HIV AND THE SURGEON

1. HIV AND THE SURGEON Dr.K.Bujji Babu Consultant HIV Physician Dr.Bujjibabu HIV Clinic

2. UNIVERSAL PRECAUTIONS SURGERY IN HIV PATIENTS MORBIDITY AND MORTALITY OCCUPATIONAL TRANSMISSION

3. UNIVERSAL PRECAUTIONS • 1983 BLOOD AND BODY FLUID PRECAUTIONS • PTS KNOWN TO OR SUSPECTED TO HAVE INFECTIONS • REALISATION THAT MANY ASYMPTOMATIC • ? TAILOR TO DEGREE OF ANTICIPATED EXPOSURE

4. CARDINAL RULES • CONSIDER ALL PATIENTS INFECTIOUS • ASSUME ALL BODY FLUIDS CONTAMINATED • ASSUME ALL UNSTERILE SHARPS AS INFECTIOUS • IDENTIFY RISKS BEFORE STARTING PROCEDURE

5. LOW RISK EXPOSURE • CONTACT WITH SKIN WITH NO VISIBLE BLOOD • INJECTIONS • MINOR DRESSINGS • GLOVES HELPFUL BUT NOT MANDATORY

6. MEDIUM RISK EXPOSURE • POSSIBLE CONTACT WITH BLOOD SPLASH UNLIKELY • INSERTION REMOVAL OF CANNULAE • LARGE OPEN WOUND DRESSING • INTUBATION • GLOVES MUST • GOWN OR APRON MAY BE NECESSARY

7. HIGH RISK • PROBABLE CONTACT WITH BLOOD,SPLASH OR UNCONTROLLED BLEEDING • MAJOR SURGERY • VAGINAL DELIVERY • GLOVES + WATERPROOF GOWN +EYE WEAR + MASK + SHOES

8. GLOVES • NOT 100% SAFE • MANUFACTURERS ACCEPTABLE LEAK RATE 1.5% • VOLUME OF BLOOD INJECTED BY SOLID NEEDLES DECREASE BY 70% • 2 GLOVES FURTHER 50% REDUCTION

9. PREVENTION OF INJURY FROM SHARPS • DON’T RECAP NEEDLES • USE A TRAY TO HAND SHARPS • DO NOT BEND SHARPS • PROPER DISPOSAL IN SHARPS CONTAINER

10. HIGH RISK SURGERIES • DENTAL • ORTHOPAEDIC • OBSTETRIC AND GYNAE • COLORECTAL

11. UNIVERSALTESTINGIS NOT A SUBSTITUTE FOR UNIVERSAL PRECAUTIONS

12. POST EXPOSURE PROPHYLAXIS • BASIC PEP ZIDOVUDINE 300 mg BD +LAMIVUDINE 150mg BD FOR 28 DAYS • EXPANDED PEP ADD INDANAVIR 800mg TID OR NELFINAVIR 750mg TID • REPEAT TESTING 6 WKS , 3 AND 6 MONTHS

13. LYMPH NODES • AS FAR AS POSSIBLE FNA • ONLY 2 SITUATIONS BIOPSY • TO CLASSIFY LYMPHOMA • FNA NEGATIVE NODE WHICH ENLARGES OR WITH UNEXPLAINED SYSTEMIC ILLNESS IN THE PATIENT

14. ITP • HIV ASSOCIATED ITP DOES NOT RESPOND WELL TO STEROIDS • POST SPLENECTOMY SIGNIFICANT RISE IN CD4 COUNTS AND PLATELETS

15. ABDOMINAL LYMPHADENOPATHY AND ORGANOMEGALY • LAPAROSCOPY PREFFERED FOR BIOPSY • ONLY 8-10% OF HIV +ve PATIENTS WITH ACUTE ABDOMINAL PAIN REQUIRE EMERGENCY SURGERY

16. ANORECTAL SURGERY • ANAL CONDYLOMATA • PERIANAL ABSCESSES AND FISSURES • ANAL CANAL CA

17. POST SURGICAL COMPLICATIONS • LOW MUSCLE MASS • LOW CD 4 DELAYED HEALING • LOW CD 4 INCREASED SEPTIC COMPLICATIONS

18. RISK AFTER OCCUPATIONAL EXPOSURE • HOLLOW NEEDLES 0.3% • 5 FOLD INCREASE IF BLOOD ON NEEDLE • 6 FOLD INCREASE IF HIGH VIRAL TITRE • 16 FOLD INCREASE IF NEEDLE PENETRATES DEEPLY • NON HOLLOW NEEDLES

19. CHANGES IN SURGICAL TECHNIQUE • AVOIDANCE OF HAND TO HAND PASSAGE OF SHARPS • BLUNT NEEDLES FOR FASCIAL CLOSURE • NEEDLE HANDLING ONLY WITH INSTRUMENTS • LAPAROSCOPY-- ? DROPLETS ON EVACUATION OF PNEUMO

20. MANDATORYPREOPTESTING

21. NONOPERATIVETREATMENT

22. THANKYOU