Infection control in pulmonary and critical care medicine

During the routine care of patients, pulmonary and critical care specialist may have significant exposure to respiratory infections and potentially infectious body fluids such as blood and pleural fluid. Bronchoscopy and intensive care services often require close contact with patients and the use of sharp devices required for intravascular catheterization. Rendering such care places physicians at risk for acquiring agents such as human immunodeficiency virus (HIV), hepatitis viruses, and Mycobacterium tuberculosis. As of December 1998, 188 cases of occupational transmission of HIV to health care workers (HCWs) in the United States have been reported to the Centers for Disease Control. Most documented cases of seroconversion involve percutaneous injury involving blood, with the greatest risks being associated with injury from a hollow-bore needle that has been in an infected patient's vein or artery. Because thousands of HIV-infected persons are unaware of their infection, HCWs must consider all patients to be infected with HIV and improve work practices accordingly. Nevertheless, elimination of all exposures is impossible, and postexposure prophylaxis with combination antiretroviral therapy is recommended for persons deemed a high risk of contracting HIV. Pulmonary specialists are at high risk of exposure to tuberculosis; proper precautions include isolation of patients with suspected tuberculosis and the use of DMF-HEPA respirator masks, especially while performing procedures like bronchoscopy. Contaminated bronchoscopes have been implicated in transmission and 'pseudoinfection' of tuberculosis and nontuberculous mycobacteria, underscoring the need for rigorous cleaning and disinfection practices.