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Northern Territory Department of Health Library Services Historical Collection
'Wlr-
DEPARTMENT OF HEAL TH.a.Iii.
AND COMMUNITY SERVICESDL HIST 614.5993 HIV
1993
007S~
HISTORICAL COLLECTION
Acknowledgement
The Working Party wishes to acknowledge and thank Community Child Care Co-Op Ltd NSW for the use of their booklet "AIDS in Child Care" as the main and most valuable resource in the development of this publication. We have incorporated extracts from their booklet which was produced and printed with a grant made available by the NSW
INTRODUCTION
The following guidelines have been produced to assist Children's Services providers to develop appropriate informed policies and safe working practices in respect of AIDS.
It is hoped to achieve consistency of policy in all Children's Services to prevent unnecessary exclusion of children and/ or caregivers infected with the HIV virus which may cause AIDS (Acquired Immune Deficiency Syn- drome).
These guidelines refer specifically to HIV infection and AIDS. The recommended first aid hygiene procedures are appropriate for many infectious diseases (eg hepatitis B) and should be generally applied.
It is anticipated that these guidelines and procedures may need to be revised annually as further information about HIV infection including (AIDS) becomes available.
WHAT IS AIDS?
AIDS stands for Acquired Immune Deficiency Syndrome. It is caused by a virus called the Human Immunode- ficiency Virus (HIV) and referrred to as HIV in this booklet. Once a person becomes infected with HIV they have it indefinitely and may transmit it to others at any stage of infection.
HIV damages our immune system by destroying the white blood cells that normally fight off infections and prevent the spread of certain cancers. With the body's defences weakened, other infections that are usually rare or of little danger can become life-threatening. When the disease reaches this stage it it known as AIDS.
HOW IS IT TRANSMITTED?
HIV can get into your bloodstream through infected semen, blood or vaginal fluids. This can occur:
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through having anal or vaginal sexual intercourse without a condom
through sharing needles and syringes for intravenous drug use
through an infected woman passing HIV on to her baby in the womb, or possibly during the birth process or through breast feeding
• through blood transfusion. This is not a problem in Australia any more, due to the screening process used by the Blood Bank to ensure that blood donations are free of HIV.
. HOW AIDS IS NOT TRANSMITTED ?
HIV is NOT transmitted through:
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coughing or sneezing•
shared use of crockery or cutlery•
swimming pools or toi~t•
it is not known to be transmitted by biting insects There is no known car
where in the world :W:IV infectio having been transmitted in child careHYGIENE AND FIRST AlD PROCEDURES IN CHILDREN'S SERVICES
Cases of AIDS in children's services may be very rare for many years to come. However, because of the severe nature of the disease, it is important to re-emphasise basic hygiene and to review first aid procedures.
These procedures are relevant to many diseases and should be generally applied.
All service providers should be reminded of the particular need for care in handling blood. This is particularly relevant to minimise the risk of infection from HIV or hepatitis B. Although there is no evidence that HIV has been transmitted through social contact, the following precautions are recommended by the National AIDS Task Force:
It should be recognised that there is minimal risk of transmission of HIV through contact with saliva, faeces and urine. However, any person with sores or cracked skin around the mouth should not share crockery or mouth pieces with another person. Contact with either a bleeding or weeping lesion may constitute a risk of cross infection from several infectious diseases. Basic hygiene procedures for washing and drying should be followed where there is the shared use of such items as crockery and musical instruments. Staff involved in toileting children should continue to exercise strict hygiene, paying added attention to cuts or broken skin, and protecting these areas from direct contact with body fluids by keeping them covered.
BLOOD CONTACT PROCEDURES
There is very little risk of getting HIV through giving First Aid to someone who is bleeding. Theoretically it could occur if the accident victim was HIV infected, but only if you had an uncovered open wound or a skin disease like dermatitis and the accident victim's blood got into your bloodstream.
Although infection from external contact with blood is rare, all cases of external bleeding should be dealt with carefully. The following precautions should be observed:
• Avoid contact with blood, if hands or lower arms have open cuts or unhealed wounds
• Use disposable gloves when time and the situation permit. However, first aid for a severely bleeding wound should not be delayed.
• After handling blood or other body fluids, wash hands, lower arms and any other parts of the body in contact with or splashed by blood, thoroughly with soap and water.
• Disposable towels and tissues should be used wherever possible
• Place waste materials after contact with blood or other body fluids into a plastic bag and seal for disposal or incineration.
FAECES AND URINE
Wherever blood is present, including blood found in faeces and urine, extreme care must be taken. However, because blood is not always visible in faeces and urine, all bodily wastes should be handled with appropriate hygiene procedures.
There is a risk of catching other common and more easily transmitted infections like Hepatitis A or B and gastroenteritis if basic standards of hygiene are not maintained. Hygiene procedures to prevent the spread of these infectious diseases are more than adequate to prevent the spread of AIDS.
If you have a cut or lesion (eg dermatitis or eczema) on your hands, cover it or wear disposable gloves when dealing with faeces, urine or blood. Healthy skin provides an adequate barrier to infection so it is important to look after your skin (eg use hand cream after washing your hands).
NAPPIES, LINEN AND CLOTHES
It is recommended that gloves are worn when handling nappies or linen soiled by body fluids. It is recommended that disposable gloves be made available in your service. Faecal matter or Vomitus should be scraped off and flushed down the toilet.
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Dirty linen should be rinsed and then:- EITHER laundered as soon as possible using ordinary commercial detergent in a cold water wash OR stored in separate covered receptables or a names plastic bag per child collection by parents. Soak any bloodied clothes for 10 minutes in recommended bleach solution (1:10).
DISPOSABLE NAPPIES
Faecal matter should be removed and flushed down down the toilet. Soiled nappies should be placed in a plastic bag for disposal via garbage removal service.
VOMIT
The virus is not found in vomit; gastric juices in the stomach destroy it.
SALIVA AND TEARS
HIV has been found in saliva and tears but not in sufficient concentrations to be a risk. Given this low concentration, spitting, kissing and wiping noses are considered safe.
BITING
This has always been a concern in child care. The usual strategies to reduce biting should deal with this problem.
There have been no cases in which biting has been proven as the way HIV was transmitted.
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For transmission through biting to occur, a significant quantity of infected blood would have to get into the uninfected child's bloodstream. Ths means both children would have to be bleeding when the bite occurred or the infected child would have to be bleeding and the uninfected child have an open wound or active skin disease. If there is a biting incident where the skin is broken, wash the bitten area thoroughly with water
~nd apply appropriate antiseptic. Rinse the biting child's mouth with water.
MOUTH TO MOUTH RESUSCITATION
The risk of infection from mouth-to-mouth resuscitation is negligible and there is no reason to withhold first aid and resuscitation from any child or adult in need of emergency assistance. A disposable Resuscitation Unit is available from St John Ambulance and it is recommended it be kept with the First Aid Kit.
CHILDREN'S SEX PLAY
This does not carry any risk of HIV infection because before puberty boys do not produce semen and girls do not produce sufficient vaginal fluids to be infectious.
BLOOD BROTHERS AND SISTERS
This is a children's ritual where they deliberately cut themselves and press their wounds together to mix blood.
It carries a significant risk of infection and should be strongly discouraged.
FURNITURE
All items that are in contact with blood or body fluids should be:
wiped down with cold tap water and detergent then with an approved disinfectant,
e.g. household bleach (sodium hypochorite) freshly diluted daily to a 0.5% solution (e.g. 1 % availablechlorine
=
1 part bleach to 10 parts water).These include items such as: benches, tables, chairs, cots, toys, potties and toilet seats.
Wash carpeted areas with detergent and water.
PROCEDURES FOR CHILDREN WHO HAVE BEEN INFECTED BY HIV
In general children who have been infected by HIV should not be excluded from the centre or service or isolated within the centre or service.
The most recent information from the National AIDS Task Force recommends that children who have been infected with the virus and -
a. who are clinically healthy, need not be excluded from children's services, provided the normal acceptable levels of hygiene andsupervision are maintained;
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b. who are clinically unwell, should be assessed by a doctor before any decision is made as to whether they should stay away from the service until clinically better;
c. who have moist skin lesions or abrasions, should cover those lesions whilst attending the service.
The covering should be impermeable to leaking fluids and be attached securely. If lesions are weeping or discharging, and cannot be covered, as a precaution it is advised that children so affected remain away from the service until their lesions have healed or can be covered.
d. those who have developed impairment of immunity should remain away from the service during outbreaks of serious contagious diseases such as measles or chicken pox, as those children are more susceptible to such infections.
Parents or guardians are not obliged by law to inform the service that their child has been infected by HIV.
Parents or guardians may choose to advise the Director /Co-ordinator or individual caregivers of the condition.
PROCEDURES FOR SERVICE PROVIDERS AND STAFF MEMBERS WHO HA VE BEEN INFECTED BY HIV
Service providers and staff members who have been infected by HIV are not obliged to inform their employer of their condition. However, any such advice received must remain confidential. Such persons are not to be discriminated against.
In view of the potential for a small number of these personnel to become ill with AIDS they should seek medical assistance in monitoring their own health. They should also be particularly aware of the danger to others of accidental transmission through blood from cuts and abrasions. Staff members who are haemo- philiacs should take added precautions.
The symptoms and effects of the disease AIDS are such that staff may be unable to continue work or may require intermittent sick leave. As in the case of other serious illnesses, where a service provider or staff member becomes ill because of HIV, the employer should ensure that the staff member is acquainted with sick leave entitlements and procedures.
These guidelines are based on information available as of October 1989 and should be reviewed on an annual basis.
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Services should ensure that Child Care Workers attend available in-services on HIV infection.
CONFIDENTIALITY
If a staff member is told that a child or a child's parent or another staff member is infected with HIV this information must remain confidential.
If it is considered that other member or staff should be informed, this can only occur with the consent of the HIV infected person or the parents/ guardians of the child concerned.
If parents or staff request that information remain confidential and this request is breached, legal action could ensue.
In all States and Territories of Australia, doctors have to notify AIDS cases to the Department of Health. In the Nothem Territory this information is currently coded to protect the individual's rights to confidentiality.
Disclosure of identity can only be done with patient's consent or court's order .
ANTI-DISCRIMINATION
Amendments to the Human Rights and Equal Opportunity Regulations which came into effect on 1 January 1990 declared any distinction, exclusion or preference in employment on the grounds of medical record,
impairment, or imputation of either of these, to constitute discrimination. The definition of impairment applies to HIV/ AIDS status.
THE CHILD CARE WORKER'S ROLE
The child care worker's role includes support to children and their families. A reasoned and sensible approach to the AIDS issue will provide great support to families affected by AIDS, whether they choose to inform the service or not.
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INFORMATIONAL AND ADVISORY FACILITIES ON AIDS
Telephone "HOTLINES" have been established in the main Northern Territory towns:
Other AIDS organisations who can provide information on AIDS includes:
DARWIN 81 2951 and 410024 (24hour) ALICE SPRINGS 50 2639 (24 hour)
GOVE KATHERINE TENNANT Ck
87 0269 (Relevant section of 79 1916 local hospital - 62 3166 office hours only) These facilities will direct the caller to information and counselling services, screening facilities and community based organisations.
Counselling and AIDS antibody testings are available to all free of charge on request at hospitals, community health centres and local m'edical practitioners.
In D~rwin the Nightcliff Community Health Centre and Central Darwin Health Centre are designated centres for AIDS/STD information and testing.
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Northern Territory AIDS Council (NTAC)
Family Planning Association NT Inc
Communicable Diseases Centre, Royal Darwin Hospital
Communicable Diseases Control Centre -Alice Springs Hospital
Crisis Line Congress
Human Rights & Equal Opportunity Commission N .T. Office of Equal Opportunity Central Australian AIDS Action Group (CAAAG)
This booklet is a joint production of Children's Services and the AIDS/STD Unit Communicable Diseases Centre NT Department of Health & Community Services.
41 1711
480144
22 8007
50 2638 81 9227 50 3377
81 9111 89 5390
531118
