Human immunodeficiency virus infection in emergency department patients. Epidemiology, clinical presentations, and risk to health care workers: the Johns Hopkins experience.

In a study to assess the impact of the human immunodeficiency virus epidemic on The Johns Hopkins Hospital Emergency Department, we found 152 (6.0%) of 2544 consecutive patients to have human immunodeficiency virus infection, an absolute increase of 0.8% from the previous year. Of the 57 patients with a known history of infection, 49.1% had no insurance vs 36.0% of seronegative patients. Infected patients were three times more likely to be admitted as seronegative patients. Overall, health providers followed universal precautions during 44.0% of interventions. In patients with profuse bleeding, adherence fell to 19.5%. The most common reasons given by providers for not following precautions were insufficient time to put on protective attire and interference with procedural skills. We conclude that the human immunodeficiency virus epidemic has a major impact on emergency services and that strategies need to be developed for appropriate use of emergency resources and also for maximizing provider protection.