HIV and Trauma

HIV and HIV and TRAUMATRAUMADr.S.MURUGANDr.S.MURUGAN

Consultant HIV and Sexual Consultant HIV and Sexual MedicineMedicine

Medical SuperintendentMedical Superintendent

SHIFA HOSPITALSSHIFA HOSPITALS

TIRUNELVELITIRUNELVELI

TAMILNADUTAMILNADU

DefinitionDefinition

Trauma is defined as any body wound or shock Trauma is defined as any body wound or shock produced by sudden physical injury, as from produced by sudden physical injury, as from

accident, injury, or impact.Trauma patients usually accident, injury, or impact.Trauma patients usually require specialized care, including require specialized care, including surgerysurgery and and

sometimes sometimes blood transfusionblood transfusion

HIV InfectionHIV Infection• People infected with HIV---People infected with HIV---

• May look and feel health for a long time.May look and feel health for a long time.• Can infect others even if they don’t look or fell sick.Can infect others even if they don’t look or fell sick.• May have symptoms that are like those of many other illnesses.May have symptoms that are like those of many other illnesses.

• When people develop AIDS, they may get illnesses that healthy When people develop AIDS, they may get illnesses that healthy people usually don’t get.people usually don’t get.

• Only a test can show if someone is infected with HIV.Only a test can show if someone is infected with HIV.

• Only a doctor can diagnose AIDS.Only a doctor can diagnose AIDS.

Source: American Red Cross HIV/AIDS Program: HIV Education and Source: American Red Cross HIV/AIDS Program: HIV Education and PreventionPrevention

MSDE HIV/AIDS Program

HIV STATUS& TRUAMAHIV STATUS& TRUAMA

Status not known to patients Status not known to patients Relatives or Care takerRelatives or Care taker Not in a position to tellNot in a position to tell Not willing to reveal- fear of denial Not willing to reveal- fear of denial

of treatmentof treatment Due to stigma and discrimination by Due to stigma and discrimination by

the societythe society

Source of infectionsSource of infections

Where are blood-borne pathogens Where are blood-borne pathogens found?found?

Body fluids containing visible bloodBody fluids containing visible blood

Semen and vaginal secretionsSemen and vaginal secretions

Torn or loose skinTorn or loose skin

Operating on HIV/High risk Operating on HIV/High risk groupsgroups

It is a concern all should be cared equally.It is a concern all should be cared equally. HIV infected carries the risk of being HIV infected carries the risk of being

neglected at the time of crisis.neglected at the time of crisis. Law may not change for equality but Law may not change for equality but

motivated health workers should bring in motivated health workers should bring in change of attitude.change of attitude.

Adherence of Universal Health precaution Adherence of Universal Health precaution bring in safety to all HCW.bring in safety to all HCW.

Follow the precautions even in Non HIV Follow the precautions even in Non HIV patients as some of our patients are in patients as some of our patients are in window period and more dangerous than window period and more dangerous than truly positive with Sero testing.truly positive with Sero testing.

Caring Bleeding PatientsCaring Bleeding Patients

Primary health care workers who handle Primary health care workers who handle the patients in Emergencies, and the patients in Emergencies, and Accidents to be trained in basic principles Accidents to be trained in basic principles of Universal Health care precautions.of Universal Health care precautions.

Mouth to Mouth resuscitation is life Mouth to Mouth resuscitation is life saving in the Critically injured accident saving in the Critically injured accident victims. May be neglected because of fear victims. May be neglected because of fear of HIV infection.of HIV infection.

If the situation warrants, Bleeding from If the situation warrants, Bleeding from mouth can be wiped out with clean cloth, mouth can be wiped out with clean cloth, or Handkerchief, and still one can do or Handkerchief, and still one can do resuscitation.resuscitation.

Importance of UWPImportance of UWP

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

Universal Precautions

Universal precautions are work practices that helpprevent contact with blood and certain other bodyfluids. Universal precautions are:

• Your best protection against HIV (the virus that causes AIDS), hepatitis B and some other infectious diseases.• Required in certain jobs.• Can help prevent illness and save lives—including your own!

MDE HIV/AIDS PROGRAM

How Universal Precautions Work

Certain infectious diseases are caused by viruses.

For example: • AIDS is caused by HIV (human immunodeficiency virus). HIV attacks the body’s natural defense against disease.

• Hepatitis B is caused by HBV (hepatitis B virus). Hepatitis C is caused by HCV (hepatitis C virus). HBV and HCV attack the liver and can result in severe illness—even death.

MDE HIV/AIDS PROGRAM

Preventing Infection

Universal precautions help prevent infection through the use of:

• protective barriers, such as gloves, gowns, masks and goggles• safe work practices, such as proper disposal of sharps and proper hand washing.

http://www.itsasnap.org/snap/teachers_nurses.asp

MDE HIV/AIDS PROGRAM

HIV, HBV and some other viruses are spread through certain

body fluids, including:

• blood (or any fluid containing visible blood)• semen• vaginal secretions• fluids surrounding the heart, lungs, brain, stomach, • joints, and tendons; fluids in the womb of a pregnant woman.

How Universal Precautions Work cont.

MDE HIV/AIDS PROGRAM

SOCIAL HAND WASHING

Water-proof strongly adhesive plastic dressings for break in skin

and to seal off areas that are oozing blood

Gloves, Mask, CapGloves, Mask, Cap

The used needles must be destroyed in needle-cutters.

After the blood / clinical sample has been collected the syringes/other instruments should

immediately be submerged in the disinfectant

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

Always use sterile trays and forceps

Spillage of Blood/Body Spillage of Blood/Body fluidsfluids

A common health hazard in the A common health hazard in the working environment.working environment.

Never wipe the spillage with Never wipe the spillage with working wet mop.working wet mop.

Always cover the spills with paper and Always cover the spills with paper and pour 1 % Hypochlorite or Bleaching pour 1 % Hypochlorite or Bleaching powder to decontaminate the spills powder to decontaminate the spills

with HIV/HBV virus.with HIV/HBV virus.

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.

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

along with disinfectant.

Precaution for Invasive Precaution for Invasive ProceduresProcedures

All HCW’s who participate in invasive All HCW’s who participate in invasive procedures must routinely use procedures must routinely use appropriate barrier precautions.appropriate barrier precautions.

All Health care workers who All Health care workers who perform/assist vaginal, and cesarean perform/assist vaginal, and cesarean deliveries should wear gloves and gowns deliveries should wear gloves and gowns when handling, the placenta, and the new when handling, the placenta, and the new born, till blood and amniotic fluid has born, till blood and amniotic fluid has been removed from infants. been removed from infants.

Amniotic fluid is rich in HIV/HBV virus, in Amniotic fluid is rich in HIV/HBV virus, in infected mothers.infected mothers.

Decontamination of Decontamination of Hospital LinenHospital Linen

All the linen contaminated with All the linen contaminated with Blood or Body fluids should be Blood or Body fluids should be soaked in 1: 100 bleach solution for soaked in 1: 100 bleach solution for 30 minutes.30 minutes.

Advised Autoclaving, as the most Advised Autoclaving, as the most ideal procedure for decontaminating ideal procedure for decontaminating LinenLinen

Care of EndoscopesCare of Endoscopes

Endoscopes are delicate/precious Endoscopes are delicate/precious instruments.instruments.

Follow the instruction of Follow the instruction of Manufacturers.Manufacturers.

It is commonly cleaned with 2 % It is commonly cleaned with 2 % Glutaraldehyde solution.Glutaraldehyde solution.

Specified time schedules to be Specified time schedules to be followed to decontaminate for HIV.followed to decontaminate for HIV.

Mycobacterium needs even > 2 hours Mycobacterium needs even > 2 hours for decontmination.for decontmination.

Decontamination of Metal Decontamination of Metal InstrumentsInstruments

Hold all contaminated instruments Hold all contaminated instruments with Gloved hands.with Gloved hands.

Subject all metal instruments to Subject all metal instruments to washing with soap and water.washing with soap and water.

Treat all contaminated instruments Treat all contaminated instruments with 2% Glutaraldehyde. For at least with 2% Glutaraldehyde. For at least 30 minutes.30 minutes.

Many consider sterilizing in Hot air Many consider sterilizing in Hot air oven if not sharp instruments.oven if not sharp instruments.

Universal PrecautionsUniversal Precautions

All blood and potentially infectious All blood and potentially infectious materials are treated as if they are materials are treated as if they are infectious, regardless of the infectious, regardless of the perceived status of the source perceived status of the source individual.individual.

You treat all blood and body fluids as You treat all blood and body fluids as if they are infected.if they are infected.