ATLANTA, JULY 28 -- The man speaking for U.S. surgeons said fear and prejudice would be the only results of a policy of testing patients for AIDS before they undergo surgery. The woman representing health-care workers said that even though it would deny workers information they want, she could not support it either.
Inner-city doctors said the sweeping plan would drown them in bureaucracy, and public health officials asked where the money would come from.
During two days of arguing the hazards of acquired immune deficiency syndrome for health-care workers, a panel at the Centers for Disease Control here agreed on the need for strict guidelines to protect workers' safety. But they cautioned the U.S. government not to go too far and impose ineffective, unenforceable and possibly frightening rules on the nation's 6.5 million nurses, doctors, physician's aides and other health-care workers.
"I honestly feel we are headed back to the Dark Ages," said Dr. Ernest Hardaway, who represented the National Dental Association at the meeting. As they now are written, he added, the guidelines are "trouble for everyone."
And the trouble will be difficult to resolve. When they become final -- perhaps as early as next week -- the guidelines will become the general rule for millions of health-care workers who in their work might encounter people with the AIDS virus.
CDC officials said today they didn't know what the final guidelines would be or who would draft them; the conference was intended to gather advice but not to adopt rules. They said senior officials at the White House and the Department of Health and Human Services would be involved in writing the final draft.
The proposed guildlines emphasize the need for health-care workers to consider all patients as potentially infected and to adhere to rigorous infection-control precautions.
The 37-page draft prepared by Public Health Service officials is riddled with controversial suggestions that caused confusion and debate at the meeting. Consensus was rare.
"We are mostly scientists being asked to develop what is turning out to be legal standards and bargaining positions," said Dr. Thomas Zuck of the Food and Drug Administration.
The most animated discussion concerned recommendations that would greatly increase the percentage of hospital patients tested for HIV, the AIDS virus.
Although the risk of transmission of HIV from patients to health-care workers is minute, the draft states that "some hospitals may wish to initiate testing of certain patients in an attempt to provide an added element of safety."
The suggestion that hospitals test health-care workers brought several speakers quickly to their feet.
"I can see the time coming when patients are going to ask us what our antibody status is," said Dr. Charles McIntosh, a cardiac surgeon at the National Institutes of Health. "If we tell them we are negative, they will ask us to prove it."
But CDC officials said they had received many phone calls from hospital administrators who feared that a surgeon on their staff had AIDS or was infected with the virus.
"What do you tell these people when they ask you what to do," asked Dr. James Hughes, director of CDC's hospital infections program. "We usually just say that's a tough one."
Although an emotional issue, testing was not the only area of dispute. The draft urges all health-care workers to avoid mouth-to-mouth contact during resuscitation. Although mouthpieces now commonly are used, it will be hard to eliminate contact in all cases.
"If that message gets out as official policy, it will have an overwhelming impact on sudden death in this country," said Dr. Corey Slovis, of the American College of Emergency Physicians. "It will mean an effective end to CPR."
Other provisions would prevent inexperienced personnel from operating on patients infected with the AIDS virus. The draft also urges greater efforts to educate health-care workers about AIDS.
Current U.S. statistics show that 886 health-care workers have had direct exposure to the AIDS virus through cuts or needle sticks. So far, only three of them have tested positive for the virus.
Few people at the conference thought testing would enhance safety, and most urged better use of current regulations.