The human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS) pandemic is a catastrophe to communities all over the world. Over 1 million people in the US are living with HIV, but 1 in 7 of them do not know they have the disease. At the end of 2021, approximately 38.4 million people worldwide were living with HIV/AIDS.
Pacific Medical Training recognizes the magnitude of the problem and the need for all of us to respond accordingly. It is critical for each of us to understand how this bloodborne pathogen is, and is not, transmitted.
The following guidelines on the first aid for people with HIV/AIDS address the concern of transmission in first-aid situations, present preventative measures and hygienic practices, and enable you to provide care without discrimination.
Understanding HIV transmission
HIV is the virus that causes AIDS and only occurs when the virus enters the bloodstream. People with AIDS have a compromised immune system that leaves the body susceptible to many diseases; the body is unable to fight off infections and diseases that most people typically fight off on their own. The condition is eventually fatal, due to the lack of immune system forces. While there is no vaccine for HIV, and there is no cure for AIDS, available medications are a successful treatment option.
There is no fixed period between the first contact with HIV and the development of the disease. Many HIV positive individuals may have no symptoms for several years while others may develop symptoms within three years from the time of infection. Transmission of the virus can still occur even when a person has zero symptoms.
HIV is much harder to contract than one might think—it dies quickly outside of the body, and a soap and water combination has shown to decrease its infectivity. This is not to be taken lightly, however. HIV can live in a used needle for up to 42 days depending on temperature and other factors. To ensure the destruction of HIV, surfaces require proper disinfection other than soap and water.
Ways in which HIV is transmitted
- Blood and blood products, other body fluids (semen, pre-seminal fluid, rectal fluids, and vaginal fluids), and transplanted organs that contain HIV
- Contaminated needle or syringe (drug use and accidental needle stick)
- Exposure through broken skin
- From a mother infected with HIV to her child during pregnancy, childbirth, or breastfeeding (breastfeeding is a low risk, especially when taking an antiretroviral regimen)
- Unprotected sex with someone who has HIV (man to woman, man to man, and woman to woman)
Ways in which HIV is not transmitted
- Following proper safety practices when giving first aid—this includes cardiopulmonary resuscitation (CPR)
- Contact with blood or other body fluids on intact skin
- Donating blood or blood products
- Caring for someone with HIV/AIDS when appropriate precautions are in use
- Food, water, and air
- Touching, hugging, and shaking hands
- Closed-mouth kissing
- Coughing, sneezing, or sweat
- Toilet seats, shared bedding, and clothes
- Mosquitoes or other biting insects
What is the risk of HIV transmission during first aid?
Concern about the transmission of HIV works both ways—transmission from the injured individual to the first-aid provider or from the first-aid provider to the injured individual. The risk of contracting a bloodborne pathogen when giving or receiving first aid is far less than people think. Appropriate precautions and basic hygienic measures reduce this risk even further.
The fear of acquiring infection can delay the prompt initiation of mouth-to-mouth breathing. Although pathogens can be isolated from the saliva of infected persons, salivary transmission of HIV is unusual, and the transmission of the infection is extremely rare: three reported cases of HIV acquired during the resuscitation of an infected patient resulted from high-risk cutaneous exposures, such as an accidental needle stick. There have been no reports of HIV infection acquired during CPR training.
What kind of precautions can we take to minimize the risk of HIV transmission?
Blood is the primary source of infection for HIV and is the major route of transmission in health care professionals and first responders. Whenever there is the possibility of contact with blood, health care workers (and bystanders) should take precautions to prevent contact with broken skin and mucous membranes (e.g., eyes and mouth).
Routine Practices (universal precautions) to prevent the spread of HIV are based on the principle that all blood, body fluids, secretions, and excretions are infectious. These steps involve using personal protective equipment (PPE), such as gloves, gowns, masks, and eye-wear, when dealing with people’s blood and other blood-contaminated body fluids.
Universal precautions in first aid
- Wash your hands before and after providing basic first aid. If gloves are available, wash your hands before and after use.
- Wear PPE whenever possible.
- Be attentive to avoiding contact with blood, body fluids, or soiled items.
- Be careful of broken glass or sharp objects near the injured person.
- Cover cuts or open skin with a clean, dry dressing.
- Decontaminate surfaces that do not require sterilization between patients with a hospital-grade disinfectant solution.
Giving mouth-to-mouth breathing
- Provide this lifesaving procedure without discrimination—do not withhold ventilation through fear of contracting HIV.
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There are no reported cases of HIV transmission from mouth-to-mouth ventilation; however, if you have open-mouth sores, avoid direct contact with blood. In this situation, you can initiate hands-only CPR for teens and adults who suddenly collapse. Continue hands-only CPR until an automated external defibrillator (AED) arrives and is ready for use or until additional help arrives to take over the victim.
- Learn how to use a barrier device, such as a pocket mask and face shield. If possible, carry a stocked first-aid kit or invest in a personal mask or shield. Keychains with a pocket mask are also available.
Dealing with someone who is bleeding
- Follow universal precautions. If you have gloves with you, wear them, especially in the case of fighting or mass casualties.
- If possible, instruct the victim to apply direct pressure to the wound.
- If the person cannot stop the bleeding, you can use a clean, thick cloth as a barrier to avoid direct contact with the blood. If this is not efficient or possible, apply proximal pressure to the main artery, which is a pressure on the artery above the injury site to stop the bleeding.
Contact with the injured person’s blood
- Thoroughly wash your hands as soon as possible if you contact blood or body fluid.
- If you have a splash of blood or body fluids on another part of your body, wash or flush it with a lot of water, especially your eyes.
- If you are punctured or cut with a contaminated object, thoroughly wash the wound and secure a clean, dry dressing.
- Seek testing, counseling, and confidential medical advice if you are worried that you have been in contact with any infection.
Cleaning up blood spills
- Follow universal precautions, secure the area, and soak up the blood spill with an absorbent material, such as cloth or paper towels.
- If medical gloves are not available, wear thick rubber gloves or general-purpose utility gloves. Use other materials, such as plastic bags, to avoid direct contact with the blood if gloves are not available.
- Clean the contaminated area with a disinfectant (e.g., household bleach diluted 1:10 with water to provide a 0.1–0.5% concentration). Wait for 10 to 15 minutes before rinsing the area. In the workplace, follow facility guidelines or the material safety data sheet (MSDS) for contact time.
- Place all contaminated material in a plastic bag or container for disposal. If available, use appropriately labeled biohazard bags and containers.
What you can do
Precautionary and safe practices are essential to prevent the transmission of HIV when giving first aid. Protect yourself and tell others, including friends and family, how to protect themselves against HIV.
While fear of contracting an infectious disease is a significant factor in the reluctance to provide CPR, the chance of contracting an infectious disease while providing CPR is extremely low.
Resources
US and global statistics — Review the HIV/AIDS data and trends provided by the US Department of Health and Human Services.
What are the symptoms of HIV and when do they appear? — Learn the symptoms and incubation period of HIV/AIDS.
Virucidal efficacy of soap and water against human immunodeficiency virus in genital secretions — This report shows how a common bar soap and tap water solution might be used to inactivate HIV in genital secretions.
How is HIV transmitted? — Review the facts about how HIV is passed from one person to another.
HIV therapy for breastfeeding mothers — This news release from the National Institute of Health (NIH) discusses a three-drug antiretroviral regimen during breastfeeding that essentially eliminates HIV transmission by breast milk.
Fear of infection — Read a report about the fear of acquiring HIV during CPR and the benefit of initiating lifesaving resuscitation for a victim in cardiac arrest.
Occupational HIV risk for healthcare workers — Examine the risk factors and the risk of infection in the course of professional activities.
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