1. Prevention of HIV in Health Care Facilities Dr KANUPRIYA CHATURVEDI

2. 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

3. 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

4. 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

5. Blood-borne Pathogens In addition to HIV, blood-borne pathogens include –Hepatitis B and C –Syphilis –Malaria –Bacterial infections like Brucellosis

6. 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

7. Infection Control Measures Universal Precautions Management of the work environment Ongoing education of employees in all aspects of infection prevention

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Key Points Universal precautions apply to all patients, regardless of diagnosis Key components of UPs include 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

24. 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

25. Key Points (continued) Clean, disinfect, and sterlise al instruments used in invasive procedures Burnout syndrome is related to intense, prolonged job stress