Page 270 - AIDSBK23C

Page 270

INVASIVE AND SURGICAL PROCEDURES

A variety of diagnostic and therapeutic procedures may be performed in the management
of patients with HIV infection and with AIDS. Procedures can be as routine as phlebotomy to as
complex as major surgery. About 15% of HIV-infected persons will have one or more surgical
procedures performed during the course of their infection and about 3 to 4% of patients with
AIDS will require major surgery.[1072] In order for health care workers to avoid risk of
exposure to HIV during performance of procedures, adherence to universal precautions is a must.
Procedures must have written guidelines, personal protective equipment must be readily
available, and personnel must be trained. Equipment as simple as latex gloves can reduce by
50% the volume of blood transmitted in a needlestick injury. Solid needles used in surgery do
not carry as much blood through barriers as do hollow core needles. Avoidance of injury-prone
techniques, such as recapping of needles, would eliminate many injuries. Nurses and laboratory
personnel, particularly phlebotomists, have the greatest number of occupational infections.[161]
Risk of infection through reduction in blood contacts in the operating room may be
decreased by:

1. Use of double gloves

2. Use of cut-resistant gloves

3. Use of instruments and not fingers to hold or retract tissues

4. Not picking up dropped or broken sharps with fingers

5. Keeping needle use to a minimum

6. Keeping track of sharp instruments in use

7. Use of blunt instruments where applicable

8. Use of fluid-resistant gowns when blood splashing to the body may occur

9. Use of face protection when blood splashing to the face may occur

10. Requiring non-operating room personnel to wear gloves and gowns while in the operating
room

Surgical procedures in the operating room are associated with a 1.7 to 5% risk for blood
exposure for personnel in that setting. The majority of these exposures are to skin and eye, and
the majority could be avoided by use of gloves, face protection, and fluid-resistant gowns.
Surgeons and scrub staff have the highest risk for percutaneous exposures, about 1 incident per
100 procedures. Blood contacts are more frequent when performing emergency procedures,
when patient blood loss exceeds 0.25 L, and when personnel are in the operating room longer