HIV/AIDS Training for Health Facility Employees

1. HIV/AIDS Training for Health Facility Employees Based on KNOW Curriculum from the Washington State Department of Health Edition 7- December 2014 revised and edited by Janee Moore MPH, Luke Syphard MPH, and David Heal MSW

2. Transmission and Infection Control Section Two

3. Necessary Conditions for Infection with HIV • Three conditions must occur for HIV to be transmitted: • There must be an HIV source • There must be a sufficient dose of virus • There must be access to the bloodstream of another person • Transmission primary occurs through: • Blood • Semen • Vaginal secretions • Breast milk

4. HIV Transmission • How is HIV transmitted? • Unprotected anal, vaginal, and oral intercourse • Sharing improperly sterilized needles or other injection equipment • Mother to baby transmission before or during birth • Breastfeeding • Accidental needle stick injuries • Transfusion prior to 1986 • Sharing razors or toothbrushes (extremely rare)

5. HIV Transmission Requirements • The transmission of HIV depends on.. • The availability of HIV in sufficient quantity • How viability (strength) of the HIV • How infectious the HIV is • The ability of the HIV to reach the blood stream, mucous membranes, or broken skin • The viral load (how much HIV is present in the bloodstream) is a predictor of how infectious an HIV-positive person is

6. Probability of HIV transmission from one HIV Exposure The CDC estimates the following probabilities of infection following ONE exposure to HIV: *A 1% risk means 1 in 100 chance for infection to occur. A 0.10% risk means 1 in 1,000 chance.

7. Behaviors that Increase Risk for HIV Transmission HIV Transmission Through Sexual Intercourse • Sexual Intercourse • HIV can enter bloodstream through mucous membranes, breaks, cuts, cores, and cuts in the mouth, anus, vagina or penis • Sharing Needles and Drug Injection Equipment • “Indirect Sharing” • Shared drug injector paraphernalia • HIV and Pregnancy • HIV passed to child through pregnancy, birth process, and/or by breastfeeding Source: https://www.fairview.org/patient-education/82145. Accessed on July 16, 2018.

8. Other Factors Affecting Transmission • Presence of other STIs • May reduce an infected person’s ability to combat HIV infection • Multiple partners can increase change of exposure • Use of non-injecting drugs • Can impair judgment and increase chance of risky behavior • Gender and equality issues • Lack of power decreasing ability to insist on sexual protection, domestic violence • Not transmitted through casual contact (touching, hugging, shaking hands) • Accidental needle stick injury in workplace situations

9. Risk Reduction Methods • Sexual abstinence • Monogamous, long term relationships • Limiting the number of sexual or drug-injecting partners • Safer sexual practices (condoms, dental dams/other barriers) • Pre-Exposure Prophylaxis (PrEP) • Everyday medication to prevent against HIV • Treatment with HIV medications • Avoidance of injecting drug use • Syringe Exchange • Disease prevention program that trades in used syringes for clean ones

10. Occupational Exposure to Blood-Borne Pathogens • WAC 296-823, Occupational Exposure to Blood-borne Pathogens • Requirements to protect employees from blood or other infectious materials (OPIM) that may contain blood-borne pathogens • Occupational groups recognized as having potential exposure to HIV include, but are not limited to: • Healthcare employees • Law enforcement • Fire, ambulance, and other emergency response personal • Public service employees

11. Blood-Borne and Other Potentially Infectious Materials • Bodily fluids that have been liked to transmission of HIV, HBV, and HCV include: • Blood • Blood Products • Semen • Vaginal secretions • Cerebrospinal fluid • Synovial (joint) fluid • Amniotic fluid (fluid surrounding the fetus) • Saliva in dental procedures • Specimens with concentrated HIV, HBV, and HCV viruses

12. Exposure Control Plan (ECP) • Each employer covered under WAC-296-823 must develop an ECP including at least the following elements: • A written “exposure determination” including job classifications and positions • The evaluation procedure for exposure incidents • The workplace’s infection control system • Documentation of use of safer medical devices designed to eliminate or minimize occupational exposure • Must be updated annually or whenever changes occur • All new employees must receive WAC-296-823 training • All employees must be offered Hepatitis B vaccination

13. Universal and Standard Precautions • Universal Precautions • System designed to prevent blood-borne pathogens transmission in healthcare • All blood / other infectious materials should always be considered infectious • Standard Precautions • Newer system • All bodily fluids, except sweat, should be considered potentially infectious

14. Infection Control Strategies • Personal protective equipment • Gloves, masks, protective eyewear, chin-length plastic face shields • Use of safer medical devices • Proper hand hygiene • Good housekeeping (clean and sanitary work areas) • Decontamination of surfaces with chemical germicides and disinfectants • Closable, labeled, leak-proof containers for blood or OPIM specimen handling • Treat laundry as contaminated • Regulated waste disposal • Prohibit eating, drinking, smoking, applying cosmetics, handling contact lenses • No food storage where blood or OPIM is stored • Post-exposure management and medical evaluation

15. Occupational Exposure Infection Risks • Occupational Exposure • Defined as a percutaneous injury, or contact of mucous membrane/non-intact skin with blood, tissue, or other potentially infectious materials • Factors influencing risk of infection include: • If exposure was from a hollow-bore or other sharp instrument • If exposure was through non-intact skin or a mucus membrane • Amount of blood involved • Amount of virus present in source’s blood

16. Occupational Exposure Infection Risks • Risks of HIV transmission • Healthcare worker needlestick infection risk: Less than 1% • Approximately 1 in 300 needlestick exposures result in infection • Infection through splashes of blood to eyes, nose or mouth risk: 1 in 1,000 • Risks of Hepatitis B and C transmission • Those who have received Hepatitis B vaccine: Virtually no risk • Needle stick or cut exposure for susceptible person risk: Ranges from 6%-30%

17. Treatment Protocol after a Potential Exposure • Mucous membrane exposure • Flush with water, saline, or sterile irritants • Sharp injuries • Wash exposed area with soap and water • Bite or scratch wounds • Wash with soap and water, cover with sterile dressing as appropriate • Exposure to urine, vomit, or feces • Not considered an exposure unless fluid is visibly contaminated with blood, follow employer’s procedures for cleaning • Reporting the exposure • Clean exposed area, report to department responsible for managing exposure • Obtain medical evaluation as soon as possible

18. Treatment Protocol after a Potential Exposure • Post Exposure Prophylaxis (PEP) • Anti-HIV medications used after substantial exposure • Start within hours of exposure, continue medication for 28 days • HIV/HBV/HCV Testing Post-Exposure • Evaluation by health care professional including follow-up counseling, post-exposure testing, and medical evaluation • Mandatory Source Testing • HIV antibody testing of “source person” when law enforcement officer, fire fighter, health care provider/faculty staff, or other professionals experience exposure

19. Sanitary Procedures for Home and Home-like Settings • Gloves should be worn when caretakers anticipate direct contact with any body substances • Correct hand-washing technique • Use soap, warm water, and good friction. Make sure to scrub the top, and all slides of the fingers • Lather and rinse for 10 seconds, beginning at the fingertips • Dry with paper towels • Cleaning Blood/OPIM on Skin • Wear gloves. Use sterile gauze, follow first-aid techniques to stop bleeding. After applying bandage, remove gloves slowly and wash hands.

20. Sanitary Procedures for Home and Home-like Settings • Cleaning Body Fluid Spills on Vinyl Floors • Sweep any broken glass with a broom and dustpan. Empty dustpan into well-marked container • Pre-treat body fluid spill with full-strength liquid disinfectant or detergent • Wipe up spill either a hot, soapy mop, or gloves and paper towels • Disinfect spill area with household bleach with water • If paper towels were used, dispose into well-marked container. If mop was used, disinfect mop and empty mop bucket water into toilet.

21. Sanitary Procedures for Home and Home-like Settings • Cleaning Body Fluid Spills on Carpeting • To absorb body fluid, pour kitty litter or other absorbent material on spill • Pour full-strength liquid detergent on carpet to disinfect • Sweep kitty litter with dustpan and broom • Pour carpet-safe liquid disinfectant on contaminated area, let sit for time recommended by disinfectant manufacturer • Absorb spill with paper towels and rubber gloves • Dispose of paper towels, kitty litter into a sealed plastic bag that has been place inside another plastic garbage bag • Vacuum

22. Sanitary Procedures for Home and Home-like Settings • Cleaning Clothes or Other Laundry in Home Settings • Have person remove clothes, assisting with gloves if needed • Transport soiled clothing items to washing machine in a strong plastic bag • Place clothing in washing machine and wash in cold, soapy water • For next washing cycle, use hot soapy water and detergent • Place bag used for transportation of clothing in another plastic bag and dispose

23. Sanitary Procedures for Home and Home-like Settings • Diaper Changes • Use gloves and wash hands immediately after changing the diaper • Disinfect the diapering surface after • Wash cloth diapers in hot water, detergent and a cup of bleach. Dry in a hot dryer. • Cleaning Sponges and Mops • Disinfect routinely with bleach solution or other disinfectant • Do not use kitchen sponges and mops to clean body fluid spills

24. Sanitary Procedures for Home and Home-like Settings • Toilet/Bedpan Safety • If toilet seat is infected with blood/OPIM, spray solution of 1:10 bleach. • Wearing gloves, wipe away with paper towels • Urinals/bedpans should not be shared unless thoroughly disinfected • Thermometers • Wash glass thermometers with soap and water before and after each use • If shared by family members, soak in 70-90% ethyl alcohol for 30 minutes and rinse

25. Kitchen Safety and Proper Food Preparation Skills • Proper Kitchen safety skills are important for HIV-positive people because they are susceptible to unsterilized or spoiled food products • Wash hands before preparing food • Be careful when tasting food, do not taste with the same spoon twice • Avoid unpasteurized milk, raw eggs, raw fish, and cracked or non-intact eggs. • Cook all meat, eggs, and fish thoroughly. • Wash fruits and vegetables • Disinfect countertops, stoves, sinks, refrigerators, door handles and floors regularly • Discard any food that’s expired, past the safe storage date, has mold, or smells bad

26. Safe and Legal Disposal of Sharps • Disposal of sharps (syringes, needles and lancets) is regulated • Throwing them in the trash or flushing them down the toilet can cause health risks • Safe Disposal of Found Syringes • Do not pick up with bare hands • Do not break the needle off from the syringe • Place used sharps and syringes in a safe container • Tape container shut and label with the following: “Sharps, Do Not Recycle” • Call your local health department to find available disposal sites