Prevention of HIV in Health Care Facilities

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Prevention of HIV in Health Care Facilities

• Dr KANUPRIYA CHATURVEDI

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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

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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

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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

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Blood-borne Pathogens

• In addition to HIV, blood-borne pathogens include
• Hepatitis B and C
• Syphilis
• Malaria
• Bacterial infections like Brucellosis

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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

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Infection Control Measures

• Universal Precautions
• Management of the work environment
• Ongoing education of employees in all aspects of
  infection prevention

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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

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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

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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

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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

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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

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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

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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

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Personal Protective Equipment

• Basic personal protective equipment
• Glovescorrect size
• Apronsas a waterproof barrier
• Eyewearto avoid accidental splash
• Footwearrubber boots or clean leather shoes

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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

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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

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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

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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

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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

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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 

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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  

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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

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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

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Key Points (continued)

• Clean, disinfect, and sterlise al instruments
  used in invasive procedures
• Burnout syndrome is related to intense, prolonged
  job stress