Protection of health workers

Health workers, AIDS and prevention
Professional risk

The main way of HIV infection in the professional health environment is a skin injury (eg, needle stick) and its exposure to blood infected with HIV. Research shows that infection following needle stick is not common since there are 3 infections per 1000 stitches. Although the risk of accidental infection of a small needle stick is low, this way of infecting understandably represent a cause for serious concern to many health care workers.

In Great Britain, for example, since 1984. health care workers who have been exposed to viruses that are transmitted through blood in any way were monitored. In October 2003. Health Agency of Great Britain reported 5 documented cases of HIV seroconversion (infection) through occupational exposure to the virus in a health facility and 12 possible, also resulting from professional risks. Four of these 17 people have died since then. These health workers have been infected before prophylaxis intended for incidental exposure to the virus (urgent intensive therapy) was available.
In our country this kind of monitoring the health of workers does not exist.


Some specific factors have a greater risk when a needle injury occuresd, for example:
• Deep injury
• Violation of the hollow needle
• When a patient with AIDS uses a needle
• When a sharp instrument is visibly contaminated with blood of others
• When a sharp instrument had been previously in an artery or vein

If exposure to other people's blood through the injury on the skin occurs, there should induce and reinforce bleeding, pressing around the site of the injury (but taking care not to pressure directly on the site of injury). It is best to do this under running water.

Researchs suggest that exposure of mucous membrane to infected blood carries risk of HIV infection less than 1 in 1000 (eg, if infected blood is splashed in the eye). If this occurs, contact point should be washed with soap and water. If the eye is affected, it should be well rinsed.

If the intact skin is exposed, there is no risk of infection!

Prophylaxis

Prophylaxis (preventive measures) intended for incidental exposure to the virus (Post Exposure Prophylaxis) is a treatment of anti-HIV drugs to reduce the risk of infection, which is applied immediately after contact with infected blood.

Researchs show that the use of anti-HIV drugs such as Zidovudine in combination with some other anti-HIV drugs administered immediately or as soon after the resulting injury may reduce the rate of infection.

The recommendation is to start with this treatment within 24 - 36 hours after injury, preferably within the first few hours of the resulting contamination of infected blood.

Although exposure to the virus through needle injury usually can be prevented and avoided by complying with the practices and rules of conducting in the workplace, health workers should consider the implications for the incidental use of prophylactic treatment, which would help them make quick decisions in case of an injury.

Across the world needle sticks are usually treated with drug Lamivudine (3TC, Epivir) for 4 weeks. For severe exposure to the virus adding a protease inhibitor is recommended.

In any case, it is wise to turn to colleagueses, professionals in the field of HIV/AIDS at your clinic, hospital or other health institution.

Precautions

What are the universal precautions for infection control?

Universal precautions for infection control means that the precautions are taken during a work with each person, so that health workers have no need for assumptions and speculations about the lifestyles of people and possible risks of infection.

Health workers should have the right to be protected against infection, regardless of whether it is HIV, hepatitis or other infections.

Universal measures that should be applied to protect against any infection that is spread by blood:
• Always wear gloves when handling blood or any body fluid.
• If you have cuts or other injuries cover them with waterproof tape.
• Wipe the spilled blood by using gloves and paper towels and wash with detergent or chlorine solution or tablets made from sodium-dichloro-Cijanurata (NADC). Alternatively a 1% solution of sodium hypochlorite can be used. When these assets are not available, household bleach solution can be used.
• In a hospital environment, all the sheets and linens soiled with blood should be packed in suitable bags and labeled according to the hospital regulations. In the outpatient conditions, such material should be washed in the washing machine at high temperature (70 degrees or more).