Since the advent of the HIV pandemic, health care workers including medical trainees have been at increased risk of infection through exposure to blood or body fluids. The risk of occupational exposure is high even among medical students working in resource-rich North American hospitals. A survey conducted among the graduating class of 2003 at the University of Toronto School of Medicine revealed that 35% (55 of 157) of students selleck chemicals had sustained at least one needlestick injury and less than 50% of those with exposures sought medical advice.5 The American Medical Association recommends that US medical schools ensure that medical students who engage in clinical rotations

abroad have immediate access to HIV postexposure prophylaxis (PEP), and encourages medical schools to provide information to students regarding potential health risks associated with international electives and education regarding appropriate precautions STA-9090 to minimize risks.6 Among health care workers globally, 2 million needlestick injuries occur annually.7 Although the risk for HIV transmission from needlestick

accidents in the United States is estimated to be 0.3%, the global rate is estimated to be 4.4%.8,9 The World Health Organization (WHO) estimates that annually there are 1,000 (range 200–5,000) new HIV infections due to occupational exposures experienced by health care workers.9 Among all HIV-infected health care workers, 2.5% of their infections are believed to result from occupational exposures, indicating the significant risk of nosocomial exposures. While the greatest number of documented reports of occupational infection are from the United States and Europe, the majority

of exposures occurs in the developing world.7 Although 70% of the world’s HIV-infected population resides in sub-Saharan Africa, only 4% of worldwide occupational cases of HIV infection have been reported in this region.10 Given substantial underreporting and the lack of basic supplies such as gloves, protective eyewear, and special safety devices such as needleless phlebotomy devices, the risk of nosocomial exposure to blood and body fluids is likely to be much greater in developing Tyrosine-protein kinase BLK countries than in industrialized countries. Consistent with this hypothesis, a South African study found that 91% of junior physicians sustained needlestick injuries in the previous year, with 55% of those exposures occurring with patients who were known to be HIV positive.11 Thus, percutaneous exposure to blood products internationally remains a serious threat and must be recognized as a health hazard to traveling health care workers, including medical trainees. In developed countries, PEP has greatly reduced the potential risk of infection for health care workers.