Protocols and Information For HIV Control in Operation Theatre

By: Akhtiar Ahmed Solangi

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I am Akhtiar Ahmed Solangi, I had worked in Many Hospitals for the past 24 years as an OT Incharge.I had handle numerous emergency cases, outbreaks, and surgeries involving infected and virus-contaminated patients. We are committed to meticulously disinfecting and sterilizing the operation theatre after each procedure.

What is HIV virus?

  • HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome).  There is currently no effective cure. Once people get HIV, they have it for life.  But with proper medical care, HIV can be controlled. People with HIV who get effective HIV treatment can live long, healthy lives and protect their partners.
    How HIV Get or Transmit?
    You can only get HIV by coming into direct contact with certain body fluids from a person with HIV who has a detectable viral load. These fluids are:
     Blood
     Semen (cum) and pre-seminal fluid (pre-cum)
     Rectal fluids
     Vaginal fluids
     Breast milk

 

  • For transmission to occur, the HIV in these fluids must get into the bloodstream of an HIV-negative person through a mucous membrane (found in the rectum, vagina, mouth, or tip of the penis), through open cuts or sores, or by direct injection (from a needle or syringe).
    People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long and healthy lives and will not transmit HIV to their HIV-negative partners through sex.

 

How HIV spread from person to person?
HIV can only be spread through specific activities. In the United States, the most common ways are:
Having vaginal or anal sex with someone who has HIV without using a condom the right way every time or taking medicines to prevent or treat HIV. Anal sex is riskier than vaginal sex for HIV transmission. Learn more about the HIV risk associated with specific sexual activities.
Sharing injection drug equipment, such as needles, syringes, or other drug injection equipment (“works”) with someone who has HIV because these items
may have blood in them, and blood can carry HIV. People who inject hormones, silicone, or steroids can also get or transmit HIV by sharing needles, syringes, or other injection equipment. Learn more about HIV and injection drug use.

Less common ways are:
An HIV-positive person transmitting HIV to their baby during pregnancy, birth, or breastfeeding. However, the use of HIV medicines and other strategies have helped lower the risk of perinatal transmission of HIV to less than 1% in the United States. Learn more.
Being exposed to HIV through a needlestick or sharps injury. This is a risk mainly for health care workers. The risk is very low.

HIV is spread only in extremely rare cases by:
Having oral sex. Oral sex carries little to no risk for getting or transmitting HIV. Theoretically, it is possible if an HIV-positive man ejaculates in his partner’s mouth during oral sex. Factors that may increase the risk of transmitting HIV through oral sex are oral ulcers, bleeding gums, genital sores, and the presence of other sexually transmitted diseases (STDs), which may or may not be visible. However, the risk is still extremely low, and much lower than with anal or vaginal sex.

Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV. The risk is extremely small these days because of rigorous testing of the U.S. blood supply and donated organs and tissues. (And you can’t get HIV from donating blood. Blood collection procedures are highly regular and very safe.)

Being bitten by a person with HIV. Each of the very small number of documented cases has involved severe trauma with extensive tissue damage and the presence of blood. This rare transmission can occur through contact between broken skin, wounds, or mucous membranes and blood or body fluids from a person who has HIV. There is no risk of transmission if the skin is not broken. There are no documented cases of HIV being transmitted through spitting as HIV is not transmitted through saliva.

Deep, open-mouth kissing if both partners have sores or bleeding gums and blood from the HIV-positive partner gets into the bloodstream of the HIV-negative partner. HIV is not spread through saliva.

Eating food that has been pre-chewed by a person with HIV. The only known cases are among infants. HIV transmission can occur when the blood from an HIV-positive caregiver’s mouth mixes with food while chewing and an infant eats it. However, you can’t get HIV by consuming food handled by someone with HIV.

  • How HIV not spreads?
    HIV is not spread by:
     Air or water
     Mosquitoes, ticks, or other insects
     Saliva, tears, sweat, feces, or urine that is not mixed with the blood of a person with HIV
     Shaking hands; hugging; sharing toilets; sharing dishes, silverware, or drinking glasses; or engaging in closed-mouth or “social” kissing with a person with HIV
     Drinking fountains
     Other sexual activities that don’t involve the exchange of body fluids (for example, touching).
     Donating blood
     HIV can’t be passed through healthy, unbroken skin.

 

  • Survival of HIV in operation Theaters?
    HIV (Human Immunodeficiency Virus) cannot survive for long outside the human body. In a healthcare setting like an operation theatre, where proper cleaning and disinfection protocols are followed, the risk of HIV transmission from environmental surfaces is extremely low.

According to the Centers for Disease Control and Prevention (CDC), HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce outside a human host. The virus is susceptible to environmental factors such as temperature and pH, and it rapidly becomes inactive when exposed to air and light. The exact survival time of HIV outside the body can vary depending on factors such as temperature, humidity, and the presence of bodily fluids, but generally, it is a matter of minutes to hours rather than days.

However, it’s crucial to maintain stringent infection control measures in operation theatres and other healthcare settings to minimize the risk of transmission of HIV and other infectious agents. This includes thorough cleaning and disinfection of surfaces and equipment between patient procedures, as well as adherence to universal precautions to prevent exposure to blood and other bodily fluids.

  • HIV Precautions for healthcare in Operation Theatre?
    Healthcare workers take several precautions during surgery in an operation theatre to minimize the risk of HIV transmission. These precautions are part of standard infection control protocols and are designed to protect both healthcare workers and patients. Some of the key precautions include:

1. Universal Precautions: Healthcare workers should treat all patients as potentially infectious and take appropriate precautions to prevent exposure to blood and other bodily fluids. This includes wearing personal protective equipment (PPE) such as gloves, gowns, masks, and eye protection when handling blood or performing procedures that may involve exposure to bodily fluids.

2. Safe Handling of Sharps: Sharps, such as needles and scalpels, should be handled carefully to prevent accidental needlestick injuries. Proper disposal procedures should be followed to minimize the risk of exposure to contaminated sharps.

3. Hand Hygiene: Healthcare workers should practice good hand hygiene by washing hands with soap and water or using alcohol-based hand sanitizer before and after patient contact, after removing gloves, and after touching potentially contaminated surfaces or equipment.

4. Environmental Cleaning and Disinfection: Operation theatres should be regularly cleaned and disinfected using appropriate disinfectants to eliminate any potential sources of contamination. This includes cleaning and disinfecting surfaces, equipment, and instruments between patient procedures.

5. Safe Injection Practices: Healthcare workers should follow safe injection practices to prevent the contamination of medications and equipment with bloodborne pathogens like HIV. This includes using aseptic techniques, using single-dose vials whenever possible, and avoiding the reuse of needles and syringes.

6. Post-Exposure Prophylaxis (PEP): In the event of a potential exposure to HIV, healthcare workers should follow established protocols for post-exposure prophylaxis, which may involve receiving antiretroviral medications to reduce the risk of HIV transmission.

7. Education and Training: Healthcare workers should receive regular education and training on infection control practices, including precautions specific to HIV and other bloodborne pathogens. This helps ensure that all staff members are aware of and compliant with established protocols.

Cleaning and disinfection of facilities, equipment, and sterilization of instruments
Educating healthcare professionals and patients in infectious disease prevention
Implementing policies and programs that help identify and mitigate infection risks
By following these precautions, healthcare workers can minimize the risk of HIV transmission during surgery in an operation theatre and provide safe and effective care to all patients.

  • Best OT Disinfecting Solution?
    Bleach
    To effectively disinfect surfaces contaminated with HIV, the Centers for Disease Control and Prevention (CDC) recommends using a bleach solution. Here’s a general guideline for preparing a bleach solution to disinfect surfaces:

1. Prepare the Solution: Mix 1 part bleach with 9 parts water. This translates to a dilution of approximately 1:10. For example, you can mix 1 cup (240 milliliters) of bleach with 9 cups (2,160 milliliters) of water.

2. Use Fresh Solution: Prepare the bleach solution fresh each day you plan to use it, as bleach loses its effectiveness over time when diluted.

3. Apply the Solution: Wear gloves and other appropriate personal protective equipment (PPE) when handling bleach. Apply the bleach solution to the surface you wish to disinfect.

4. Contact Time: Allow the bleach solution to remain on the surface for at least 5 minutes to ensure proper disinfection.

5. Ventilation: Ensure adequate ventilation in the area where you’re using the bleach solution, as bleach can produce fumes that may irritate the respiratory system.

6. Rinse and Dry: After the appropriate contact time has elapsed, rinse the surface with clean water to remove any residue of bleach. Allow the surface to air dry.
It’s essential to follow manufacturer’s instructions for the specific type and concentration of bleach you are using, as well as any safety precautions and recommendations for use.
Remember, while bleach is effective at killing HIV and many other pathogens, it can also cause damage to some surfaces and materials. Test the bleach solution on a small, inconspicuous area first to ensure it won’t cause discoloration or damage. Additionally, never mix bleach with ammonia or other household cleaners, as this can produce toxic fumes.

  • Hydrogen Peroxide
    Hydrogen peroxide is also an effective disinfectant against HIV. Here’s how you can use hydrogen peroxide to disinfect surfaces:

1. Prepare the Solution: Commercial hydrogen peroxide solutions typically come in concentrations of 3% to 6%. For disinfecting surfaces, you can use the hydrogen peroxide solution as is, without dilution.

2. Apply the Solution: Wear gloves and other appropriate personal protective equipment (PPE) when handling hydrogen peroxide. Apply the hydrogen peroxide solution directly to the surface you wish to disinfect.

3. Contact Time: Allow the hydrogen peroxide solution to remain on the surface for at least 1 minute to ensure proper disinfection.

4. Ventilation: Ensure adequate ventilation in the area where you’re using the hydrogen peroxide solution.

5. Rinse and Dry (Optional): Hydrogen peroxide breaks down into water and oxygen, so rinsing is not always necessary. However, if desired, you can rinse the surface with clean water after the contact time has elapsed. Allow the surface to air dry.

6. Safety Precautions: While hydrogen peroxide is generally safe to use, it can cause skin and eye irritation. Avoid contact with eyes and skin, and use in a well-ventilated area.

  • Alchol
    Alcohol, particularly isopropyl alcohol (rubbing alcohol) and ethanol (ethyl alcohol), can also be effective in disinfecting surfaces contaminated with HIV. Here’s how you can use alcohol to disinfect surfaces:

1. Choose the Right Alcohol Concentration: Alcohol solutions with concentrations between 60% and 90% are most effective at disinfecting surfaces. Lower concentrations may not be as effective, while higher concentrations can evaporate too quickly, reducing their efficacy.

2. Apply the Alcohol Solution: Pour or spray the alcohol solution directly onto the surface you wish to disinfect. Ensure that the surface remains wet with the alcohol solution for the required contact time.

3. Contact Time: Allow the alcohol solution to remain on the surface for at least 30 seconds to 1 minute to ensure proper disinfection.

4. Ventilation: Ensure adequate ventilation in the area where you’re using the alcohol solution, especially if using large quantities, as alcohol vapors can be flammable.

5. Rinse and Dry (Optional): Alcohol typically evaporates quickly, leaving little residue behind. However, if desired, you can allow the surface to air dry after the contact time has elapsed.

6. Safety Precautions: Alcohol is flammable, so use caution and avoid open flames or sparks when using alcohol-based disinfectants. Also, avoid contact with eyes and prolonged skin exposure, as alcohol can cause irritation.

7. Follow Manufacturer’s Instructions: Always follow manufacturer’s instructions for the specific type and concentration of alcohol you are using, as well as any safety precautions and recommendations for use.

  • Proper Disposal of Healthcare Waste
    Proper disposal of waste in healthcare settings is crucial for preventing the transmission of HIV and other infectious diseases. Here are some guidelines for disposing of waste contaminated with HIV:

1. Segregation of Waste: Healthcare facilities should have clear protocols for segregating different types of waste, including infectious waste. Infectious waste, which includes materials contaminated with blood or other bodily fluids, should be segregated from other types of waste at the point of generation.

2. Use of Biohazard Bags: Contaminated materials should be placed in leak-proof, puncture-resistant biohazard bags or containers labeled with the universal biohazard symbol. These bags help contain potentially infectious materials and prevent exposure to healthcare workers and waste handlers.

3. Double-Bagging: To provide an extra layer of protection, it’s often recommended to double-bag biohazardous waste. This involves placing the filled biohazard bag into a second bag and securely sealing both bags.

4. Proper Storage: Biohazard bags should be stored in designated areas away from patient care areas and inaccessible to unauthorized personnel. Storage areas should be secure, well-ventilated, and equipped to prevent leaks or spills.

5. Transportation: When transporting biohazardous waste within the healthcare facility, it should be handled with care to prevent spills or contamination of other surfaces. Use dedicated carts or containers for transporting biohazard bags, and avoid overcrowding or overfilling containers.

6. Treatment and Disposal: Depending on local regulations and facility capabilities, biohazardous waste may undergo treatment, such as autoclaving (steam sterilization) or incineration, to kill pathogens before final disposal. Properly treated waste can then be disposed of in accordance with local regulations for medical waste disposal.

7. Training and Education: Healthcare workers involved in waste management should receive training on proper waste segregation, handling, and disposal procedures. Regular education and reinforcement of these protocols help ensure compliance and minimize the risk of exposure to infectious agents like HIV.
8. Recordkeeping: Facilities should maintain accurate records of waste generation, treatment, and disposal activities to demonstrate compliance with regulations and track the handling of potentially infectious materials.

  • Healthcare and Surgeon HIV Exposure Monitoring Protocol
    For healthcare workers, particularly surgeons, monitoring for HIV infection after exposure during surgery involves a specific set of protocols and procedures. Here’s how healthcare facilities can track and monitor surgeons and other healthcare workers for HIV infection following exposure incidents:

1. Immediate Reporting of Exposure Incidents: Healthcare workers, including surgeons, should immediately report any potential exposure incidents, such as needlestick injuries or
mucous membrane exposures, to their supervisors or occupational health department. Prompt reporting allows for timely evaluation and initiation of post-exposure management.

2. Post-Exposure Prophylaxis (PEP): Surgeons and other healthcare workers who experience occupational exposure to HIV may be offered post-exposure prophylaxis (PEP) to reduce the risk of HIV transmission. PEP typically involves a 28-day course of antiretroviral medications, which should be initiated as soon as possible following exposure.

3. Baseline Testing: Healthcare workers who experience occupational exposure to HIV should undergo baseline testing for HIV infection and other bloodborne pathogens. Baseline testing helps establish the healthcare worker’s HIV status before exposure and provides a reference point for subsequent testing.

4. Follow-Up Testing: Surgeons and other healthcare workers should undergo follow-up testing for HIV infection according to established protocols. Follow-up testing may include repeat HIV testing at various intervals (e.g., 6 weeks, 3 months, and 6 months post-exposure) to detect seroconversion, which is the development of detectable HIV antibodies in the bloodstream.

5. Medical Evaluation and Monitoring: Surgeons and other healthcare workers who experience occupational exposure to HIV
should receive medical evaluation and monitoring by occupational health professionals or infectious disease specialists. This may involve regular clinical assessments, laboratory testing, and counseling regarding HIV risk reduction and infection control practices.

6. Documentation and Recordkeeping: Healthcare facilities should maintain detailed records of occupational exposure incidents, including the circumstances of the exposure, PEP administration, baseline testing results, follow-up testing schedules, and clinical outcomes. Documentation ensures accountability, facilitates communication among healthcare providers, and supports quality improvement initiatives.

7. Education and Training: Healthcare facilities should provide comprehensive education and training to surgeons and other healthcare workers on occupational exposure prevention, including safe work practices, use of personal protective equipment (PPE), and procedures for reporting exposure incidents. Ongoing education and training help raise awareness, reinforce best practices, and promote a culture of safety within the healthcare setting.

  • Linen Cloth Use in Surgery: HIV Prevention Guidelines
    Using linen cloth during surgery, particularly in the context of HIV infection prevention, requires careful consideration of
    infection control practices. Linen cloth, like any other surgical fabric, can potentially become contaminated with blood or other bodily fluids during procedures. Here are some key points to consider:
    1. Barrier Protection: Linen cloth should not be directly used as a barrier between the patient and the surgical team or equipment. Instead, sterile surgical drapes and gowns made from appropriate materials should be used to create a barrier that helps prevent the transfer of blood and bodily fluids between the patient and healthcare workers.
    2. Disposable vs. Reusable: In healthcare settings, there is a preference for using disposable materials, including surgical drapes and gowns, to minimize the risk of cross-contamination and transmission of infectious agents such as HIV. Disposable items are typically discarded after a single use to prevent reuse and potential contamination. Reusable linen cloth may be used in some non-sterile applications, but strict protocols for cleaning, disinfection, and sterilization must be followed to ensure their safety and effectiveness.
    3. Cleaning and Sterilization: If linen cloth is used in a surgical setting, it must be cleaned and sterilized according to established protocols to remove any potential contaminants,
    including HIV. Proper laundering and sterilization methods, such as high-temperature washing and autoclaving, should be employed to ensure that linen cloth is free from infectious agents before reuse.4. Risk Assessment: Healthcare facilities should conduct a risk assessment to evaluate the appropriateness of using linen cloth during surgery, taking into account factors such as the type of procedure, patient population, infection control policies, and available resources. The goal is to balance the need for effective infection prevention with practical considerations such as cost, availability, and environmental impact.

5. Education and Training: Healthcare workers should receive education and training on proper infection control practices, including the use and handling of surgical textiles like linen cloth. This includes understanding the risks associated with potential exposure to bloodborne pathogens like HIV and adhering to established protocols for minimizing those risks during surgical procedures.

According to my concern, reusable linen should not be used in HIV patients’ surgery because the laundry department doesn’t properly clean up the reusable linen. They haven’t been educated or trained, and they
mishandle the linen, not properly using chemicals or dilutions, nor wearing gloves. This could result in the transmission of the virus, causing harm to both the patient and their entire family. Therefore, the best practice is to use disposable linen. [In Most Asia]

This article was written by Akhtiar Ahmed Solangi, he is working in the field of hospital.

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