HIV and health workers

Health workers include doctors, nurses, paramedics and aides who work with patients in hospitals, clinics and other health-care settings. The following HIV-related issues are especially relevant to health workers:

The burden of HIV/Aids and health worker burnout
Health workers are often described as being at the “frontline” of the battle against HIV/Aids, because, on a daily basis, they deal directly with people who are ill or dying of the disease.

The epidemic places a great burden on health workers, especially in Africa. As more people become ill, health-care resources are increasingly strained, not least because there are too few health workers to deal with the rising numbers of Aids patients. In addition to the physical stress of overwork, caring for patients with an incurable disease is often emotionally draining, especially where resources are too limited to provide good treatment. Effective support systems may be lacking for health workers themselves, many of whom are also HIV-positive or are caring for infected family members.

Ongoing stress can lead to “burnout”: you become too physically and emotionally exhausted to function properly. It is important to take care of your own well-being as well as that of your patients, and to monitor yourself for early signs of burnout. These include irritability, anxiety, tiredness and difficulty concentrating, and you may start performing poorly at work. Left unchecked, stress may lead to depression and chronic fatigue.

Help prevent burnout:

• Form support structures with other health workers, such as a group of colleagues who share experiences and discuss ways of easing workplace stress.
• Avoid unnecessary worrying. Act on problems that you can do something positive about; don’t waste energy on those about which you can do nothing.
• Take breaks and rest when your energy levels start to drop.
• Look after yourself: eat nutritious food, exercise regularly, get enough sleep and take time out to relax.
• Learn to ask for help and say “no” when your workload threatens to overwhelm you.

Health-care work and the risk of contracting HIV
Health workers frequently have to deal with patients’ blood and other body fluids, and risk HIV infection when they are accidentally exposed to these through:

• needle-stick injuries (pricking yourself with a used needle)
• cutting yourself with sharp objects contaminated with body fluids
• handling body fluids when you have broken skin
• splashes of body fluid into your eyes or mouth.

Overall risk of infection from a needle-stick injury is 1 in 300. Correct prophylactic antiretroviral treatment reduces this risk by 70-80%. Risk of infection after a splash of HIV-infected blood into the mouth or eye, or contamination of a skin abrasion, is less than 1 in 1000.

Protective measures for healthcare workers
Protect yourself and your patients from HIV infection as follows:

• Wash your hands thoroughly with soap and water before and after contact with each patient, and immediately after touching body fluids.
• Wear gloves when touching broken skin, mucous membranes, body fluids and instruments that have been in contact with body fluids. For examinations and cleaning, use clean (not necessarily sterile) gloves. For surgery and deliveries, use sterile gloves. Change gloves after each patient contact. If sterile gloves are washed and re-sterilised for re-use, invisible tears can occur, so wear two pairs for procedures involving contact with body fluids.
• Wear a mask if there is a chance of body fluids splashing into your mouth.
• Wear protective glasses if there is a chance of body fluids splashing into your eyes.
• Wear a plastic apron or gown during procedures where body fluids may dirty your clothes.
• Remove dirty clothes and linen as soon as possible and place them in a bag or container.
• Don’t eat, drink or put anything in your mouth that might have touched body fluids.
• De-contaminated and sterilise instruments immediately after use. De-contaminate instruments in disinfectant solution such as Jik. Make sure your steriliser works and is used properly.
• Wipe surfaces with disinfectant (e.g. Biocide, Milton or Jik mixed 2:1 with water) after each examination or procedure and before the next. Wear gloves during cleaning. Clean up spilt blood immediately and wipe the surface with disinfectant. Use paper towels, then place these in a disposal bag for incineration.
• Contaminated waste, like used swabs, should be disposed of safely and burned. Wear gloves to handle waste.
• Put used disposable needles immediately in a container for “sharps” (needles, lancets, blades). Don’t re-sheath (cap) needles. When sharps containers are full, close them securely and dispose of them. Never re-use a sharps container.
• Put re-usable needles in de-contamination solution immediately after use.
• Place laboratory specimens in a leak-proof container.
• Once used, keep the sharp end of needles or blades pointing away from you, but be careful not to stick anyone.

Procedure for healthcare workers accidentally exposed to HIV

• Encourage bleeding from a sharps wound and wash it with soap and water.
• Rinse mouth or eyes with water immediately after a blood splash.
• Notify the person responsible for dealing with accidental exposure.
• Start prophylactic treatment, within six hours of exposure, with AZT (zidovudine) or, preferably AZT and 3TC (lamivudine).
• Obtain consent and collect blood samples from the patient for an HIV test as soon as possible. If the patient tests HIV-negative, stop prophylactic treatment. If positive, continue treatment for 28 days, and get tested yourself. You should get tested again after six weeks to determine if you have become HIV positive. If you test negative, get tested again after three months, and again after six months if the three-month test is negative.