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HIV and TRAUMA Dr.S.MURUGAN Consultant HIV and Sexual Medicine Medical Superintendent SHIFA HOSPITALS TIRUNELVELI TAMILNADU

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Definition Trauma is defined as any body wound or shock produced by sudden physical injury, as from accident, injury, or impact.Trauma patients usually require specialized care, including surgery and sometimes blood transfusion

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HIV Infection <ul><li>People infected with HIV--- </li></ul><ul><ul><li>May look and feel health for a long time. </li></ul></ul><ul><ul><li>Can infect others even if they don’t look or fell sick. </li></ul></ul><ul><ul><li>May have symptoms that are like those of many other illnesses. </li></ul></ul><ul><li>When people develop AIDS, they may get illnesses that healthy </li></ul><ul><li>people usually don’t get. </li></ul><ul><li>Only a test can show if someone is infected with HIV. </li></ul><ul><li>Only a doctor can diagnose AIDS. </li></ul><ul><ul><ul><ul><ul><li>Source: American Red Cross HIV/AIDS Program: HIV Education and Prevention </li></ul></ul></ul></ul></ul>MSDE HIV/AIDS Program

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HIV STATUS& TRUAMA <ul><li>Status not known to patients </li></ul><ul><li>Relatives or Care taker </li></ul><ul><li>Not in a position to tell </li></ul><ul><li>Not willing to reveal- fear of denial of treatment </li></ul><ul><li>Due to stigma and discrimination by the society </li></ul>

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Source of infections <ul><li>Where are blood-borne pathogens found? </li></ul><ul><li>Body fluids containing visible blood </li></ul><ul><li>Semen and vaginal secretions </li></ul><ul><li>Torn or loose skin </li></ul>

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Operating on HIV/High risk groups <ul><li>It is a concern all should be cared equally. </li></ul><ul><li>HIV infected carries the risk of being neglected at the time of crisis. </li></ul><ul><li>Law may not change for equality but motivated health workers should bring in change of attitude. </li></ul><ul><li>Adherence of Universal Health precaution bring in safety to all HCW. </li></ul><ul><li>Follow the precautions even in Non HIV patients as some of our patients are in window period and more dangerous than truly positive with Sero testing. </li></ul>

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Caring Bleeding Patients <ul><li>Primary health care workers who handle the patients in Emergencies, and Accidents to be trained in basic principles of Universal Health care precautions. </li></ul><ul><li>Mouth to Mouth resuscitation is life saving in the Critically injured accident victims. May be neglected because of fear of HIV infection. </li></ul><ul><li>If the situation warrants, Bleeding from mouth can be wiped out with clean cloth, or Handkerchief, and still one can do resuscitation. </li></ul>

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Importance of UWP <ul><li>Adopting certain precautions with all patients immaterial of their HIV status whenever there is an invasive procedure or whenever there is a chance to handle blood, blood products, body fluids, vaginal fluid, semen by all the health care providers. </li></ul>

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Universal Precautions <ul><li>Universal precautions are work practices that help </li></ul><ul><li>prevent contact with blood and certain other body </li></ul><ul><li>fluids. Universal precautions are: </li></ul><ul><li>Your best protection against HIV (the virus that </li></ul><ul><li>causes AIDS), hepatitis B and some other infectious </li></ul><ul><li>diseases. </li></ul><ul><li>Required in certain jobs. </li></ul><ul><li>Can help prevent illness and save lives—including </li></ul><ul><li>your own! </li></ul>MDE HIV/AIDS PROGRAM

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How Universal Precautions Work <ul><li>Certain infectious diseases are caused by viruses. </li></ul><ul><li>For example: </li></ul><ul><li>AIDS is caused by HIV (human immunodeficiency virus). </li></ul><ul><li>HIV attacks the body’s natural defense against disease. </li></ul><ul><li>Hepatitis B is caused by HBV (hepatitis B virus). Hepatitis </li></ul><ul><li>C is caused by HCV (hepatitis C virus). HBV and HCV </li></ul><ul><li>attack the liver and can result in severe illness—even death. </li></ul>MDE HIV/AIDS PROGRAM

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Preventing Infection <ul><li>Universal precautions help prevent infection through the </li></ul><ul><li>use of: </li></ul><ul><li>protective barriers, such as gloves, gowns, masks and </li></ul><ul><li>goggles </li></ul><ul><li>safe work practices, such as proper disposal of sharps </li></ul><ul><li>and proper hand washing. </li></ul><ul><li> </li></ul>http://www.itsasnap.org/snap/teachers_nurses.asp MDE HIV/AIDS PROGRAM

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<ul><li>HIV, HBV and some other viruses are spread through certain body fluids, including: </li></ul><ul><li>blood (or any fluid containing visible blood) </li></ul><ul><li>semen </li></ul><ul><li>vaginal secretions </li></ul><ul><li>fluids surrounding the heart, lungs, brain, stomach, </li></ul><ul><li>joints, and tendons; fluids in the womb of a pregnant </li></ul><ul><li>woman. </li></ul>How Universal Precautions Work cont. MDE HIV/AIDS PROGRAM

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SOCIAL HAND WASHING

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Water-proof strongly adhesive plastic dressings for break in skin and to seal off areas that are oozing blood

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Gloves, Mask, Cap

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The used needles must be destroyed in needle-cutters.

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After the blood / clinical sample has been collected the syringes/other instruments should immediately be submerged in the disinfectant

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Never recap the used needles by using both hands even with Gloves

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Always use sterile trays and forceps

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Spillage of Blood/Body fluids <ul><li>A common health hazard in the working environment. </li></ul><ul><li>Never wipe the spillage with working wet mop. </li></ul><ul><li>Always cover the spills with paper and pour 1 % Hypochlorite or Bleaching powder to decontaminate the spills with HIV/HBV virus. </li></ul>

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If by some reason the blood has fallen on floor, the blood spot must be covered with tissue paper / towel and soaked with disinfectant and left for 30 minutes.

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After 30 minutes the sanitation staff puts on heavy-duty gloves and mopes the blood spot along with disinfectant.

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Precaution for Invasive Procedures <ul><li>All HCW’s who participate in invasive procedures must routinely use appropriate barrier precautions. </li></ul><ul><li>All Health care workers who perform/assist vaginal, and cesarean deliveries should wear gloves and gowns when handling, the placenta, and the new born, till blood and amniotic fluid has been removed from infants. </li></ul><ul><li>Amniotic fluid is rich in HIV/HBV virus, in infected mothers. </li></ul>

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Decontamination of Hospital Linen <ul><li>All the linen contaminated with Blood or Body fluids should be soaked in 1: 100 bleach solution for 30 minutes. </li></ul><ul><li>Advised Autoclaving, as the most ideal procedure for decontaminating Linen </li></ul>

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Care of Endoscopes <ul><li>Endoscopes are delicate/precious instruments. </li></ul><ul><li>Follow the instruction of Manufacturers. </li></ul><ul><li>It is commonly cleaned with 2 % Glutaraldehyde solution. </li></ul><ul><li>Specified time schedules to be followed to decontaminate for HIV. </li></ul><ul><li>Mycobacterium needs even > 2 hours for decontmination. </li></ul>

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Decontamination of Metal Instruments <ul><li>Hold all contaminated instruments with Gloved hands. </li></ul><ul><li>Subject all metal instruments to washing with soap and water. </li></ul><ul><li>Treat all contaminated instruments with 2% Glutaraldehyde. For at least 30 minutes. </li></ul><ul><li>Many consider sterilizing in Hot air oven if not sharp instruments. </li></ul>

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Universal Precautions <ul><li>All blood and potentially infectious materials are treated as if they are infectious, regardless of the perceived status of the source individual. </li></ul><ul><li>You treat all blood and body fluids as if they are infected. </li></ul>