HIV transmission and universal precautions

Definition
Human immunodeficiency virus (HIV, the virus that causes AIDS) is considered a blood-borne pathogen. This means the virus is a microorganism carried in blood and body tissues that can be passed to others and cause an infectious disease.

Transmission
Blood, semen, breast milk and vaginal secretions all contain enough of the virus to spread HIV. Urine, saliva, respiratory secretions and tears may also carry the virus, but not in quantities large enough to cause infection. Other body fluids withdrawn from a body cavity -- such as a joint, the abdomen or the spinal column -- may also be contaminated, but these fluids have never been documented to spread HIV. However, any body fluid that contains visible blood, such as saliva during dental work, is capable of transmitting HIV.
The virus can enter the body through mucous membranes, such as those lining the eyes, nose, mouth, genitals or rectum. HIV may also enter the body through breaks in the skin, as may occur with contaminated needles or other sharp instruments. This rule also applies to contaminated instruments used to pierce the skin for tattooing, body piercing or acupuncture. According to recommendations from the Centers for Disease Control and Prevention (CDC), such instruments should be used only once and thrown away properly or be sterilized between uses.

Other methods of transmission for HIV, hepatitis B and other blood-borne pathogens include:

sexual contact (The virus can enter the body through the lining of the vagina, vulva, penis, rectum or mouth.)
sharing contaminated needles, most common with injection drug users
accidental sticks from contaminated needles or other sharp instruments, most common in medical settings
HIV can also spread from an infected mother to her unborn child in the womb, during childbirth or through breast milk. The presence of other sexually transmitted diseases increases the chances of HIV entering the body during genital sexual contact or childbirth. Mothers who are HIV-positive should not breastfeed their children.

The screening and treatment of donated blood and blood products since 1985 in the United States and other countries have made the risk of acquiring HIV from contaminated blood and blood products very minor. This may not be the case in developing countries where the financial resources for screening are inadequate, however.

HIV does not spread through ordinary contact that does not involve body fluids, such as routine social or community contact. Because the virus cannot survive outside the body for long, you can't pick up the virus from inanimate objects, such as toilet seats or doorknobs. When fluids infected with HIV dry, there is considered to be no risk of infection.


Prevention
Today, the number of AIDS cases related to occupational exposure is small. The CDC and the Occupational Safety and Health Administration (OSHA) have established guidelines for reducing the risk of contracting HIV and other infections. In turn, employers of health care professionals and others working in high-risk fields have developed policies, procedures and training courses on how to avoid exposures. Employees also learn how to handle exposure incidents.
When providing care or services in any setting that may involve exposure to potentially infected blood or body fluids, familiarize yourself with your employer's policies and procedures. Follow those recommendations as well as the universal precautions recommended by the CDC. (Universal precautions consider all blood and certain body fluids potentially infectious for HIV and other blood-borne pathogens.)

Wear gloves when touching or handling blood and body fluids, mucous membranes or skin that is broken. Change gloves after contact with each patient. Wash your hands with soap and water after removing the gloves.

Wear gloves when handling equipment or touching surfaces contaminated with blood or body fluids.

Separate clean or sterile equipment from contaminated articles.

Wear masks and protective eyewear during procedures. Wear a face shield if there is danger of a splash or spray of blood or body fluids.

Wear an apron, gown or other clothing that provides covering if blood or body fluids could splash or drip onto your clothing during procedures.

If you're providing emergency resuscitative care, use resuscitation devices that prevent direct mouth-to-mouth contact.

Discard needles and other sharp instruments in puncture-resistant containers. Keep these containers as close to the work area as possible. Dispose of the containers before they are overfilled. Do not recap or manipulate needles by hand.

Dispose of soiled aprons, gowns or clothing covers in containers designated for decontamination or disposal of contaminated items.

Place contaminated waste in leak-proof hazardous waste containers for disposal.

Clean spilled blood or body fluids with a commercial germicide or diluted household bleach solution. Depending on the amount of soiled material to be disinfected, concentrations of 1:10 to 1:100 dilution are effective.

Cover specimen containers to decrease splashing. Transport them in a leak-proof container labeled "biohazard."

Do not eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in work areas where blood or body fluids are present.

Do not keep food and drink where potentially infectious material is kept.
You may want to discuss any concerns with your health care provider or another health care professional. Ask for recommendations on which precautions to take for the tasks you perform.


Handling workplace exposure
If you are exposed to infected blood or body fluids or suspect exposure:
Wash the exposed area of skin immediately with soap and water. Flush splashes to mucus membranes (the nose or mouth) with water. If blood or other body fluids have gotten into your eyes, irrigate your eyes with clear water or sterile eye irrigants.

Report the exposure immediately.

Complete any paperwork required by your employer to document the incident. In 2001, Congress passed the Needlestick Safety and Prevention Act which includes requirements for employers to keep a sharps injury log.

Record the date of exposure for future reference.

Verify your immunization status.

Ask a medical authority immediately about testing and treatment, including counseling. The CDC has a protocol for postexposure preventive treatment for health care workers exposed to HIV on the job. According to the CDC, occupational exposure is an urgent situation that should be addressed within hours.

Get baseline blood tests for yourself and the potentially infected person. Repeat your blood tests at future intervals, usually at six weeks, three months and six months after exposure.

Discuss risk and benefits of antiviral treatment with your health care provider.

Report any signs and symptoms of infection to your health care provider.