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PREVENTION
OF TRANSMISSION OF THE HUMAN IMMUNODEFICIENCY VIRUS
(HIV)
In the clinical setting, HIV may be transmitted by:
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Injury
with needles or sharp instruments contaminated with
blood or body fluids |
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The
use of equipment that has not been properly disinfected,
cleaned and sterilized |
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Contact
between open wounds, broken skin (for example, caused
by dermatitis) or mucous membranes and contaminated
blood or body fluids |
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Transfusion
of infected blood or blood products |
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"Vertical” transmission
between mother and child during pregnancy, delivery
and breast feeding. |
Most
of the small number of reported infections of health workers
with HIV have resulted from injuries caused by needles
(for example, during recapping) and other sharp instruments.
After use, always put disposable needles and scalpel blades
(“sharps”)
into a puncture- and tamper-proof container that
has been labelled clearly. The risk of transmission
in the case of any given exposure is related to the
prevalence of the disease in the area, the portal
of entry (cutaneous, percutaneous or transfusion)
and the inoculum dose from the exposure.
Take care of your patients, your co-workers and yourself:
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Do
not recap needles |
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Set
up sharps containers in the places where you use sharps;
the further you have to move to dispose of a sharp
the greater the chance of an accident |
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Do
not use the same injection set on more than one patient |
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Dispose
of your own sharps |
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Pass
needles, scalpels and scissors with care and consideration. |
Several
points of aseptic routine applicable to members of the
surgical team are also particularly relevant to the prevention
of transmission of HIV:
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Protect
areas of broken skin and open wounds with watertight
dressings |
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Wear
gloves during exposure to blood or body fluids and
wash your hands with soap and water afterwards |
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Wash
immediately in the case of skin exposure or contamination,
whether from a splash, glove puncture or non-gloved
contact |
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Wear
protective glasses where blood splashes may occur,
such as during major surgery; wash out your eyes as
soon as possible if they are inadvertently splashed |
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Wear
a protective gown or apron if splash potential exists |
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Clean
blood spills immediately and safely. |
The
purpose of infection precautions and aseptic technique
is to prevent the transmission of infection. The best protection
against HIV and other transmissible infection is attention
to every detail of asepsis, with special care to avoid
injury during operation. In some places, prophylactic medications
are offered after needlestick injury or other potentially
infectious contact. Each hospital should have clear guidelines
for the management of injury or exposure to infectious
materials.
Latex allergy
Increased exposure to latex has resulted in reactions
by some people to certain proteins in latex rubber.
Reactions range from mild irritation to anaphylaxis.
When caring for a patient with latex allergy, always
check the composition of tape, tubes, catheters, gloves
and anaesthetic equipment. Even the stoppers at the
top of medication vials may contain latex. All health
care workers should be aware of this possibility and,
if sensitized, consider the composition of gloves and
using non-latex gloves.
Aseptic technique
Infection is the most important and preventable cause
of impaired wound healing.
Microorganisms can reach the tissues during an operation
or manipulation of the surgical wound. They are carried
and transmitted by:
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People,
including the patient |
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Inanimate
objects, including instruments, sutures, linen, swabs,
solutions, mattresses and blankets |
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Air
around a wound, which can be contaminated by dust and
droplets of moisture from anyone assisting at the operation
or caring for the wound. |
The
aseptic treatment of a wound is an attempt to prevent contamination
by bacteria from all these sources, during the operation
and throughout the initial phase of healing. Bacteria can
never be absolutely eliminated from the operating field,
but aseptic measures can reduce the risk of contamination.
Aseptic technique includes attention to innumerable
details of operating technique and behaviour. Anyone
entering the operating room, for whatever reason, should
first put on:
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Clean
clothes |
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An
impermeable mask to cover the mouth and nose |
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A
cap or hood to cover all the hair on the head and face |
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A
clean pair of shoes or clean shoe-covers. |
Caps,
gowns and masks are worn to decrease the risk of patient
exposure to contamination or infection from the surgical
team. Sterile instruments, gloves and drapes are also key
elements in the fight against contamination.
Operative procedure list
An operative procedure list is needed whenever the
surgical team will perform several operations in succession.
The list is a planned ordering of the cases on a given
day. Elements such as urgency, the age of the patient,
diabetes, infection and the length of the procedure
should all be considered when drawing up the list.
Operate on “clean” cases before infected
cases since the potential for wound infection
increases as the list proceeds. Also consider other factors
when making up the operative list: children
and diabetic patients should be operated on early in the
day to avoid being subjected to prolonged periods without
food.
Ensure that between operations:
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The
operating theatre is cleaned |
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Instruments
are re-sterilized |
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Fresh
linen is provided. |
It
is essential to have clear standard procedures for cleaning
and the storage of operating room equipment; these must
be followed by all staff at all times. The probability
of wound infection increases in proportion to the number
of breaches of aseptic technique and the length of the
procedure.
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