HIV - infection control in hospitals

What is HIV?

HIV stands for human immunodeficiency virus. It can spread from one person to another through:

• blood
• semen
• vaginal fluids
• anal mucus
• breast milk.

HIV can cause acquired immune deficiency syndrome (AIDS) if left untreated. However, due to the level of health care and availability of HIV medication in Australia, progression to AIDS is extremely rare.

Hospitals follow strict infection prevention and control guidelines to prevent the spread of HIV and other infections to patients, staff and visitors. This includes:

• safe disposal of needles and syringes after single use
• decontaminating and sterilising reusable medical devices after every use
• using personal protective equipment (PPE) – such as gloves and eye protection during procedures involving blood and body fluids.

How HIV spreads

HIV can spread through:

• Unprotected vaginal or anal sex – that is, sex without condoms, or other forms of barrier protection with someone who has HIV. (Unprotected oral sex is extremely low risk for the transmission of HIV.).
• Sharing needles, syringes and other injecting equipment.
• From mother to child during pregnancy, childbirth or breastfeeding – this can happen when a mother doesn't know she has HIV, or is not on effective HIV treatment.

People on treatment for HIV who achieve and maintain an undetectable viral load (U=U) cannot pass on the virus through vaginal or anal sex.

HIV is not spread by:

• casual contact (such as shaking hands, kissing, hugging or massage)
• being washed
• having dressing changed
• receiving an injection
• toilet seats or bathrooms
• food
• cutlery or crockery
• mosquitoes
• air.

Even if a healthcare worker has HIV infection, there are strict infection prevention and control guidelines that protect patients, visitors and hospital staff.

Blood transfusions and HIV risk

The risk of contracting HIV from blood transfusions is very low – less than one chance in a million.

Blood donations and HIV risk

Every unit of donated blood in Australia is laboratory screened for a range of blood-borne infections (including HIV, hepatitis B and hepatitis C). These tests have included HIV screening since 1985.

Screening tests for HIV involve:

• testing for the presence of HIV antibodies (the body’s response to HIV infection) and part of the virus (p24 antigen)
• testing for the virus’s genetic material – this is called a nucleic acid test (NAT) and is more sensitive.

Thanks to the development of NAT, the ‘window period’ – the time between infection and the detection of the virus in the blood – has been reduced from around 22 days to 6 days. This method is also used to screen donated blood for hepatitis C.

People at risk of HIV infection and some other infectious diseases are excluded from donating blood for a period of time.

Hospital guidelines protecting patients from HIV and other infectious diseases

To prevent the spread of HIV, hospitals follow strict infection prevention and control guidelines. All blood and body fluids from patients are treated as potentially infectious:

• Syringes and needles are ‘single use’ and disposed of in approved sharps containers.
• Reusable medical devices are decontaminated and sterilised after each patient use.
• Many medical devices are disposed of after single use.
• Healthcare workers wear protective equipment (including gowns, gloves and eyewear) when carrying out any invasive procedures involving a patient’s blood or body fluids.
• All spilt blood and body fluids are cleaned up according to strict cleaning guidelines.
• Laundry is cleaned according to strict Australian Standards (AS/NZS 4146:2000).

Hospital workers and HIV prevention

Hospital workers can become infected with HIV if they accidentally prick themselves with a needle or other sharp instrument contaminated with the virus. However, only a very small number of hospital workers around the world have become infected with HIV in this way.

Preventive treatment (called post-exposure prophylaxis, or PEP) is available for healthcare workers who have accidentally pricked themselves with a needle or other sharp instrument contaminated with HIV. Their health will be monitored closely.

Protecting hospital workers from patients who have HIV and other infectious diseases

If a hospital worker has an accident that involves a patient's blood, the patient may be asked to have blood tests for HIV, hepatitis C and hepatitis B.

Blood testing helps the hospital know how to manage the health of its workers. For example, if a patient tests positive for HIV, a recommendation might be to give post-exposure prophylaxis (PEP) to the staff member.

HIV and other infectious disease treatment for hospital workers

PEP is an antiretroviral medication (ART) to prevent HIV following a high-risk exposure. It can significantly reduce the risk of HIV infection.

Ideally, PEP is started as soon as possible, and within 72 hours of contact with HIV.

In these circumstances, if you were unaware of your status and you test positive for HIV, hepatitis B or hepatitis C, it would enable you to access the appropriate treatment and prevent any long term complications from these infections.

New drug treatment is very effective at curing hepatitis C for more than 95% of people. And HIV and hepatitis B treatments keep people with these infections well with a near normal life expectancy.

Where to get help

• Your GP (doctor)
• Victorian HIV Service, Alfred Health Tel. 1800 889 887
• Get PEP Tel. 1800 889 887 (Victoria) – with the option of a translation service
• National standards and guidelines on infection prevention Tel. 1300 651 160