00:00:00 Hello, I'm Gwynn Akin, Syntex's Vice President for Public Policy.

00:00:14 The video presentation you're about to see is sponsored by Syntex as a public service.

00:00:20 It's part of our continuing commitment to quality healthcare and to sharing useful information

00:00:26 with members of the healthcare team.

00:00:29 This commitment isn't new.

00:00:31 For nearly half a century, Syntex has discovered, developed, and manufactured prescription medicines.

00:00:38 More recently, through our subsidiary, Syva, we're focusing on diagnostic products, including

00:00:44 tests for AIDS, hepatitis, and other infectious diseases.

00:00:49 The spread of the human immunodeficiency virus, which causes AIDS, has reemphasized the need

00:00:55 for healthcare workers to know and to practice universal precautions for infection control.

00:01:02 In other words, the blood and certain other body fluids of all patients should be considered

00:01:08 potentially infectious with HIV, hepatitis B virus, and other blood-borne pathogens.

00:01:16 We believe that all members of the healthcare team should be trained to practice universal

00:01:21 precautions.

00:01:23 It is this belief that brought Syntex and the General Foundation for Medicine together

00:01:28 on this project.

00:01:30 We're grateful to the Foundation for its expert advice and participation in this presentation.

00:01:37 This video is based on the universal precautions recommended by the Centers for Disease Control.

00:01:44 Syntex hopes you will find this program useful and meaningful.

00:01:47 Thank you.

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00:02:18 We are currently faced with an epidemic caused by human immunodeficiency virus, or HIV, more

00:02:25 commonly called the AIDS virus.

00:02:28 As more and more people infected with HIV develop AIDS and other complications of HIV

00:02:34 infection, increasing numbers of healthcare workers are expressing concern about the risk

00:02:39 of infection in the hospitals, clinics, and laboratories where they work.

00:02:45 Fortunately, we have learned a great deal about the AIDS virus, where it is found, how

00:02:50 it is transmitted, how to detect infection, how to kill the virus, and perhaps most importantly,

00:02:57 what kind of infection control precautions can prevent transmission to healthcare workers

00:03:01 on the job.

00:03:03 This program will answer some of your questions about the AIDS virus and provide an overview

00:03:08 on a new approach to infection control.

00:03:11 This new approach will help protect healthcare workers from infection.

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00:03:35 The emergence of the AIDS epidemic has required a reevaluation of our infection control procedures.

00:03:43 As a result, a new universal approach to infection control has been developed, referred

00:03:49 to as body substance precautions.

00:03:52 The basic concept of these new precautions is that all blood and other body fluids from

00:03:57 all patients should be considered infectious.

00:04:01 This new approach will minimize exposure to both diagnosed and undiagnosed infections,

00:04:06 including AIDS and hepatitis.

00:04:09 In addition, these precautions will also help protect our patients from infection with bacteria

00:04:15 and other organisms that can be transmitted in healthcare settings.

00:04:19 We'll give more specific details on these procedures later in this program.

00:04:24 Effective infection control starts with what we know about the AIDS virus.

00:04:30 Dr. Merle Sandy.

00:04:32 Well, the virus was first detected in the late 1970s and early 1980s, and it causes

00:04:37 disease by destroying certain cells in the body that help fight infection.

00:04:43 Patients that get the virus are also affected in their brain because the virus affects the brain cells.

00:04:51 Here we see how the AIDS virus infects a healthy cell.

00:04:58 The virus replicates and new AIDS virus is formed.

00:05:03 This process will destroy the healthy cell, and over time, more and more cells will be destroyed.

00:05:10 The result is that the immune system is not functioning properly.

00:05:16 This provides an opportunity for life-threatening infections and unusual cancers to occur.

00:05:22 The disease occurs very slowly.

00:05:24 Patients become infected with the virus but may be very healthy for years and years.

00:05:29 The important thing is that during this time, the patients may actually and probably will be infectious.

00:05:36 One way HIV infection can be diagnosed is by a special test which measures antibodies to the virus.

00:05:44 An antibody test usually becomes positive within a few weeks after infection,

00:05:48 but occasionally could take many months to become positive.

00:05:52 I think we need to use very good infection control methods in our hospital,

00:05:58 and testing clearly will not take the place of those infection control methods.

00:06:04 Two things are necessary for HIV infection.

00:06:08 First, the virus must be present in high concentration.

00:06:12 Second, the virus must get into the bloodstream after exposure.

00:06:17 HIV is readily detected in the blood, semen, and spinal fluids of infected persons.

00:06:23 HIV can also be found in most other body fluids.

00:06:27 Because the concentration in these other fluids is low, infection from occupational exposure is unlikely.

00:06:34 HIV is predominantly transmitted through sexual contact with infected semen and vaginal fluids,

00:06:41 by injection of infected blood in IV drug users sharing needles,

00:06:46 and from a mother to her offspring.

00:06:48 To date, only blood is known to have caused HIV infection in hospital workers.

00:06:54 HIV is a fragile virus, even though it can cause a fatal disease for which we presently have no cure.

00:07:01 It is easily killed by hospital disinfectants,

00:07:04 and even washing carefully with soap and water is a good way to eliminate it.

00:07:10 I'm doing pretty good.

00:07:12 As a result, it is no surprise that as of today,

00:07:16 there are no cases of anyone ever getting AIDS from casual contact with an AIDS patient.

00:07:22 Nor is there any evidence that the virus is transmitted by touching objects such as telephones,

00:07:28 toilet seats, drinking fountains or waste cans,

00:07:31 or by eating foods prepared by an infected person.

00:07:35 The AIDS virus is not transmitted through the air.

00:07:39 Dr. Julie Gerberding.

00:07:41 We have a lot of good information now to answer the question about risks to health care workers.

00:07:46 We've studied more than 4,000 people who have been intensively exposed to this virus on the job.

00:07:52 What we know from these studies is that there is some small risk associated with needle stick exposure to infected blood.

00:07:59 But you don't get AIDS from having routine contact with patients,

00:08:03 from delivering food trays, from handling contaminated linen,

00:08:07 or from discarding infectious waste.

00:08:10 You simply don't get AIDS from those kinds of exposures.

00:08:15 In contrast to HIV, hepatitis B is much more contagious and poses a greater risk to health care workers.

00:08:23 Even though infection with hepatitis is usually not a fatal disease,

00:08:28 an estimated 200 health care workers die each year from liver damage

00:08:33 caused by on-the-job infection with this common virus.

00:08:37 All health care workers with exposure to blood who are not already immune to hepatitis B

00:08:43 should be vaccinated to prevent infection.

00:08:47 We've talked about the risks of health care workers acquiring infections.

00:08:52 Health care workers can also transmit infections from one patient to another.

00:08:57 Infections transmitted by health care workers cause serious problems for patients

00:09:02 and cost millions of dollars each year for treatment.

00:09:05 We can and should do our best to protect our patients

00:09:10 at the same time we protect ourselves from these infections.

00:09:15 This concludes our background review of HIV and other infections.

00:09:20 Now let's turn our attention to the specific infection control procedures

00:09:25 which will help protect both health care workers and their patients.

00:09:30 This video focuses on an updated approach to infection control called body substance precautions.

00:09:37 These precautions are based on the premise that all body fluids and tissues from all patients

00:09:43 could be infected.

00:09:45 Based on the premise that all body fluids and tissues from all patients could be infectious.

00:09:51 Body substance precautions for all patients and all specimens make sense.

00:09:58 Use of these body substance precautions is our best defense against occupational infection.

00:10:06 Before reviewing these procedures, let's first look at three of the most common mistakes made

00:10:12 due to accidental exposure to body fluids.

00:10:15 First, these people are handling urine and blood without gloves.

00:10:20 This should not be done.

00:10:22 In addition, failure to remove one's gloves can lead to contamination of the environment.

00:10:28 And finally, but most important, these needle stick accidents could have been avoided

00:10:33 if the needles had been properly discarded.

00:10:36 By using body substance precautions, these and other accidental exposures will be prevented.

00:10:43 Now let's review body substance precautions.

00:10:47 Hand washing before and after each contact with patients or specimens

00:10:52 is an important precaution that should not be neglected.

00:10:56 Washing with soap and water will eliminate the majority of infectious agents

00:11:00 including HIV and hepatitis.

00:11:03 Hand washing is probably the most important precaution in the majority of patient contacts.

00:11:10 Gloves provide an extra margin of safety

00:11:13 and should be worn whenever contact with blood or other body fluids and tissues is expected.

00:11:19 For example, gloves should be worn when cleaning up contaminated areas.

00:11:24 The gloves should then be removed as soon as the risk of exposure has ended

00:11:28 and hands should then be washed.

00:11:31 Healthcare workers with open sores or wounds should cover them with protective dressings.

00:11:38 Instruments, utensils, or equipment used on one patient should not be used on another

00:11:44 unless the items are thoroughly cleaned and disinfected first.

00:11:50 Gowns or other protective clothing should be worn

00:11:53 if your clothing is likely to be soiled or splashed with blood or body fluids.

00:11:58 Ordinarily, protective clothing is not needed for changing linens.

00:12:03 When soaking wet linen must be handled, however, protective clothing should be worn.

00:12:11 Masks should be worn during close contact with coughing patients

00:12:15 when tuberculosis or other contagious respiratory infections are suspected

00:12:19 or until such infections have been rendered non-contagious by treatment.

00:12:24 Because masks are only needed for these special situations,

00:12:28 most hospitals have developed mechanisms to alert healthcare workers when masks are required.

00:12:35 Masks and protective eyewear should be worn whenever spray or splatter of saliva,

00:12:40 blood, or other body fluids may occur.

00:12:43 For example, masks and protective eyewear should be used routinely

00:12:47 by emergency personnel who encounter bleeding patients.

00:12:52 The single most important principle for preventing infection with HIV and hepatitis B

00:12:58 is to handle needles and other sharp instruments with extreme caution.

00:13:04 Needles are dangerous.

00:13:06 Most of the healthcare workers who have been infected with AIDS virus

00:13:09 have gotten infected through accidental needle stick exposures.

00:13:13 A few people have been infected where blood has been splashed into a mucous membrane

00:13:18 or into a skin wound, but these are very unusual cases.

00:13:22 They remind us, however, how important it is to use good infection control precautions

00:13:27 and avoid any kind of direct contact with blood or some other body fluid that could be infected.

00:13:36 Most needle sticks occur when needles are improperly handled after use.

00:13:41 Needles should never be bent, broken, resheathed, or manipulated after use.

00:13:47 They should be immediately discarded in puncture-resistant containers.

00:13:52 Improperly discarded needles should be picked up with extreme caution and disposed of properly.

00:14:00 Waste containers sometimes contain needles carelessly discarded by others.

00:14:05 Such containers should always be handled with extreme care to avoid accidental punctures.

00:14:12 Needles should never reach into a garbage can or compact garbage manually.

00:14:17 When laboratory specimens spill, they should be cleaned as soon as patient safety permits.

00:14:23 Gloves should always be worn.

00:14:26 The bulk of the spill should be wiped with disposable absorbent toweling.

00:14:31 The area should then be disinfected with an approved hospital disinfectant.

00:14:37 While taking greater care, it is also important not to go too far and overdo infection control precautions.

00:14:44 Fear of HIV and other infections should not lead to overprotection.

00:14:50 There is no need to use eye protectors, masks, or gloves for activities that do not involve contact with body substances.

00:14:59 Body substance precautions really make good sense.

00:15:02 These precautions should be used by all health care workers for all patients and laboratory specimens

00:15:08 whenever there is a chance that direct contact with the body fluid might occur.

00:15:13 I think it's very important for health care workers and people that work in the hospitals to remember

00:15:19 that transmission of the AIDS virus in the hospital can be prevented.

00:15:26 It's preventable.

00:15:27 If you use good infection control, if you wash your hands,

00:15:31 and particularly if you're very careful with needles and don't stick yourself with contaminated needles,

00:15:37 the chances of you acquiring the virus working in the hospital, working with AIDS patients, is extremely unusual.

00:15:46 The AIDS epidemic has vividly reminded us that health care workers may encounter serious infections on the job.

00:15:55 The best way to prevent infection and to make the work environment as safe as possible

00:16:00 is to practice good infection control.

00:16:03 The body substance precautions presented in this program will help protect health care workers

00:16:09 from infection with the AIDS virus and other infections that they may encounter in the hospital, clinic, or laboratory.