Prevention of HIV in Health Care Facilities

Dr KANUPRIYA CHATURVEDI

LESSON OBJECTIVES

• Describe strategies for preventing HIV transmission in the healthcare setting

• Describe universal precautions (UPs) in the context of PMTCT

• Identify key steps and principles involved in the decontamination of equipment and materials

Objectives (continued)

• Assess occupational risk and identify risk-reduction strategies in MCH settings

• Describe management of occupational exposure to HIV

• Identify measures to minimize stress and provide support to healthcare workers and caregivers

Basic Concepts of HIV Transmission

• Primary source of HIV infection in the healthcare setting

• Blood or body fluids in direct contact with an open wound, or by needle or sharp stick

• High-risk MCH settings• Obstetric procedures• Labour and delivery• Immediate care of the infant

Blood-borne Pathogens

• In addition to HIV, blood-borne pathogens include

– Hepatitis B and C– Syphilis– Malaria– Bacterial infections like Brucellosis

Prevention of HIV Transmission

•Healthcare worker to patient and patient to healthcare worker or another patient

• Apply Universal Precautions

•Patient to patient

• Sterilize contaminated equipment and devices

Infection Control Measures

• Universal Precautions

• Management of the work environment

• Ongoing education of employees in all aspects of infection prevention

Universal Precautions Definition

Safe or good clinical practices

applied ‘universally’ in caring for all

patients, regardless of the

diagnosis in order to minimise or

avoid exposure to infection

Universal Precautions

– Applied universally in caring for all patients

• Hand washing

• Decontamination of equipment and devices

• Use and disposal of needles and sharps safely (no recapping)

• Wearing protective items

• Prompt cleaning up of blood and body fluid spills

• Systems for safe collection of waste and disposal

Promotion of a Safe and Supportive Work Environment

• Management of the work environment to• promote safety includes

• Implementation, monitoring and evaluation of use of UPs

• Procedures for reporting and treating occupational exposure to HIV infection

• Attaining and maintaining appropriate staffing levels

• Providing protective equipment and materials

• Providing appropriate disinfectants

Education in Infection Prevention

• Education of HCWs includes

• Making all staff aware of established infection control policies

• Ongoing training to build skills in safe handling of equipment and materials

• Monitoring and evaluation of practices

to remedy deficiencies

Handling of Equipment and Materials

• Risk reduction strategies

• Hand washing

• Assessment of condition of protective equipment

• Safe disposal of waste materials

• Ensuring that appropriate cleaning and disinfecting agents are available

• Decontamination of instruments and equipment

• Monitoring of integrity of skin

Handling and Disposal of Sharps

• Use syringe or needle once only

• Avoid recapping, bending, or breaking needles

• Use puncture-proof container for disposal

• Clearly label container “SHARPS”

• Never overfill or reuse sharps containers

• Dispose of sharps so people cannot access them

Hand Hygiene

– Recommended Practice

• Soap and water hand washing using friction under running water for at least 15 seconds

• Using alcohol-based hand rubs (or antimicrobial soap) and water for routine decontamination

Personal Protective Equipment

• Basic personal protective equipment

• Gloves—correct size

• Aprons—as a waterproof barrier

• Eyewear—to avoid accidental splash

• Footwear—rubber boots or clean leather

shoes

Safe Decontamination of Equipment

• Cleaning • Removes high proportion of micro organisms and

contaminants

• Disinfection• Eliminates most recognized pathogenic micro

organisms, inactivates HIV

• Sterilization• Destroys all micro organisms, inactivates HIV

Safe Work Practices

• To reduce occupational risks

• Assess high-risk situations and areas

• Develop safety standards and protocols

• Institute measures to reduce occupational stress

• Orient new staff to safety protocols

• Provide ongoing staff education and supervision

• Develop protocols for post-exposure prophylaxis (PEP) and general first aid

Risk Reduction in the Obstetric Setting

• Minimize high risk of exposure to HIV-infected blood and body fluids in labour room

• Cover broken skin with watertight dressing

• Practice universal precautions

• Wear proper protective clothing

• Double-glove during procedures

• Long-cuffed gloves during manual removal of placenta

• Dispose of solid waste according to recommended protocols

Managing Occupational Exposure to HIV Infection

Post-Exposure Prophylaxis (PEP:

• PEP – Following occupational HIV exposure, short-course of ARV drugs can be used to reduce the likelihood of infection

• Register occupational exposures

• Ensure that HIV counselling, testing,and ARV drugs are available

• Educate healthcare workers

Post-Exposure Prophylaxis (PEP)

• Immediate steps post- exposure

• Wash exposed wound or skin with soap and water

• For needle or sharp injury, allow to bleed for a few seconds before washing

• Inform supervisor of type of exposure and the actions taken

• Assure confidentiality to the HCW

• Ensure support and referral for treatment

Guidelines for PEP

• Ideally, initiate PEP treatment within 2 hours of exposure     

• If source patient is HIV negative, discontinue PEP and retest at 6 weeks, 3 months, and 6 months

• If source patient is HIV positive, counsel, support, and refer the HCW for continued treatment 

Guidelines for PEP (continued

– Follow approved PEP regimen

– Examples

• ZDV 200 mg 3 times daily for 4 weeks

• Combivir tablet (300 mg ZDV and 150 mg lamivudine) twice daily +

• Indinavir 800 mg 3 times daily for 4 weeks  

Key Points

• Universal precautions apply to all patients, regardless of diagnosis

• Key components of UPs include• Hand washing

• Safe handling and disposal of sharps

• Use of personal protective equipment

• Decontamination of equipment

• Safe disposal of infectious waste materials

• Safe environmental practices

Key Points (continued )

• Needle-stick injuries from HIV-infected patients are the most common source of HIV transmission in the workplace

• During labour and delivery, safe care reduces the risk of occupational exposure

• Short-term ARV treatment reduces risk of HIV infection after occupational exposure

Key Points (continued)

• Clean, disinfect, and sterlise al instruments used in invasive procedures

• Burnout syndrome is related to intense, prolonged job stress