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Health Care Workers & HIV Prevention
Occupational exposure to HIV
Post Exposure Prophylaxis
How many occupational infections have
been reported?
What are Universal Precautions?
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.
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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. For
more information about these drugs, see the introduction to HIV &
AIDS treatment.
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Up until December 2001, health care workers in the
USA reported 57 occupational HIV infections. Of these, 48 had
percutaneous exposure; 5, mucocutaneous exposure; 2, both
percutaneous and mucocutaneous exposure; and 2, an unknown route of
exposure. In addition, 139 other cases of HIV infection or AIDS have
occurred among healthcare personnel who have not reported other risk
factors for HIV infection and who report a history of occupational
exposure to blood, body fluids, or HIV-infected laboratory material,
but for whom seroconversion after exposure was not documented.
In the UK, as of July 2003, the Health Protection Agency (HPA)
reported that there have been five documented HIV seroconversions
through occupational exposure in the healthcare setting, and twelve
possible/probable occupational seroconversions.
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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 Organization3 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.
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