Lecture | Quiz | Learning Exercise | Answer Key

Developed by JHPIEGO’s Training in Reproductive Health Project with funding from USAID.

Lesson 9: Infection Prevention for Healthcare Workers
Instructor: Linda Tietjen, Infection Prevention Consultant

Answer Key

Quiz 

1. The risk of acquiring HIV after a single needlestick from an HIV-positive patient is:
   1. 50%
   2. 30%
   3. 5%
   4. 0.4%
2. Which of the following best describes when standard precautions should be used:
   1. when patients are known to be infected with HIV, hepatitis B or hepatitis C
   2. when patients have known risk factors for HIV, hepatitis B or hepatitis C
   3. with all patients
   4. with patients living in areas with high prevalence of HIV
3. To help prevent injuries from accidental needlesticks, needles
   1. should be recapped prior to disposal
   2. should be disposed of in a regular trash container
   3. should be carried uncapped to a puncture-proof container kept in a central location in the clinic
   4. should be placed in a puncture-proof container immediately after use
4. Which of the following situations is associated with the greatest risk of transmission of HIV if an exposure occurs?
   1. deep puncture with syringe needle 
   2. postexposure prophylaxis with two antiretroviral agents is used
   3. exposure is a splash of blood on the arm
   4. patient who is the source of exposure has HIV but is without symptoms

Learning Exercise

1. There does seems to be a lot of misunderstanding about the risk of HIV transmission in the health care setting. There are problems from both overestimating and underestimating the risk. The problem with overestimating risk is that it promotes stigma and fear of patients with HIV. The problem with underestimating risk is healthcare workers may be more careless.
   
   Keep in mind that testing patients who are thought to be at risk for HIV is not an effective strategy for preventing transmission in the healthcare setting. It is expensive and may not be a good use of scarce resources. It will underestimate the number of those truly infected because many people who are infected do not realize that they are even at risk. For example, their husbands, who are their only sexual partner, infect many women. Furthermore, someone who is newly infected will test negative but still be infectious. These problems are the reason that standard precautions are recommended for use by EVERY healthcare worker with EVERY patient.
   
   Accidental blood/body fluid exposure is fairly common, though most involves lower risk exposures than needlesticks. The fact that there are a lot of accidental exposures points out the importance of using standard precautions with ALL patients.
   
   Using personal protective equipment (PPE's) to protect yourself from accidental exposure is new, especially in rural areas. It takes time to change practices that have been in place a long time. It also takes continuing education as well as practice to reinforce proper IP practices. In the USA, anyone drawing blood is expected to wear gloves when doing so. This was a big change and took some time for healthcare workers to feel comfortable using gloves when drawing blood or anytime they thought they would be in contact with blood or body fluids. When something new is introduced, it feels uncomfortable but with practice you get use to it and it becomes natural. Initially, people complained about loss of sensitivity. However, that changed and I don't hear that type of complaint in the USA anymore. Now, in any healthcare facility it is very unusual to see people NOT using PPE’s, that includes clinics and dentist offices but it did take time. HCW's do need to work with administration so they are aware that PPE's need to be included in the budget. 
   
   Standard precautions also include using safe practices in the operating room or theater. In emergency settings, such as a ruptured ectopic pregnancy or an emergency C-section, everyone on the surgical team is moving very fast and accidental sharp injuries are more likely to occur. One suggestion is to have a safe zone (a pan or basin) in which to pass or place sharp instruments, rather than passing these hand-to-hand. As always, it is recommended that you (the surgical team) discuss and practice how you will do this prior to an emergency so that it also becomes comfortable and automatic. One suggestion is to discuss how and then role play using a safe or neutral zone when you are outside of the OT - so the team will be comfortable using these safe practices during routine surgery as well as during an emergency. Luckily, this is something people can adopt that doesn't take extra supplies or money.
   
   One of the best ways to avoid the "stigma" for the patient/client of being thought to have AIDS or HBV or HCV is to use standard precautions with all contacts (each and every patient/client without considering testing.) This way you are protecting yourself at all times and don't have to wait for results and then still need to worry about if the test results are correct or not. And since all patients/clients are treated the same - no one person is singled out and you are protecting yourself at all times.
2. Lack of clean water can be a barrier to using standard precautions. Hand washing is very difficult when you do not have clean water or in some areas any water. However, using an antiseptic handrub (add 2cc of glycerin to 100cc of 60-90% alcohol) is one excellent alternative to handwashing. If your water is contaminated you can make clean water. First, if your water is cloudy, most particulates can be removed by filtering through four layers of cotton cloth (such as old sari material or cheese cloth) then the water can be boiled for 5 minutes (can be used for drinking) or you can add chlorine to make a 0.001% solution (10ppm). This water is considered safe for drinking as well but is less expensive so can be used for hand hygiene and instrument processing in rural areas. (Attached are formulas for mixing bleach - MS Word 44k.)
   
   Improving knowledge about standard precautions will help reduce risks to HCW's so that each person feels that they can do something to protect themselves while caring for their patients. This will improve quality of care for all patients.