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HIV/AIDS Precautions - Correctional Institutions: What Precautions Should I Take When Employed in Correctional Services?
HIV/AIDS Precautions - Correctional Institutions: What Precautions Should I Take When Employed in Correctional Services?
Institutions
|What precautions should I take when employed in
correctional services?
Correctional service workers are at risk of infectious diseases including AIDS.
Identify high risk areas and procedures. Eliminate "blind" searches where you cannot see
what your hands are touching. Use mirrors and other devices.
Wash hands:
NOTE: Correctional service workers do not routinely wear masks and protective eye
wear. This equipment should be available when needed.
Wear gowns:
Change gowns daily or when visibly soiled with blood or body fluids.
Wear masks, face/eye protection or chin-length plastic face shields (with safety glasses or
goggles):
To protect oral and nasal mucosa from the splatter of blood, saliva or gingival fluid.
Wash hands:
Between patients.
After completing procedure and before leaving work area.
With germicidal soap before and immediately after removing gloves.
Consider blood and body fluids from all patients as potentially infective.
Take proper precautions to prevent exposure to blood and body fluids.
with waterless antiseptic hand cleaner when hand washing facilities are not available.
Follow manufacturer's recommendations
after direct contact with a potentially infected person
after removing gloves
if hands become contaminated with blood or body fluids
Be careful in situations such as body searches and removing people from automobile wrecks
where the chance for broken glass, needles, or sharp edges is possible.
Consider blood and body fluids from all patients as potentially infective.
Take proper precautions to prevent exposure to blood and body fluids.
NOTE: Emergency personnel do not routinely require gowns, masks and protective eye wear.
This equipment should, however, be available for certain medical emergencies such as
controlling bleeding with spurting blood.
with waterless antiseptic hand cleaner when hand washing facilities are not available.
Follow manufacturer's recommendations
after direct contact with a potentially infected person
after removing gloves
if hands become contaminated with blood or body fluids
Be careful in situations such as body searches and removing people from automobile wrecks
where the chance for broken glass, needles, or sharp edges is possible.
Wear protective eye wear, masks or face shields (with safety glasses or goggles):
Protective eye wear, masks and clothing are not needed for routine care of AIDS virus-
infected persons.
Wear gowns:
Wash hands:
Before and after direct patient contact.
Immediately and thoroughly when contaminated by blood or body fluids.
After removing gloves.
After a glove tear or suspected glove leak.
Before leaving a work area.
The use of gloves does not eliminate the need for hand washing. Hand washing is one of the
most important procedures for the prevention of transmission.
Wash hands:
After a spill of blood or body fluid. Disinfect with a medical grade disinfectant.
Before reprocessing contaminated material used in lab tests.
When work activities have been completed.
HIV is not found in vomit, feces, nasal secretions, tears or urine unless these fluids are visibly
contaminated with blood.
HIV is not spread by casual contact. There is no risk of becoming infected with HIV by
working on the same assembly line, using the same equipment, sharing locker rooms or toilet
facilities or being in the same office as someone with HIV infection or AIDS.
skin and mucous membrane contact with blood and other body fluids of an infected
person
accidents with needles or other sharp instruments contaminated with the blood of an
infected person
The full name for AIDS describes several of the characteristics of the disease.
Immune Deficiency indicates that the body's immune system breaks down.
B-cells produce particular proteins, called antibodies, that try to neutralize the invading germ.
After a person recovers from an infection, these antibodies continue to circulate in the
bloodstream, acting as part of the immune system's "memory." Immune system memory
explains why a person rarely suffers a second attack from an infectious disease such as
measles. If the same germ is encountered again, the antibodies will recognize and neutralize
it. T-cells attack the germ directly and try to kill it.
Special white blood cells, called T-helper cells, activate B-cells and T-cells to fight infection.
When a virus gets into the blood stream, T-helper cells activate B-cells and T-cells. These
then start communicating with each other to develop the proper strategy to fight the virus. But
when the body is infected with HIV, this does not happen. HIV penetrates T-helper cells and,
over time, multiplies. This eventually kills T-helper cells. Without T-helper cells, activation
of B-cells and T-cells does not occur. Without activation of B-cells and T-cells, the body's
immune system cannot function properly. When T-cell counts reach a certain level and there
are HIV antibodies present in the bloodstream, a person is considered to have AIDS.
Unprotected sexual intercourse with infected people poses the single most important risk of
infection. HIV can also be passed from one partner into the bloodstream of the other through
tiny cuts or scratches.
Intravenous drug abusers may contract HIV if they share needles with infected people.
Hemophiliacs requiring frequent transfusions or blood products (factor VIII) are at risk due to
the possibility of receiving contaminated blood. Since 1985, Canada's Red Cross has been
screening all blood donations for HIV antibodies.
HIV can be transmitted from an infected mother to her unborn child before or during birth, or
through breastfeeding. Studies indicate infection takes place across the placenta. Therefore, a
Cesarean section delivery does not prevent the transmission of HIV from an infected mother
to her infant.
Some reports indicate that HIV can be transmitted through heart, pancreas, kidney, liver and
bone transplants, and by artificial insemination. No recipients have developed AIDS but all
organs are screened for HIV antibodies.
The transmission of HIV occurs only when the virus enters the bloodstream. Casual contact
with a person who has HIV does not pose a risk. Several studies indicate that sharing
telephones, swimming pools, toilets or other household items and facilities with people
infected with HIV poses no risk. The virus is not transmitted during the preparation or
serving of food and beverages. The virus is also not known to travel through air or to be
transmitted by mosquitoes or other insects.
Some studies show HIV transmission did not occur after bites from patients infected with the
HIV. This suggests that transmission of HIV through contact with saliva alone is unlikely.
Symptoms of HIV infection are fever, swollen lymph glands in the neck and armpits,
sweating, aches, fatigue, unexplained weight loss and diarrhea.
Within eight years, about 50 percent of all infected people develop specific conditions
categorized as AIDS. These conditions include a lung disease called "pneumocystis carinii
pneumonia," skin tumours called "Kaposi's sarcoma," fungal and viral infections such as
candidiasis and herpes zoster, and severe diarrhea.
Some AIDS patients also suffer from dementia resulting in problems with memory and
thinking. AIDS patients are prone to various infections of the brain, just as they suffer from
an unusually high number of cancers, bacterial and viral infections of other parts of the body.
Doctors diagnose AIDS by blood tests (tests showing less than 200 CD4+ T cells per cubic
millimeter of blood, compared with about 1,000 CD4+ T cells for healthy people, and CD4+
T cells accounting for less than 14 percent of all lymphocytes, a type of white blood cell.) and
the presence of specific illnesses such as pneumocystis carinii pneumonia or Kaposi's
sarcoma. These diseases overcome the weakened immune system and are responsible for the
high death rate among AIDS patients.
"Standard Precautions" are recommended to prevent the spread of HIV in the workplace.
Standard Precautions are based on the principle that all blood, body fluids, secretions, and
excretions except sweat, non-intact skin, and mucous membranes, unless they contain visible
blood, may contain transmissible infectious agents. Standard Precautions involve using
protective clothing such as gloves, gowns or aprons, masks and protective eye wear when
dealing with people's blood and other blood-contaminated body fluids such as semen and
vaginal secretions. They also do not apply to saliva except in dentistry where saliva is likely
to be contaminated with blood. Standard precautions are sometimes referred to as Routine
Practices.
Hand washing after contact with blood, blood-contaminated body fluids and soiled items is
also recommended to reduce the risk of infection.
The occupational groups listed below risk exposure to HIV in the workplace. The table that
follows suggests preventive measures for these groups. For many situations, using all
protective barriers listed in the table is not necessary, but workplaces should always make
them available in case of emergency response scenarios.
Only a few cases of virus transmission to health care workers have been reported. Surgeons,
nurses and nurses' aides, however, should take precautions to avoid needlestick injuries, cuts
with sharp instruments and exposure through skin lesions to potentially infectious blood and
body fluids.
These people continuously handle infectious samples. Doctors, in diagnosing HIV patients,
carry out physical examinations and collect blood samples. Laboratory technicians analyze
potentially infected samples. Although in Canada none of these professionals has been
reported to have developed AIDS, they should always implement safe laboratory practices.
Ambulance Workers
Ambulance workers are potentially at risk because they attend accidents and fatalities.
Ambulance workers perform first aid on individuals for whom no medical information is
available. Blood contact is a possibility for workers when removing injured people from the
scene of an accident.
Dental Workers
Dental workers are exposed daily to the blood and saliva of patients. Precautionary measures
should be adopted because of possible exposure to HIV, and because the mouth can be the
vehicle for the transmission of many infectious diseases.
Embalmers
Embalming the bodies of persons with a HIV infection presents a risk because HIV can live
for hours in a deceased body.
These workers attend accident scenes where they might be exposed to HIV through blood
contact with skin cuts or scratches.
These workers risk exposure to HIV when cleaning blood spills or when giving first aid
where there is a possibility of blood contact.
A particular concern that correctional service workers share with police is dealing with
violent people. Workers bitten by prisoners or suspects require prompt medical attention.
Bites frequently result in infection with organisms other than HIV.
Cleaners
Cleaning staff risk exposure when cleaning up spills of blood or other body fluids. Cleaning
staff need to know how to use protective clothing and proper cleaning techniques. All
cleaning equipment used to clean spills of body fluids should be kept in a restricted area and
should not be used in any other area of the workplace.
Laundry Workers
Launderers are exposed to potentially contaminated linen. All laundry should be bagged and
labeled as possibly infectious if there was contact with any person with an infectious disease.
Incinerator Attendants
Incinerator attendants in health care facilities risk exposure to HIV while disposing of
infectious waste.
Post-mortem Attendants
These workers are at risk especially if an autopsy is necessary when a patient with a HIV
infection dies.
What is Hantavirus?
Hantavirus is a virus that is found in the urine, saliva, or droppings of infected deer mice and
some other wild rodents (cotton rats, rice rats in the southeastern Unites States and the white-
footed mouse). It causes a rare but serious lung disease called Hantavirus pulmonary
syndrome (HPS). The virus does not remain active for long once outside of its host -- less
than 1 week outdoors and a few hours when exposed to direct sunlight.
For workers that might be exposed to rodents as part of their normal job duties, employers are
required to comply with relevant occupational health and safety regulations in their
jurisdiction. Typically, employers are required to develop and implement an exposure control
plan to eliminate or reduce the risk and hazard of Hantavirus in their workplace.
Thoroughly wash hands with soap and water after removing the gloves.
Hepatitis A
What is hepatitis A?
Hepatitis A is an infectious liver disease caused by the hepatitis A virus (HAV). The disease
varies in clinical severity from a mild illness lasting 1-2 weeks to a severely disabling disease
lasting several months.
There are other kinds of viral hepatitis such as hepatitis B, hepatitis C, hepatitis D, and
hepatitis E. These diseases and the viruses that cause them are not related to hepatitis A
although they also affect the liver. They may have other, different symptoms and different
modes of transmission. This means that there are different ways of spreading the disease and
different means for preventing and controlling these diseases.
Infected individuals can spread the virus from 2 weeks before the symptoms begin to 2 weeks
after symptoms end. However, an infected person who has no symptoms can still spread the
virus. Unlike some other forms of viral hepatitis, hepatitis A does not cause long-term
(chronic) damage and is usually not fatal. Those with pre-existing liver disease have a higher
risk of complications. The severity of the illness tends to increase with age. After infection,
most people are immune to HAV for life.
People can get hepatitis A by drinking contaminated water or eating raw and undercooked
shellfish harvested from contaminated water. Fruits and vegetables or other foods can
become contaminated during handling. However, working with an infected person, for
example sharing an office, does not pose the risk for hepatitis A.
A report from Quebec shows that sewage workers may be at increased risk during community
outbreaks.
In the US some reports state that staff of institutions for disabled children may be at increased
risk. However, due to insufficient data, the National Advisory Committee on Immunization
(NACI) in Canada has not recommended routine vaccination of such workers.
Education programs for workers about personal hygiene practices should emphasize that
careful hand washing is extremely important in the prevention of disease. Workers should be
informed about using appropriate protective clothing and about removing it at the end of the
shift. They should also be informed about the necessity of washing hands frequently, and
before eating, drinking, or smoking; they should also avoid nail biting.
A hepatitis A vaccine is available and highly effective in preventing infection. Consult your
health professional.
Hepatitis B
What is hepatitis B?
Hepatitis B is an infectious liver disease. It is caused by the hepatitis B virus (HBV).
Infections of hepatitis B occur only if the virus is able to enter the blood stream and reach the
liver. Once in the liver, the virus reproduces and releases large numbers of new viruses into
the bloodstream.
To combat the disease, the body has several defenses. White blood cells, which protect the
body from infections, attack and destroy the infected liver cells. The body also produces
antibodies which circulate in the blood to destroy the virus and protect against future
infections of hepatitis B. During the infection and recovery process, the liver may not
function normally causing illness that affects the entire body.
For reasons that are not completely understood, 10 percent of people who develop hepatitis B
become carriers of the disease. Their blood remains infected for months, years, sometimes for
life. Seventy percent of carriers develop chronic persistent hepatitis B. Most do not appear to
be ill. The remaining 30 percent of carriers experience continuous liver disease. This
condition often progresses to cirrhosis and then, after 30 to 40 years, possibly to liver cancer.
At present, there is no way of curing carriers. The risk of becoming a chronic carrier is
related inversely with a person's age when infected. For example, the risk of an infant
becoming a carrier is 90-95% whereas the risk of an adult becoming a carrier is 3-10%.
There are other kinds of viral hepatitis such as hepatitis A, hepatitis C, hepatitis D (delta), and
hepatitis E. These diseases and the viruses that cause them are not related to hepatitis B even
though they also affect the liver.
The annual rate of occupational infections has decreased 95% in health care workers since the
vaccine became available in 1982.
Direct contact with infected blood can transmit the hepatitis B virus through:
To a lesser extent, indirect contact with blood-contaminated surfaces can also transmit the
hepatitis B virus. The virus may be stable in dried blood for up to 7 days at 25°C. Hand
contact with blood-contaminated surfaces such as laboratory benches, test tubes, or
laboratory instruments may transfer the virus to skin or mucous membranes.
Saliva
Saliva of people with hepatitis B can contain the hepatitis B virus, but in very low
concentrations compared with blood. Injections of infected saliva can transmit the virus, so
bite injuries can also spread the disease. There are no reports of people getting hepatitis B
from mouth contact with infected CPR manikins or mouthpieces of musical instruments.
Hepatitis B is found in semen and vaginal secretions. The virus can be transmitted during
unprotected sexual intercourse, and from mother to infant during birth.
Synovial fluid (joint lubricant), amniotic fluid, cerebrospinal fluid, and peritoneal fluid
(found in the abdominal cavity) can contain the hepatitis B virus, but the risk of transmission
to workers is not known.
Feces, nasal secretions, sputum, sweat, tears, urine, and vomit have not been implicated in the
spread of hepatitis B. Unless they are visibly contaminated with blood, the risk of contracting
hepatitis B from these fluids in the workplace is practically nonexistent.
Hepatitis B is not transmitted by casual contact. For example, hospital employees who have
no contact with blood, blood products, or blood-contaminated fluids are at no greater risk
than the general public. However, the virus can spread through intimate contact with carriers
in a household setting. Why this happens is not completely understood. Somehow, the virus
can find its way into the bloodstream of fellow family members possibly because of frequent
physical contact with the small cuts or skin rashes. The virus can also spread through biting
and possibly by the sharing of toothbrushes or razors. It is not spread through sneezing,
coughing, hand holding, hugging, breastfeeding, sharing eating utensils, water or food.
Blood tests show that certain occupational groups have different risks of getting hepatitis B.
Table 1
Risks to Occupational Groups
Low (less than 7%) Administrative hospital staff, medical and dental students,
healthy adults
Health-care workers repeatedly exposed to blood or blood products or those who are
at risk of needlestick injury.
Dentists, dental assistants, and dental hygienists.
Certain staff members of institutions for the developmentally handicapped.
Staff of institutions where workers may be exposed to aggressive, biting residents.
Embalmers.
More than half of hepatitis B infections occur and pass without noticeable symptoms.
Sometimes, only mild symptoms such as a general discomfort occur. Rarely is medical
attention needed. Often, the infection disappears without treatment. In fact, laboratory testing
is often the only way of determining whether someone has had hepatitis B.
When symptoms develop, the earliest ones often include a general discomfort, joint pain,
abdominal pain, fatigue, lack of appetite, skin rash or possibly nausea, vomiting or other flu-
like symptoms.
In relatively few cases, these symptoms are followed by jaundice causing skin and white of
eyes to yellow and urine to darken--typical signs of a malfunctioning liver. An accumulation
of a waste product, called bilirubin, in the blood causes this yellowish colour. Jaundice and
other symptoms usually subside gradually within 3 to 4 weeks and most patients fully
recover, in the process becoming immune to the disease.
People with serious cases of hepatitis B require hospitalization. A very small proportion of
these patients develop a critical form of the disease called "fulminant" hepatitis B. This
condition results from a sudden breakdown of liver function. Fulminant hepatitis B is
extremely serious. Over half of the victims of fulminant hepatitis B die from the disease.
Other tests are available to detect the body's reaction to the viral infection or the body's
reaction to vaccination against the virus. These tests work by measuring the number of
antibodies present in the blood. Tests also show how effective a vaccine will be.
For chronic infection, there are two standard treatments in Canada. Interferon may be given
for short periods and if effective, results in suppression of the virus. Lamivudine can be used
the same way or for long-term control of the virus. Other treatments are currently approved
for adult patients with chronic HBV infection in the United States. Physicians may do regular
monitoring for signs of liver disease progression.
How can the spread of hepatitis B be prevented in the
workplace?
The risk of hepatitis B can be significantly reduced by:
Infection Control
Infection control precautions are the first line of defense to protect workers from hepatitis B
and other blood-borne diseases. For this reason, the Laboratory Centre for Disease Control at
Health Canada and the United States Department of Health and Human Services developed a
uniform approach called "routine practices".
Originally developed for hospitals, routine practices have been adapted to a wide range of
workplaces. They apply to all situations where workers have risk of exposure to blood or
certain body fluids.
Routine practices recommend the use of engineering controls, safe work practices, and
personal protective equipment to suit the specific task and workplace.
Engineering controls include the use of equipment to isolate or contain the hazard, such as
puncture-resistant containers for disposing of used sharps, or biological cabinets for certain
procedures in laboratories.
Safe work practices are required for all tasks involving possible exposure to blood or certain
body fluids. They include:
Safe collection of fluids and tissues for disposal in accordance with local, provincial,
territorial, or federal regulations.
Safe removal and disposal or decontamination of protective clothing and equipment.
Procedures to follow in the event of spills or personal exposures such as needlestick
injuries.
Specific and detailed procedures to observe when using and disposing of needles and
other sharp objects.
Personal protective equipment provides a barrier to blood and certain body fluids. Equipment
recommended by routine practices include:
Please see the OSH Answers document Routine Practices for more information.
Immunization
Hepatitis B vaccines are licensed in Canada. They provide safe, reliable protection from
hepatitis B when used either before or immediately after exposure to the virus. Tests show 90
to 95 percent of vaccinations of healthy people result in the development of resistance against
hepatitis B. At present, vaccination is the surest way to avoid acquiring hepatitis B as an
occupational disease.
Side effects are usually mild with soreness at the injection site being the most commonly
reported. Studies show no link between the hepatitis B vaccine and multiple sclerosis, chronic
fatigue syndrome, rheumatoid arthritis or Guillain-Barré syndrome. The vaccine may very
rarely cause a severe life-threatening, whole-body allergic reaction (anaphylaxis). People
with allergies to any hepatitis B vaccine ingredients, for example, yeast, should not receive
the vaccine. Check with your health professional for more information.
Protection from the vaccine lasts at least fifteen years. Booster doses are generally not
recommended for people with normal immune status.
Since the risk varies from workplace to workplace, institutions should review their situations
and develop their own vaccination priorities. Hospital employees who have no contact with
blood, blood products, or blood-contaminated body fluids and who are not at risk of
needlestick injuries, are at no greater risk of hepatitis B than the general population.
If the blood is known to contain the hepatitis B virus, and the exposed worker has not been
vaccinated or does not have antibodies against hepatitis B, post-exposure immunization is
strongly recommended to prevent the development of hepatitis B.
If the worker's blood has antibodies against hepatitis B, or if the contaminated blood is free of
virus, further treatment may be unnecessary.
In summary, hepatitis B is a serious occupational concern for workers who may be exposed
to blood or certain body fluids. However, the use of routine practices for blood and certain
other body fluids, and immunization (complete hepatitis B vaccine series) including post-
vaccination testing to document immunity, greatly reduces and can eliminate the risk of
hepatitis B.
Hepatitis C
What is hepatitis C?
Hepatitis C is an infectious liver disease caused by the hepatitis C virus (HCV). Infections of
hepatitis C occur only if the virus is able to enter the blood stream and reach the liver.
For reasons that are not completely understood, about half of all people who develop hepatitis
C never fully recover and can carry the virus for the rest of their lives. These people have
chronic hepatitis C, and some may eventually develop cirrhosis of the liver and liver failure.
There are other kinds of viral hepatitis such as hepatitis A, hepatitis B, hepatitis D, and
hepatitis E. These diseases and the viruses that cause them are not related to hepatitis C even
though they also affect the liver. They may have other, different symptoms and different
modes of transmission. This means that there are different ways of spreading the disease and
different means for preventing and controlling these diseases.
Some people who are infected with hepatitis C virus have no symptoms and can infect others
without knowing it. These persons are at risk of becoming ill at some time in the future. It has
been estimated that it may take 10 years to develop symptoms.
People may get hepatitis C by sharing needles to inject drugs, through exposure to blood in
the workplace, from unsterile equipment used for body piercing, tattoos or acupuncture,
exposure to dental or medical practices with poor infection control practices or by sharing
personal care items including nail clippers, razors, scissors with infected people. The risk of
getting this virus from a blood transfusion is minimal but still exists. All donated blood is
now screened for the hepatitis C virus.
Hepatitis C has been transmitted between sex partners and among household members.
However, the degree of this risk still needs to be accurately defined. An infected mother can
pass HCV to her child at birth.
There is no evidence that hepatitis C virus is spread by casual contact. Sneezing, coughing
and hugging do not pose the risk for hepatitis C. In addition, there is no evidence that
hepatitis C virus is spread by food or water.
Infection control precautions are the first line of defense to protect workers from this virus
and other blood-borne diseases. For this reason, the Laboratory Centre for Disease Control at
Health Canada and the United States Department of Health and Human Services have
developed a uniform approach called "Routine Practices"
Originally developed for hospitals, routine practices have been adapted to a wide range of
workplaces. They apply to all situations where workers have risk of exposure to blood or
certain body fluids, including:
Semen.
Vaginal secretions.
Synovial fluid.
Cerebrospinal fluid.
Pleural fluid.
Peritoneal fluid.
Pericardial fluid.
Amniotic fluid.
Routine practices do not apply to situations where workers may be exposed to:
Feces.
Nasal secretions.
Sputum.
Sweat.
Tears.
Urine.
Vomitus.
Saliva (except in the dental setting, where saliva is likely to be contaminated with
blood).
Routine practices recommend the use of engineering controls, safe work practices, and
personal protective equipment to suit the specific task and workplace. Engineering controls
include the use of equipment to isolate or contain the hazard, such as puncture-resistant
containers for disposing of used sharps, or biological cabinets for certain procedures in
laboratories.
Safe work practices are required for all tasks involving possible exposure to blood or certain
body fluids. They include:
Safe collection of fluids and tissues for disposal in accordance with local, provincial,
territorial, or federal regulations.
Safe removal and disposal or decontamination of protective clothing and equipment.
Procedures to follow in the event of spills or personal exposures such as needlestick
injuries.
Specific and detailed procedures to observe when using and disposing of needles and
other sharp objects.
Personal protective equipment provides a barrier to blood and certain body fluids. Equipment
recommended by routine practices include: