Occupational exposure to HIV

In many countries for many years health care workers have become infected with HIV as a result of their work. The main cause of infection in occupational settings is exposure to HIV-infected blood via a percutaneous injury (i.e. from needles, instruments, bites which break the skin, etc). The average risk for HIV transmission after such exposure to infected blood is low – about 3 per 1,000 injuries. Nevertheless, this is still understandably an area of considerable concern for many health care workers.

Certain specific factors may mean a percutaneous injury carries a higher risk, for example:

• A deep injury
• Terminal HIV-related illness in the source patient
• Visible blood on the device which caused the injury
• Injury with a needle which had been placed in a source patient’s artery or vein

If percutaneous exposure occurs then the site of exposure should be washed liberally with soap and water but without scrubbing. Bleeding should be encouraged by pressing gently around the site of the injury (but taking care not to press immediately on the injury site). It is best to do this under a running water tap.

There are a small number of instances when HIV has been acquired through contact with non-intact skin or mucous membranes. Research suggests that the risk of HIV infection after mucous membrane exposure e.g. splashes of infected blood in the eye, is less than 1 in 1000. If mucocutaneous exposure occurs then the affected area should be washed thoroughly with soap and water. If the eye is affected, it should be irrigated thoroughly.

If intact skin is exposed to HIV infected blood then there is no risk of HIV transmission.

Post Exposure Prophylaxis

Research evidence seems to suggest that the use of anti-HIV drugs like zidovudine in combination with other anti-HIV drugs if given soon after an injury can reduce the rate of transmission. Such treatment is referred to as Post Exposure Prophylaxis (PEP). PEP is recommended for health care workers if they have had a significant occupational exposure to blood or another high risk body fluid which is likely to be infected with HIV. It is recommended that PEP should be commenced as soon as possible after exposure and ideally within the hour.

Although exposure through needle stick injuries can usually be avoided by following good working practices, health care workers should consider the implications of taking PEP. This will help them to make a swift decision in the event of an accident where an injury occurs. In the UK, the Department of Health guidelines for PEP are that most needle stick injuries should be treated with a triple combination of antiretroviral drugs for four weeks.Recommended drugs are zidovudine, lamivudine and nelfinavir.

What are Universal Precautions?

Employing universal precautions means taking precautions with everybody. If precautions are taken with everyone, health care workers do not have to make assumptions about people’s lifestyles and risk of infection. Health care workers should have the right to be able to protect themselves against infection, whether it is HIV, Hepatitis or anything else.

The following universal infection control precautions are advised by the World Health Organization to help protect health care workers from blood-borne infections including HIV:

• Wash hands with soap and water before and after procedures.
• Use protective barriers such as gloves, gowns aprons, masks, goggles for direct contact with blood and other body fluids.
• Disinfect instruments and other contaminated equipment.
• Handle properly soiled linen. (Soiled linen should be handled as little as possible. Gloves and leakproof bags should be used if necessary. Cleaning should occur outside patient areas, using detergent and hot water.)
• Use of new, single-use disposable injection equipment for all injections is highly recommended. Sterilizable injection should only be considered if single use equipment is not available and if the sterility can be documented with Time, Steam and Temperature indicators.
• Discard contaminated sharps immediately and without recapping in puncture and liquid proof containers that are closed, sealed and destroyed before completely full.
• Document the quality of the sterilization for all medical equipment used for percutaneous procedures.

Note: This information is cross-posted and slightly adapted from AVERT.org in order to emphasize some aspects refering particulary to Moldova. For more details, visual adds, updated information and primary sources, please visit AVERT.org web page.

Sources