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Clinical Predictors of Infection of Central Venous Catheters Used for Total Parenteral Nutrition

District (Ben Taub and Lyndon B. Johnson hospitals) and several private institutions care for more HIV-positive patients than our institution. Several primary care physicians at these private institutions have self-declared “acquired immunodeficiency syndrome (AIDS) practices.” There is a consensus that voluntary HIV testing to identify infection patients should be accomplished. The best approach to testing-who, how, where, and when-has not been established. We believe the authors took excep tion to the word “widespread” (not used in the first line of the abstract). As discussed in our article, we also believe in a targeted approach, but how best to select the population to test deserves further study. The statistical difference between the seroprevalence of patients agreeing to and declining HIV screening reached a p value of .12-a value that is generally interpreted as not statistically significant. Before this study, our hypothesis was that we would see a statistically significant difference in the HIV seroprevalence of these groups; we did not . Whether the difference between 0.26% and 0.60% is medically significant, even though not statistically significant, is left to the reader. With a bigger sample size or different population, statistical difference might be shown, but it was not in our study. It takes a leap of faith to believe “these data clearly suggest that persons at risk will selectively refuse participation.” As we stated, the screening process did discover 12 patients not previously known to be HIV positive by the admitting physician. Even the patient who knew he was HIVpositive did not convey this information to healthcare workers until he was told of the positive serology. Some of these patients would have been found to be HIV-positive at some time during hospitalization, but when and how many are not known. In assessing the financial aspects of HIV testing, it is important to distinguish between cost and charges. Many variables must be included in any financial equations, and several were discussed in the article. Certainly, the discovery of one HIV-positive patient and the subsequent prevention of one hospitalization for Pneumocystis carinii pneumonia or the prevention of transmission to one sexual partner would save huge sums of money. The cost analysis of an HIV screening program is very complex. HIV testing has not been a financial loss for our institution, although it might be for a public hospital. We agree that counseling high-risk patients is a valuable approach in controlling the AIDS epidemic and that screening programs are a golden opportunity for counseling. More work needs to be done in this area. As we discussed in our article, there is considerable difference in the interest demonstrated by various TMH physicians and other healthcare workers in this screening program. The majority of physicians are supportive of the program, but vary in their degree of active participation. Few physicians are against the screening program. The scope of this article did not include longterm follow-up on HIV discoveries; however, each of these patients was counseled by physicians with expertise in the care of HI&elated disease and given the opportunity for prompt and appropriate medical care. The purpose of our report was to share the “good and bad” experience of admission HIV screening in a large hospital. The program is well accepted by patients and healthcare workers. Although it is not perfect and a targeted population approach would be much more cost effective, hospitals are practical places for HIV screening, and the benefit is to the patient.