Infection control guidelines, acquired immune deficiency syndrome (AIDS)

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Northern Territory Department of Health Library Services Historical Collection

· DL HIST

·; 616.9792

, ROY

. 1985

ROY AL DARWIN HOSPITAL

INFECTION CONTROL GUIDELINES

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HISTORICAL COLLECTION

ACQUIRED IMMUNE DEFICIENCY SYNDROME

(A.I.D.S.)

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ROYAL DARWIN HOSPITAL

INFECTION CONTROL GUIDBLIN:ES

ACQIDRED IMMUNE DEFICIENCY SYNDROME (A.I.D.S.)

Compiled June 1985 by R.D.H. Infection Control from A.I.D.S. Task Force Guidelines

March 1985

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ROYAL DARWIN HOSPITAL

INFECTION CONTROL GUIDELINES

ACQIDRED IMMUNE DEFICIENCY SYNDROME (A.LD.S.) 1.0 Introduction

2.0

1.1 Guidelines have been developed by the A.I.D.S. Task Force for use by health-care workers and other personnel, including ambulance attendants, dentists and mortuary attendants, whose work may require contact with patients with AIDS or related conditions.

1.2 Sections of the AIDS Task Force Guidelines have been used to prepare this booklet for easy reference for staff.

Causative Agent of AIDS

2.1 The causative agent of AIDS has been identified. It is a retrovirus known variously as human T cell lymphotrophic virus type 111 (HTL V 111), lymphadenopathy associated virus (LAV) or AIDS-related virus (ARV).

2.2 On present evidence only a small proportion of people found to be seropositive for antibody to the virus will develop AIDS within five years. In the initial period. of infection antibodies may not be detectable until some weeks of viraemia have elapsed.

3.0 Transmission

4.0

3.1 Transmission of the disease appears to have a pattern similar to that of hepatitis B, and for this reason precautions appropriate for hepatitis B should be used as a guide in implementing infection-control procedures.

3.2 The disease may be transmitted by blood, ti&5Ue, and secretions or excretions that may contain blood (or the virus), such as saliva, semen, urine and stools, and precautions should be directed at reducing exposure to these body fluids.

3.3 The risk to health-care workers of developing AIDS appears at present to be very low. There has been no evidence of person-to- person transmission through casual contact.

Categories of AIDS 4.1 Category A

The presence of a reliably diagnosed disease at least moderately indicative of an underlying cellular immune deficiency in a person with no known underlying cause of cellular immune deficiency nor any other cause of reduced resistance reported to be associated with that disease.

4.2 Category B

4.3

Cases with either:

(i) clinical evidence of active infection and confirmed positive test for antibody to HTLV 111 or a positive test for the virus itself; or

(ii) defective cell mediated immunity and confirmed positive test for antibody to HTL V or the virus itself.

Symptoms existing for three months:

(a) (b) (c)

(d) (e)

(f)

Category C

fever and night sweats;

weight loss greater than 10 per cent of body weight;

persistent lymphadenopathy in at least two extra-inguinal and non-contiguous sites;

chronic diarrhoea;

persistent oral candidiasis;

unexplained haematological auto-immune conditions.

None of the signs or symptoms listed in category B, nor evidence of deficient cell mediated immunity, but with a confirmed positive test result for antibody to HTL V 111 or the virus.

5.0 Precautions to be observed

5.1 Cases in category B or category C are considered to be as likely to transmit the disease as those in category A. The precautions outlined here should apply to cases in all categories.

5.2 Isolation

5.3

Patients may be cared for in general hospitals and strict isolation is unnecessary. Single room and modified or full excretion, secretion blood precautions may be indicated, depending on patient's condition.

Specimens:

Specimens from patients should have a warning label with the biohazard (etiologic agent) symbol and words 'H/ A precautions' and should be placed in a water proof bag or container for transport.

'H/ A' is a code for hepatitis/ AIDS.

5.4 Gloves

Gloves should be worn by persons who are in contact with blood, serum, tis.gue, any body fluids, or excretions (including saliva, pus, menstrual fluid, semen) or articles or surfaces potentially contaminated by them.

5.5 Hand washing

After contact, hands should be washed immediately with soap and water. Thorough hand-washing is mandatory before contact with patients suspected of having or known to have AIDS and before leaving the patient's room.

5.6 Gowns

Gowns are recommended for those likely to have direct contact with patient's secretions, excretions or blood.

5.7 Masks

5.8

5.9

Masks are not routinely necessary for patients with AIDS. They should be worn by patients who are coughing when it is necessary for them to leave the hospital room. Masks should be worn by visitors and health-care workers who have direct and sustained contact with a coughing patient or an intubated patient where suction is employed to clear airways.

Protective ~Y~:!!_ear

Protective eyewear (goggles) should be worn in situations in which splattering with blood, bloody secretions, or body fluids is expected.

Should an accident occur when the face is splashed with blood, the eyes and mouth which present exposed mucous membranes should be gently rinsed with water to minimise the risk of infection via the

mucous membranes.

Needles and syringes

Needles and syringes should be disposed of in rigid-wall, puncture- resistant containers. Needles should not be reshea thed after use, and disposable equipment should be used whenever possible.

Employees with needle-stick injuries should report to the employee health service and be treated according to the needle-stick protocol at their hospital.

6.0

7.0

5.10 Linen, utensils etc

All contaminated disposable items (visibly soiled with potentially infectious material) should be considered 'infectious waste' and identified as such. Contaminated linen should be double-bagged.

Gloves should be worn when bagging linen. Once bagged, linen should not be handled directly before it is laundered. Laundry, once received at the central facility, should be washed as usual. Hospital laundry procedures provide adequate decontamination.

5.11 Patient Accommodation 5.11.1

5.11.2

5.11.3

5.11.4

A private room is not necessary if the patient is co- operative, is not coughing, and can be adequately instructed in personal hygiene.

Where the patient is coughing and there is reason to suspect the presence of pulmonary tuberculosis or other communicable pulmonary disease, then isolation measures should be instituted.

It may be prudent to admit patients with AIDS to private rooms when available.

When a double room is used, the other patient should not be an impaired host who is susceptible to opportunistic infection or someone who might harbour potential opportunistic infections that could be transmitted to the patient with AIDS.

Refusal to care for __12atients with _AIDS

6.1 There is .no scientific reason for healthy personnel to be excused from delivering care to patients with AIDS. Those who believe they are at high risk for infection because of their own immune status should be encouraged to discuss their work responsibilities with their personal medical attendant.

6.2 Pregnant employees should not engage in the direct care of patients with AIDS, b~.cause of the potential of birth defects from cytomegalovirus and the potentially large amounts of this virus that may be disseminated from such patients.

Cardiopulmonary resuscitation in the hospital s_ett~

7 .1 Resuscitation bags or disposable devices for mouth-to-mask cardiopulmonary resuscitation (CPR) should be available for every patient and should be used for resuscitation. Such devices should be kept immediately outside the room of patients with AIDS and other patients with potentially transmissible infections for example, hepatitis B infection or tuberculosis.

8.0

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7 .2 When such a CPR device is available, the employee is obligated to administer CPR. The decision to withhold direct mouth-to-mouth resuscitation from a patient with AIDS when a CPR device is not available is solely that of the individual employee.

7 .3 Hospital employees with documented AIDS or the syndromes in categories B or C above should be excused from participating in the two-person manikin phase of the CPR training program.

Disinfection and sterilisation procedures

8.1 Wherever possible, equipment used on known or suspected cases of infection should be disposable.

8.2 Before dealing with contaminated equipment operatives should wear a gown, mask, goggles and heavy duty gloves, especially if any sharp instruments are to be handled. A mask and goggles are not required if a class 1 or class 11 biosafety cabinet is used.

8 .3 Cleaning

Thorough physical cleaning of instruments is essential prior to sterilisation or disinfection. Cold water and detergent should be used to assist the removal of blood, serum or other materials containing protein; use of hot or boiling water may result in coagulation and adherence of such matter to the instruments. Such a coagulum may protect the virus from the action of a chemical disinfectant.

8.3.1 Disinfection _and Sterilization erocedures

Items must be washed first, then enclosed in a sealed clear plastic bag and sent to CSD for decontamination.

8.3.2 Heat

(i) Autoclaving - (ii) Dry air Oven

(iii) Boiling ( 30 minutes) 8.3.3 Chemicals

(i) Ethylene Oxide gas (4-16 hours - depending on object)

(ii) Glutaraldehyde (2 % fresh solution for one hour)

(iii) Sodium Hypochlorite (30 minutes '"""'fo,oooppm "dirty"

conditions, 2 ,OOOppm for "clean" conditions) (iv) Ethanol (70 % ethyl alcohol for one hour)

(v) Formalin HAS BEEN REPORTED NOT TO BE EFFECTIVE AT A CONCENTRATION OF 0.1 %)

8.4 Surface decontamination

8.4.1 Spillage onto benches, floors and walls to be cleaned up with disposable cloths soaked in sodium hypochlorite 10,000ppm (1 % ) (obtain freshly prepared solution from Pharmacy).

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9.0

8.4.2 For routine accommodation recommended.

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disinfection of AIDS and Hep. B patient rooms, Sodium hypochlorite 2 ,OOOppm is

Specialised Medical Equipment 9 .1 Lensed instruments

9.2

After each use, lensed instruments should be thoroughly cleaned physically and then disinfected with ethylene oxide or glutaraldehyde.

Anaesthetic equipment

9.2.1 Mask, mouth, oral and nasopharyngeal airway Y-pieces and corrugated tubing from anaesthetic machines or ventilators, . if not disposable, should be thoroughly washed and submitted to pasteurisation (70-80 degrees celsius for at least 30 minutes) after each use.

9.2.2 Disinfection of instruments which are frequently used such as laryngoscopes and endotracheal tubes must not be perfunctory.

These instruments come into contact with blood, saliva, pharyngeal secretions, etc. Such equipment should preferably be disposable; if not it must be adequately sterilised before each use.

9.2 .3 f:ar~~co2e blades should be replaced with a sterile blade after each use. The same blade should not be used on a series of patients with only a quick washing or swabbing with disinfectant between patients.

9 .2 .4 Any instrument or appliance which has been in contact with the patient's oropharyngeal or other secretions should not be returned to the 'clean' anaesthetist's trolley where is may contaminate other clean instruments.

10.0 Outpatients and Emergency

10.1 Separate examining rooms are not necessary and are in many situation not practical or feasible.

10.2 Efforts should be made to minimise direct contact between patients with AIDS and other severely immunocompromised patients.

10.3 Outpatients with AIDS and related conditions may use common waiting areas and bathroom facilities •