Transcript Prevention of HIV in Health Care Facilities Dr KANUPRIYA CHATURVEDI LESSON OBJECTIVES • Describe strategies for preventing HIV transmission in the healthcare setting • Describe.

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
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•
•
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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