Prevention of transmission of human immunodeficiency virus (HIV)
All body fluids from a person infected (or suspected of being infected) with HIV should be considered potentially infectious. HIV may be transmitted:
(1) by needles or sharp instruments contaminated with blood or body fluids and not properly sterilized;
(2) by contact between open wounds, broken skin (for example caused by dermatitis), or mucous membranes and contaminated blood or body fluids; and
(3) by transfusion of infected blood or blood products, semen donation, and skin or organ transplantation.
The prevention of HIV infection requires special attention to these means of transmission as well as the strict application of aseptic routine. Most of the small number of reported infections of health workers with HIV have resulted from injuries caused by needles (for example during recapping) and other sharp instruments. After use, disposable needles and scalpel blades should be put into a puncture-proof receptacle, preferably containing a sodium hypochlorite disinfectant. Reusable needles should also be placed in a special container of disinfectant before being cleaned and sterilized. Surgical gloves prevent transmission of HIV through contact with blood, but there is always the possibility of accidental injury and of a glove being punctured. Thick gloves should, therefore, be worn when needles and sharp instruments are being cleaned. Where HIV infection is prevalent among patients, needles and instruments should routinely be soaked in a chemical disinfectant for 30 min before cleaning. Linen soiled by a patient who is or may be infected with HIV should be handled with gloves and should be collected and transported in leak-proof bags. It should be washed with detergent for 25 min at a temperature of at least 71 °C.
Liquid wastes, such as blood and fluids removed by suction, should be carefully poured down a drain connected to a sewer or into a pit latrine. Otherwise, they should be chemically disinfected. Solid waste should be incinerated or disposed of in a pit latrine; chemical disinfection may be a temporary expedient.
Proper sterilization of all surgical instruments and supplies is crucial in preventing HIV transmission. All viruses, including HIV, are inactivated by steam sterilization (autoclaving) for 20 min at 100 kPa above atmospheric pressure or by dry heat in an oven for 2 hours at 170 °C.
Several points of aseptic routine applicable to members of the surgical team are also particularly relevant to the prevention of transmission of HIV:
- Areas of broken skin and open wounds should be protected with watertight dressings.
- Fluids and the hands should be washed with soap and water afterward.
- Gloves should be worn during exposure to blood or body
- Frequent use of ethanol or other antiseptics on the hands and arms should be avoided, because it may lead t0 broken skin.
- Protective glasses should be worn where blood splashes may occur, as during major surgery; if the eyes are inadvertently splashed, they should be washed out as soon as possible with saline. It should be appreciated that the whole purpose of the aseptic method is to prevent transmission of infection and that strict attention to every detail of asepsis, with special care to avoid accidental injury during operation, is the best protection against HIV.