Patient-to-Patient transmission

Patient-to-patient spread of HIV infection is usually by an indirect route. This transmission can occur through contaminated needles, syringes and instruments.

Patients can also be infected when they receive contaminated blood or blood products.

Health Care Worker to Patient Transmission

Although theoretically this is possible, however, chances of it occurring are almost nil. Thus, HIV infected health care workers are not considered a risk to patients during routine work activities.

Infection control in health care setting consists of

1. Barrier precautions (Universal precautions)
2. Aseptic precautions
3. Decontamination
4. Disposal of infective waste
5. Barrier precautions (Universal Precautions) in relation to blood, body fluids, tissue and organs.

Note

1. All blood and body fluids to be assumed infections.
2. Check the continuity of skin by alcoholic rub.

Hand Washing

Hands and other parts of the body that have been contaminated with blood and body fluids must be washed thoroughly with soap and water. Hands should also be washed immediately after removal of protective gloves and in between handling of patients.

Gloves, Masks, Eye Protector and Gowns

Health care workers should wear gloves for all direct contact with blood and body fluids. When gloves are not available, other methods should be used to prevent direct contact with blood; for example, forceps, towel gauze or, if these are not availale, any material such as a plant leaf may be employed to hold a blood stained needle or syringe in rural conditions. If gloves are not disposable, they should be disinfected, washed and sterilized after contact with each patient. When injuries from sharp instruments are possible e.g. when they are being cleaned, extra-heavy duty (rubber) gloves should be used and the instruments should be handled with extreme care.

During procedures in which there may be splashing of blood e.g. during surgery or child birth, the eyes nose and mouth should be protected with a face shield or mask and eye glasses. Suitable plastic sheet should be worn inside gowns.

Mouth-to-mouth resuscitation

Although HIV has been recovered from saliva, the virus is present in very small numbers, less than 1 virus per millitires (ml). There is no conclusive evidence that saliva can be involved in HIV transmission. Always create barrier by using gauze piece while giving mouth to mouth resuscitation.

Cleaning and Decontaminating Spills of Blood or Other Body fluids

In case of a blood/body fluid spill do the following:

1. Cover the spill with absorbent material, such as gauze cotton, newspaper, cloth.
2. Pour the disinfectant fluid over the spill starting peripherally to the centre.
3. Leave the disinfectant fluid for at least ten minutes.
4. Clean the area after wearing gloves.

Precautions in Relation to Laboratory Specimens

1. Always wear gloves when handling and processing specimens of blood and other body fluids.
2. Always collect and transport only in screw cap leak proof containers/bottle
3. Take care to avoid contamination of outer surface of the containers while transporting samples.
4. Under no circumstances mouth pipetting should be permitted (Hb estimation.) Westergren method of measuring ESR should be replaced by wintrobe technique where no mouth pipetting is required.
5. All open wounds on hands and arms of laboratory worker should be covered with a waterproof dressing, preferably, the person should not handle blood or any body fluids.
6. Hands should always be washed with soap and water immediately after exposure to specimens in laboratory procedures.