HIV - infection control in hospitals

What is HIV?#

HIV stands for human immunodeficiency virus. If it is left untreated, it can lead to acquired immune deficiency syndrome (AIDS). However, where good health care and effective HIV medication are available, progression to AIDS is now extremely rare. People who take HIV treatment can stay well and have a near-normal life expectancy.

How HIV spreads#

HIV can be passed on through certain body fluids, including blood, semen, vaginal fluids, anal mucus and breast milk. The main ways it spreads are:

• unprotected vaginal or anal sex with someone who has HIV – that is, sex without condoms or other barrier protection (unprotected oral sex is a much lower risk)
• sharing needles, syringes or other injecting equipment
• from a mother to her child during pregnancy, childbirth or breastfeeding – this can happen when a mother does not know she has HIV, or is not on effective treatment

People on HIV treatment who achieve and maintain an undetectable viral load cannot pass on the virus through vaginal or anal sex. This is often described as U=U (undetectable equals untransmittable).

HIV is not spread by casual contact. You cannot catch it from shaking hands, kissing, hugging or massage, from sharing food, cutlery or crockery, from toilet seats or bathrooms, or from mosquito bites. Everyday care activities such as helping someone wash, changing a dressing or giving an injection do not put others at risk when standard precautions are followed.

Blood transfusions and HIV risk#

The risk of catching HIV from a blood transfusion is extremely small – less than one chance in a million.

In many countries, every unit of donated blood is laboratory screened for a range of blood-borne infections, including HIV, hepatitis B and hepatitis C. HIV screening has been part of this testing since 1985.

Screening tests for HIV look for:

• HIV antibodies – the body’s response to HIV infection
• part of the virus itself (the p24 antigen)
• the virus’s genetic material – a more sensitive test called a nucleic acid test (NAT)

Thanks to NAT, the ‘window period’ – the time between infection and the point at which the virus can be detected in the blood – has been reduced from around 22 days to about 6 days. People who may be at higher risk of HIV or some other infections are asked not to donate blood for a period of time.

How hospitals protect patients#

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

• syringes and needles are single use and disposed of in approved sharps containers
• many other medical devices are also single use and discarded after use
• reusable medical devices are decontaminated and sterilised after every patient
• healthcare workers wear protective equipment such as gowns, gloves and eye protection during any procedure involving a patient’s blood or body fluids
• spilt blood and body fluids are cleaned up according to strict cleaning guidelines
• laundry is cleaned to recognised standards

Even if a healthcare worker has HIV, these guidelines protect patients, visitors and staff, and the risk of transmission in this setting is very low.

How hospital workers are protected#

Hospital workers can become infected with HIV if they accidentally prick themselves with a needle or other sharp instrument contaminated with the virus. Only a very small number of hospital workers worldwide have ever been infected in this way, and preventive treatment is available for those who have such an accident.

If a worker has an accident involving a patient’s blood, the patient may be asked to have blood tests for HIV, hepatitis B and hepatitis C. This helps the hospital decide how best to manage the worker’s health.

For example, if a patient tests positive for HIV, the staff member may be offered post-exposure prophylaxis (PEP). PEP is a course of antiretroviral medication (ART) used to prevent HIV after a high-risk exposure. It can greatly reduce the risk of infection and works best when started as soon as possible, and within 72 hours of contact.

These tests can also help a patient who did not know their own status. If you were found to have HIV, hepatitis B or hepatitis C, you would be able to start the right treatment and prevent long-term complications. Newer treatments cure hepatitis C in more than 95% of people, and HIV and hepatitis B treatments keep people well with a near-normal life expectancy.

Key points#

• HIV can lead to acquired immune deficiency syndrome (AIDS) if it is left untreated.
• HIV spreads through certain body fluids, mainly through unprotected sex, shared injecting equipment, or from mother to child – not through casual contact.
• People on effective HIV treatment with an undetectable viral load cannot pass the virus on through sex (U=U).
• To prevent the spread of HIV, hospitals follow strict infection prevention and control guidelines and treat all body fluids as potentially infectious.
• Post-exposure prophylaxis (PEP) is antiretroviral medication used to prevent HIV after a high-risk exposure, ideally started within 72 hours.

Where to get help#