIDS-infected individuals by pointing out that surgeons and operating room personnel "are at exceptionally high risk of exposure to blood. Specks of blood are commonly present on the glasses of the surgeon and his assistant. No one has told me how many specks of infected blood in the eye can transmit the virus. Furthermore, the long-term outlook for an HIV-positive patient is fuzzy and unclear. The risk of contracting exposure to {the AIDS virus} from contaminated needles is reported to be low, but not absent."

Another Milwaukee heart surgeon, Dr. Charles Reuben, has called for mandatory testing of all patients admitted to St. Joseph's Hospital, where he operates.

"I wouldn't decline to take care of them {patients infected with the AIDS virus}, but I would like to know who we should be taking special precautions with," said Dr. Reuben. "The bigger issue is not so much whether you operate, but knowing you are operating on someone exposed to AIDS for the safety of everyone on the surgical team."

The refusal to operate on patients carrying the AIDS virus has touched off a firestorm of criticism among health leaders.

At Johns Hopkins Hospital in Baltimore, during a course for medical staff about AIDS, a radiology technician was dealt with sternly after he said he did not want to treat AIDS patients. According to sources at the hospital, the instructor told the radiologist to either treat all patients or find a job X-raying luggage at an airport.

"Physicians can choose to take care of whomever they want," said Dr. Jeffrey Akman, a George Washington University psychiatrist working with AIDS patients and their care givers. "But to refuse to take care of a person because they are positive for the HIV antibody {an indication the person has been infected} is an inadequate reason to refuse care. The only thing it does is increase hysteria in the community."

U.S. Surgeon General C. Everett Koop also opposes the position of the two Milwaukee physicians. Koop, a surgeon himself, acknowledges the hazards, and often tells the story of when he accidentally put a hepatitis B-infected needle completely through his palm and gave himself the disease. When asked whether he expected that eventually a surgeon will become infected with the AIDS virus and develop the disease, Koop replied, "That's right."

While concern has grown in the Washington area, doctors and nurses are continuing to care for AIDS patients and those infected with the virus but not yet suffering symptoms of the disease, according to several local AIDS experts.

"People are not getting freaked out in Washington," said Dr. Richard DiGioia, a physician who has a large number of AIDS patients in his private practice.

Dr. Paul Volberding, director of AIDS Activity at San Francisco General Hospital is not sympathetic to those who complain about the risks of caring for AIDS patients. In 1985, he wrote that "historically, physicians have tacitly accepted an occupational risk of exposure to fatal infectious diseases. In fact, much of the prestige and respect accorded to physicians can be directly traced to public regard for the physician's willingness to assume increased personal risks."

In December, the American Medical Association's Council on Scientific Affairs concluded that the AMA should "oppose discrimination against AIDS patients or individuals with HIV positive serum . . ."

At the same time, "a little fear is not so bad," said GW's Akman. It helps health care practitioners remain vigilant and take the appropriate precautions recommended by the CDC and other groups, he said.

To help calm the fears of health care workers, Akman runs an education program, sponsored by the National Institute of Mental Health, to teach hospital staffs about the virus, routes of infection and how to protect themselves.

But the education program itself is not enough; it takes contact with AIDS patients. "I have been taking care of AIDS-infected people for seven years," said DiGioia, "the first five of which I didn't even know what was going on. {I was} examining them, drawing blood from them, having them cough on me, and I am HIV negative. This virus is not transmitted by casual contact."

In Akman's view, doctors and nurses who have "ongoing contact with people who are infected diminish their fears because they learn that the chances of being infected by a patient are very low."

But while "health care workers are good at taking precautions in the hospital, they are not so good at taking precautions in the bedroom," Akman said. "If you are having unprotected sex in Washington and you don't know your partner's past . . . {then} sex is a much easier way of getting the virus than being splattered with blood or being stuck with a needle."Neil D. Rosenberg, a medical reporter with the Milwaukee Journal, contributed to this report.