News Director: Gail M.
Pfeifer, MA, RN
infections. And a survey of physi-
cian members of the Emerging In-
fections Network showed that
18% of respondents were con-
sidering stopping or altering the
practice. “I hope we become less
dogmatic about what needs to be
done,” said Morgan, an associate
professor at the University of
Maryland School of Medicine in
Baltimore, in an interview with
AJN. He considers the CDC guide-
lines outdated, given improvements
hospitals have made in infection
control.
Many of the trends that have
allowed hospitals to consider
­relaxing contact precautions
come from good practices at the
New Guidelines on HIV Prevention in Teens and Adults
Recommendations are aimed at reducing infectiousness and
transmissions.
T
he Centers for Disease
Control and Prevention
(CDC) reports that in
2010, the last year for which
data exist, there were roughly
47,500 new HIV infections in the
United States. Although advances
in HIV treatment and prevention
have improved health outcomes
in those battling the infection, the
number of people living with HIV
has been rising by about 30,000
each year, highlighting the need
to prevent transmission to others.
Prompted by advances in HIV
care and new national preven-
tion goals, the CDC, the Health
Resources and Services Adminis-
tration, the National Institutes of
Health, and five nongovernmental
organizations have released new
recommendations on prevention
in adults and adolescents that re-
flect the most current evidence.
Recommendations for HIV
Prevention with Adults and
ajn@wolterskluwer.com
patient level, such as improved
hand hygiene, bathing patients
with chlor­hexidine, and care
bundles that reduce infections
in patients with central lines or
on ventilation.
Before VCUMC decided to
­reduce its use of contact precau-
tions, many of those practices
were in place, including a hand
hygiene–compliance rate that had
exceeded 85% for four straight
years. During the year VCUMC
tested its hypothesis, contact pre-
cautions were used only with pa-
tients infected or colonized with
MRSA or VRE who had wound
drainage not contained within a
dressing or uncontained respiratory
­ dolescents with HIV in the
A emphasize education and referral
United States, 2014 (http://stacks.
cdc.gov/view/cdc/26062) is an up-
date on 2003 recommendations
and is aimed at a wider audience,
including nurses, physicians, clini-
cal and nonclinical care providers,
health department workers, and
people with HIV.
In some ways the recommen-
dations remain consistent with
existing guidelines, advocating
the use of antiretroviral therapy
(ART) soon after diagnosis to
promote health, reduce infec-
tiousness, and reduce the risk of
transmission. Major differences
include an emphasis on actively
connecting patients with appro-
priate care providers, as opposed
to passive referral; a push to be-
gin ART sooner after diagnosis
(within three months) and do so
regardless of CD4+ cell count;
and keeping patients in the sys-
tem. The recommendations also
E-mail: ajnNews@wolterskluwer.com
secretions. Keeping the gowns
and gloves off proved popular
with staff and patients, too, and
resulted in a savings of $700,000
in materials, hospital officials said.
“More and more people are in-
terested in looking at this. Everyone
feels the same way: contact pre-
cautions are a barrier to good
care,” said Michael B. Edmond,
a former administrator at VCUMC
who is now chief quality officer at
the University of Iowa Hospitals
and Clinics in Iowa City.—John
Welsh, RN
Morgan DJ, et al. JAMA 2014;312(14):1395-
6; Bearman G, Stevens MP. Curr Infect Dis
Rep 2012;14(6):620-6; Morgan DJ, et al. Am
J Infect Control 2009;37(2):85-93.
services as means to decreasing
HIV transmission and promoting
adherence to ART.
The recommendations update
guidance on risk screening and
risk reduction, suggesting more
sensitive testing for sexually trans-
mitted disease (STD) screening, as
well as better follow-up. Patients
also need to be taught that certain
STDs increase the likelihood of
HIV transmission and should be
informed of the availability of pre-
exposure prophylaxis, as well as
postexposure prophylaxis for part-
ners, to reduce the risk of trans-
mission.—Maria Nix, MSN, RN
AJN ▼ March 2015 ▼ Vol. 115, No. 3 15