An analysis of emergency physicians' cumulative career risk of HIV infection

Study objective: To determine point and range estimates of the cumulative career risk of occupationally acquired human immunodeficiency virus (HIV) infection by emergency physicians as well as to determine if the efficacy of universal precautions was seriously diminished by prolonged risk over time. Design: Monte Carlo estimation of a mathematical model of cumulative risk. Eight scenarios were estimated for high versus low prevalence of HIV, no precautions versus universal precautions, and prevalence increasing to a steady state versus peaking and then declining. Measurements and main results: For high-prevalence areas, not using universal precautions, and assuming HIV seroprevalence increases to a steady-state level, the median estimate of cumulative risk of HIV infection over a 30-year career was 1.4% (90% tolerance range, 0.2% to 14.0%); for low-prevalence emergency departments, the median was 0.1% (0.001% to 3.6%). Universal precautions with a presumed effectiveness of approximately 40% resulted in an approximate 30% decrease in risk. Conclusions: Although the per-exposure risk is small, the cumulative risk of HIV infection may be disproportionately large. The efficacy of universal precautions does not appear to be substantially diminished over time.