Protective barriers reduce the risk of exposure of the skin or mucous membranes to potentially infective materials. Examples of protective barriers include gloves, gowns, masks, and protective eyewear. Gloves should reduce the incidence of contamination of hands, but they cannot prevent penetrating injuries due to needles or other sharp instruments. Masks and protective eyewear or face shields reduce the incidence of contamination of mucous membranes of the mouth, nose, and eyes. 15 Universal precautions are intended to supplement rather than replace recommendations for routine infection control, such as hand washing and using gloves to prevent gross microbial contamination. As noted by the CDC, specifying the types of barriers needed for every possible clinical situation is impractical, so some judgment must be exercised. 15 The risk of transmission of HIV and other pathogens can be minimized if healthcare workers follow general guidelines (Table 2). The safe removal of protective equipment also follows a specific sequence that requires special attention to areas that are now considered contaminated: 15
1. Gloves should be removed by first grasping the palm of the other hand and peeling off the first glove, keep hold of the removed glove in the gloved hand, slide the fingers of the ungloved hand under the remaining glove and peel it off over the first glove. 2. Goggles or face shield should be removed by lifting from behind the head. 3. Gowns should be untied and removed by pulling away from the neck and shoulders, turning the gown inside out and only touching the inside. 4. Mask or respirator should be removed by reaching behind the head and grasping the bottom ties then the top ties and removing without touching the front. Alternatively, the gloves and gown may be removed at the same time by grasping the gown from the front and pulling away from the body, rolling the gown into a bundle, and removing the gloves at the same time using the inside of the gown. Hand hygiene should be performed after removal of all protective equipment and anytime during removal if they become contaminated. 16
Table 2: General Guidelines to reduce Risk of HIV Transmission in the Healthcare Setting 15 Risk Precaution Handling sharp objects (needles, scalpels, etc.)
• Do not recap used needles by hand; do not remove used needles from disposable syringes by hand; and do not bend, break, or otherwise manipulate used needles by hand. • Place used disposable syringes and needles, scalpel blades, and other sharp items in puncture-resistant containers for disposal. • Locate the puncture-resistant containers as close to the use area as is practical. • Use protective barriers to prevent exposure to blood, body fluids containing visible blood, and other fluids to which universal precautions apply. • Ensure that the type of protective barrier(s) is appropriate for the procedure being performed and the type of exposure anticipated. • Immediately and thoroughly wash hands and other skin surfaces that are contaminated with blood, body fluids containing visible blood, or other body fluids to which universal precautions apply.
Potential exposure to body fluids Contaminated skin surfaces
Screening/testing About 40% of new HIV infections are transmitted by people undiagnosed and unaware that they are HIV positive. 17 Diagnosing HIV quickly and linking people to treatment immediately are crucial to reducing new HIV infections. A 2017 MMWR report noted that more than 75% of patients at high risk for HIV infection who saw a PCP in the last year were not offered an HIV test during their visit. 18 According to the CDC, PCPs are the front line for detecting and preventing the spread of HIV.19-21 The CDC recommends that all PCPs: ● Conduct routine HIV screening at least once for all of their patients between the ages of 13 and 64. ● Conduct more frequent screenings for patients at greater risk of infection; patients at high risk should be screened at least annually. ● Link all patients who test positive for HIV to medical treatment, care, and prevention services.
● Provide prevention counseling for patients at-risk for acquiring HIV (this should not be required for general testing). Routine screening should be implemented using an “opt-out” approach. 21 When an opt-out approach is implemented, patients should be informed, through a patient brochure, practice literature/form, or discussion, that an HIV test will be included in the standard preventive screening tests, and that they may decline the test (opt-out). A patient’s decision to decline testing should be noted in their medical record. 21 Laboratory tests to detect HIV RNA (or DNA), antigens and antibodies to the virus have improved substantially over the years and are now easier, less expensive, and are associated with a more rapid turnaround time. 19 Three types of tests are available: 21 ● Nucleic acid tests (NATs): detects HIV ribonucleic acid (RNA).
Book Code: CT24CME
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