|
| Home » Themes |
| |
 |
|
CLINICAL MANAGEMENT |
|
| |
|
|
| |
| Introduction |
| Infection Control Precautions |
| Environmental Contamination |
| |
| |
| Introduction
|
| |
| Clinical management of HIV infection
and AIDS is a part of comprehensive care for individuals affected
by the disease. In order to meet the total needs of persons
affected by the infection there are other facets of care like
nursing care, counselling ad social support that have to be
taken into consideration. To help meet these varied needs, the
concept of comprehensive HIV/AIDS care across a continuum is
advocated. This is the pooling together of medical and social
services within the community, and the creation of linkages
between the community care initiatives and all levels of the
health care system. |
|
Back toTop |
| |
| Infection
Control Precautions |
| |
| Universal Precautions |
| |
| The Centers for Disease Control (CDC) developed
universal precautions to prevent transmission of blood-borne
pathogens. These precautions are designed to prevent direct
contact with blood, body fluids, and certain other fluids (amniotic
fluid, semen, vaginal fluid, cerebrospinal fluid, serial transudates/exudates,
and inflammatory exudates). Recommended barrier precautions
include the use of gloves for procedures, imparting a risk of
contact with these potentially infected fluids, tissues, and
materials; the use of masks and protective eyewear when splatter
of such body fluids is anticipated; and the use of gowns or
other protective garments when clothing is likely to be soiled. |
| |
|
Back toTop |
| |
| Body Substance Precautions |
| |
Body Substance Isolation (BSI) or Body Substance
Precautions (BSP) is an alternative system of infection control,
practiced by many institutions in which the decision about barrier
protection is based on the degree
of anticipated contact with body fluids and tissues. Unlike
universal precautions, which are based on the patient's diagnosis
(disease specific), BSI is based on the degree of contact anticipated,
regardless of diagnosis. In practice, the differences are largely
semantic. Both universal precautions and BSI emphasise prevention
of sharps injuries and use of barrier protection for avoiding
exposure to potentially infectious materials. Neither requires
the use of labeling of patients or specimens for implementation.
|
| |
| Standard Precautions |
| |
| In 1996, the CDC announced an entirely new system
of infection control. These standard precautions include features
of both BSI and universal precautions and apply to all patients.
They require the use of gloves, protective clothing, and other
barriers as needed to prevent direct contact with all body fluids
(except sweat). |
| |
| Precautions for Preventing Needlestick
Injuries |
| |
| Needlestick injury is the most frequent cause
of occupational HIV infection. Immediately after use, health
care workers should discard needles and other sharp instruments
in puncture-resistant containers. They must not resheath or
otherwise manipulate used needles. Needles must never be placed
on beds, furniture, or in waste cans. Puncture-resistant disposal
containers should be located in emergency trauma rooms,on code-blue
carts, in operating room suites, and in other areas as close
as possible to the point of needle use. For the rare situation,
in which needle recapping is necessary, health care workers
should use a single-handed method (e.g., in which the needle
cap is placed in a bracket, not held in one hand) or a recapping
shield device (e.g., in which a shield device protects the hand
holding the needle cap). |
| |
| Sharp Disposals |
| |
| Access to proper sharps disposal containers,
located at the "point of needle use," can prevent many post-use
sharps injuries. Use of these impervious containers also protects
cleaning personnel, laundry workers, and trash handlers who
are at risk for "downstream" injuries when needles are carelessly
discarded or abandoned. |
| |
| Needleless Devices |
| |
| Safer needle devices, which are engineered to
retract, cover, or blunt the needle after use, are now in widespread
use. The most efficacious devices are passive (do not require
an action on the part of the user to activate the safety feature),
are readily implemented without extensive training, do not increase
discomfort or complications in the patient, and are cost-effective.
With proper training and experience, these new devices can help
to prevent needle injuries, especially those that would occur
after the needle was used for its intended purpose. |
| |
| Needleless infusion systems are associated in
some but not all studies with a reduction in the frequency of
hollow-bore needle injuries. Although many needles used for
intravenous infusions are not contaminated with blood, those
at "downstream" sites, and those used for heparin flushes, are
potentially hazardous. To the extent that the needleless systems
eliminate this higher risk subset of contaminated needles, they
should contribute to a true reduction in disease transmission.
Moreover, it is difficult to determine if the needle is contaminated,
and most injured heatlh care providers worry about the potential
risk, even if the subjective data argue against a significant
risk. Preventing this type of injury is also an important component
of risk management. |
| |
| Handwashing |
Careful handwashing with soap and water is an
essential component of infection control. Health care
workers should carefully wash their hands before and after each
patient contact, after gloves are removed, and whenever contamination
with potentially infective materials occurs. |
| |
| Gloves |
The CDC recommends using disposable protective gloves if the
health care worker anticipates direct exposure to infected blood,
secretions, excretions, other body fluids, or tissue specimens.
Gloves may provide an extra margin of safety by preventing direct
contact with body fluids, but they are no substitute for handwashing
and needlestick precautions. Health care workers with exudative
skin lesions, weeping dermatitis, or cutaneous wounds should
not perform patient care activities until the condition resolves.
Clinicians should wear two pairs of gloves (double-gloving)
when performing invasive surgical procedures and whenever they
expect prolonged contact with large amounts of blood. Workers
with evidence of glove-induced dermatitis should wear hypoallergenic
gloves. Gloves do not prevent needle injuries, but may reduce
the volume of blood transmitted into the injury during an exposure.
|
| |
| Masks, Goggles, and Face Shields |
Health care workers should wear masks and protective eyewear
when anticipating splashes of blood or other body fluids. The
CDC recommends routinely wearing masks and eyewear during airway
manipulations and endoscopic or dental procedures. Using masks
is also prudent in the presence of coughing patients, suspected
of having contagious respiratory infection until diagnosis excludes
these infections or until treatment renders them noncontagious.
Clinicians should assign to private rooms those patients with
contagious diseases, transmitted through the airborne route.
Such patients should wear masks when leaving their hospital
rooms. |
| |
| Precautions for Preventing Spread
of Tuberculosis |
Co-infection with tuberculosis and HIV is a common
problem in urban areas. Clinicians should suspect tuberculosis
in immunosuppressed patients and other patients at epidemiological
risk who present with symptoms or signs of pulmonary infection.
The major cause of nosocomial and occupational outbreaks of
tuberculosis is a failure to recognise that a patient is infectious,
not a failure of infection control precautions. Ideally, patients
with known or suspected active pulmonary tuberculosis should
be placed in rooms engineered to enhance respiratory isolation.
Ventilation should allow for at least six air exchanges per
hour and be maintained at a negative pressure relative to other
patient care areas. The doors and windows of rooms housing patients
for whom tuberculosis precautions are in place should be kept
closed. Infectious patients should leave the room only when
necessary and should wear a mask. A properly tied standard surgical
mask adequately minimises droplet dissemination from these patients;
high-efficiency masks are not required. Clinicians should maintain
the patient in respiratory isolation until diagnosis excludes
tuberculosis or until treatment results in a clinical response
and the patient is no longer infectious.
Persons in contact with patients with diagnosed or suspected
pulmonary tuberculosis should wear a high-efficiency particulate
respirator to minimise inhalation of particles in the size range
of desiccated airborne tuberculosis bacteria. Use of these masks
requires fitness testing, although the value of this requirement
has not been established. |
| |
| Laundry |
| |
| Linens and hospital garments should be placed
in impermeable bags and laundered using standard hospital procedures.
Double-bagging is not necessary unless the outside of the bag
is contaminated. |
| |
| Waste Disposal |
| |
| Contaminated disposable items should be placed
in waterproof bags and disposed of in accordance with local
ordinances. Before disposal, items saturated with body fluids,
laboratory specimens, human and animal tissues, fluid-filled
containers, and needles and other sharps should be decontaminated.
|
| |
| Sterilisation and Disinfection |
| |
| Contaminated disposable items should be placed
in waterproof bags and disposed of in accordance with local
ordinances. Before disposal, items saturated with body fluids,
laboratory specimens, human and animal tissues, fluid-filled
containers, and needles and other sharps should be decontaminated.
|
| |
| Environmental
Contamination |
| |
| Environmental surfaces and fomites should be
washed and disinfected with a mycobactericidal hospital disinfectant.
A freshly made solution of 1/100 dilution of 5.25 percent sodium
hypochlorite (household bleach) is an effective germicide. A
1/10 dilution should be used for heavily contaminated items,
although bleach may damage some environmental surfaces. Spills
should be cleaned up before disinfecting the surfaces; the presence
of organic material reduces the efficacy of disinfection. Disinfectants
may lose their potency if diluted too extensively or allowed
to stand for longer than the manufacturer's recommended time. |
| |
|
Back toTop |
|
|
| |
