Fear and uncertainty about the transmission of AIDS (Acquired Immune Deficiency Syndrome) has prompted hospitals to beef up their infection control practices and pay new attention to the hazards that face their medical personnel, lab technicians, laundry workers and other support staff.
Although there is no evidence that any of four hospital workers nationwide who have contracted AIDS had contact with AIDS patients at work, the fear surrounding the mysterious disease has focused new attention on the handling of patients and lab specimens.
In the Washington area, for example, concern about AIDS prompted security guards at the National Institutes of Health in Bethesda, where 53 AIDS patients are being treated and at least a dozen labs are engaged in AIDS research, to ask for a special briefing on infection control.
"We have to escort bodies to the morgue and patrol buildings with AIDS victims and no one was telling us how to deal with it," said Pat Roberson, of Chantilly, a security officer at NIH. "I'm not about to get exposed to it and bring it home to my family."
A special sticker is applied to the shrouds covering persons who die of infectious diseases, said NIH spokeswoman Shirley Barth, who noted that none of the guards has refused to accompany such bodies.
NIH officials had held a campus-wide seminar on AIDS June 23 as well as briefings earlier for several other employe groups that are more directly involved in patient care. The facility arranged to have a medical expert speak with security guards last week after learning of their worries.
Dr. Emmett Barkley, director of the institutes' Division of Safety, noted, "This is not a disease that has any evidence of transmission other than by intimate contact. There is apprehension that's fueled by rumor that's terribly unfortunate. Our session tried to educate the support staff so they do not develop such fears."
That meeting was just one of dozens held at local hospitals about AIDS, which attacks the victim's immune system and is often fatal. At least two local organizations, the Alexandria Hospital and the Prince George's Health Department, have planned AIDS seminars in the coming months. The Prince George's session, set for Sept. 19 at Prince George's General Hospital, is aimed specifically at health-care workers.
"I'm busy doing a lot of in-service meetings on AIDS for the hospital staff," said Kathy West, an infection control nurse at Alexandria Hospital, which has cared for two AIDS patients. "It's human nature to take short cuts from time to time and this outbreak has everyone more concerned about following recommended procedures."
Special procedures for handling AIDS patients were developed by the National Centers for Disease Control in Atlanta and were distributed to hospitals across the nation in the last two months. Dr. Nigel Jackman, director of community health services for Prince George's County, said the procedures are similar to those for handling patients with hepatitis and other infectious diseases and focus on health workers wearing gloves while handling blood samples.
In most area hospitals surveyed, the blood samples of AIDS patients, like samples from patients with infectious diseases, are labeled and wrapped in plastic to warn lab technicians to use extra caution. Standard procedure for blood spills is to use bleach as a disinfectant, noted Ronald Sacher, director of the Georgetown University Hospital blood bank.
Similarly, the bedding from AIDS and other infectious patients is usually a different color, allowing the laundry staff to segregate the linen, hospital infection control officers said.
An increased use of gloves in health workers dealing with blood samples is the chief difference hospital authorities have noticed since publicity about AIDS heightened awareness of the dangers of the disease.
"Employes don't have to wear masks because this illness is not transmitted through the air," said Donna Arbogast, a spokeswoman for the Washington Hospital Center, which has treated eight AIDS patients. The hospital held a seminar on AIDS for all employes on July 15.
At NIH, visitors to the private rooms of the eight AIDS patients who are hospitalized wear masks to protect the patients from infection, noted spokeswoman Barth.
The Centers for Disease Control also recommended that hospital workers no longer break needles, a practice aimed at preventing the needles from being used later by drug abusers, because of the hazard of cutting themselves or making contact with the contents of a syringe. "We're now disposing of them in puncture-resistant containers and then burning the containers when they're full," said West, of Alexandria Hospital.
Such containers also are used at George Washington University Hospital, which has treated six patients with AIDS, said Irene Haske, spokeswoman for the hospital.
None of the local hospitals, or representatives of hospital worker unions, are aware of instances where local health-care employes have refused to work with AIDS patients or specimens.
There have been 1,737 cases of AIDS reported nationwide, 678 of them fatal. All but 37 have been linked to one of four risk groups for the disease: homosexuals and bisexuals, intravenous drug users, Haitians and hemophiliacs.
The Service Employes International Union, which represents 25,000 health-care workers, has sent an AIDS bulletin to its 80 locals this month, including two in Washington. A second bulletin was sent after the July 15 report by federal officials that AIDS had been contracted by four health workers: a male housekeeping employe in Baltimore, a male private-duty nurse in Miami, a male nurse's aide in an out-patient department in New York City and and a female laundry worker in a New Jersey hospital. Two of the workers have died.
Authorities have said all four do not appear to be members of the identified high-risk groups, but they also had no contact with AIDS in their work. The Centers for Disease Control are continuing to research how the four were exposed.
"We're simply telling people to take precautions," said Margaret Peisert, a research analyst at the Service Employes' Washington headquarters. "No health-care employes are known to have developed AIDS through job-related exposure."