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This chapter is from the book

This chapter is from the book

HIV Prevention

The focus of prevention of the transmission of the HIV is education. The client should be taught the modes of transmission and the risk involved when the client has unprotected sexual contact or shares needles and parenteral drug equipment. Latex or nonlatex condoms with a water-soluble lubricant containing spermicide should be used during intercourse. Oral dams or condoms should be used during oral sex. Lambskin condoms are less effective in the prevention of transmission of the virus. Because transmission can occur during intercourse, the risk of introducing the virus during an attempt to conceive is present. Infection by artificial insemination using processed semen from an HIV-infected partner is being studied; however, results at present are inconclusive.

Healthcare workers and those who care for clients with AIDS should take precautions to prevent contamination with blood and body fluids. Standard precautions, including wearing gloves, masks, and/or gowns, should be taken when blood and body fluids are present. A hypochlorite solution of 1 part bleach to 10 parts water has proven to destroy the AIDS virus. The hypochlorite solution should be mixed each day, and the seal should be tight on the container to prevent loss of the bleach by evaporation. The sections that follow describe standard precautions and treatment for exposure.

Standard Precautions

  • Gloves should be worn when there is a chance of contact with blood and body fluids, when handling other potentially infected material, and when performing vascular access procedures.

  • Gloves should be changed after each client contact and between contact procedures with the same client.
  • Masks and protective eyewear should be used when there is a likelihood of splashes or when body fluids might become airborne.
  • Gloves and aprons should be worn during procedures in which there is a likelihood of splashes of blood or body fluids.
  • Handwashing should be done immediately after contact with body fluids or other potentially infected material and as soon as gloves are removed.
  • Needles and sharps should be disposed in a sharps container—no recapping, bending, or breaking of needles.
  • Mouth-to-mouth resuscitation should be performed using a mouthpiece or another ventilation device.

Airborne Transmission–Based Precautions (Second Tier of CDC Guidelines for Infection Control)

Infections caused by organisms remain suspended in the air for prolonged periods of time. Examples of infections that can be transmitted by airborne means include tuberculosis, measles (rubeola), chicken pox (varicella), and disseminated zoster (shingles). Nursing precautions for managing the client with an infection that can be spread by airborne means include

  • Placing the client in a private room with negative airflow (and with the door remaining closed)
  • Equipping persons entering the room with a HEPA mask or an N-95 mask
  • Lighting the room with ultraviolet light
  • Transporting the client only when essential
  • Fitting the client with a surgical mask when being transported

Infections are spread in several different ways. The sections that follow explain these methods of transmission and how the nurse can help to prevent the spread of germs.

Droplet Transmission–Based Precautions (Second Tier of CDC Guidelines for Infection Control)

Droplet transmission–based infections are those caused by organisms suspended in droplets that may travel three feet but are not suspended in the air for long periods of time. Examples of droplet transmission–based infections include influenza, mumps, pertussis, rubella, diphtheria, pneumonia, scarlet fever, streptococcal pharyngitis, and meningitis caused by N. meningitidis or H. influenza B.

Nursing precautions for managing the client with a droplet transmission–based infection include

  • Placing the client in a private room or cohort with a client who has the same illness. The door may remain open.
  • Placing clients no closer than three feet from one another.
  • Making sure caregivers wear a mask for face-to-face contact.

Contact Transmission–Based Precautions (Second Tier of CDC Guidelines for Infection Control)

Contact transmission–based infections are those caused by organisms spread by direct contact. Examples of contact transmission-based infections include RSV, scabies, and colonization with MRSA and VRE.

Nursing precautions for managing the client with a contact transmission–based infection include

  • The client should be placed in a private room or cohort with a client who has the same condition.
  • Caregiver should glove when entering room.
  • Gowns should be worn to prevent contact with clients.
  • Hands should be washed with antimicrobial soap before leaving the client’s room.
  • Equipment used by the client should remain in the room and should be disinfected before being used by anyone else.
  • Client should be transported only for essential procedures; during transport, precautions should be taken to prevent disease transmission.

Treatments After Occupational Exposure

If the healthcare worker is contaminated with blood or body fluid, the CDC recommends treatment dependent on the type and source of contamination. The nurse should notify the office of employee health and safety in his hospital to report exposure.

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