Future Performance Training
There is considerable evidence that HIV cannot be transmitted by the respiratory or gastrointestinal routes or by casual person-to-person contact in any setting (such as school, household, social, work, or prison). Nor is HIV transmitted via insects, food, water, toilets, swimming-pools, sweat, tears, shared eating and drinking utensils, or other agents such as clothing or telephones.
HIV has not been shown to be transmitted in the workplace except in health care or research laboratory settings. The few reported cases of HIV transmission to health care workers have resulted from exposure to the blood of an HIV-infected patient as a result of needlestick injury, blood on broken skin, or splashing of blood into the eyes or mouth (mucous membranes).
Although accidents such as these occur with some frequency in health care settings, they have only rarely led to HIV infection of health care workers.
In addition to HIV, other serious infections, such as hepatitis B and non-A non-B hepatitis can be transmitted by blood.
HIV transmission and the first aider
In relation to HIV transmission, the major concerns in first aid are mouth-to-mouth resuscitation and the management of bleeding, two situations where contact with the body fluids of another person may occur.
Mouth-to-mouth resuscitation
A worker who is unconscious and no longer breathing spontaneously (for example because of a heart attack, an electric shock, or a blow to the head) may require mouth-to-mouth resuscitation. Resuscitation must be started immediately. Mouth-to-mouth resuscitation is a life-saving procedure and should not be withheld through fear of contracting HIV or other infection.
HIV transmission from mouth-to-mouth resuscitation has not been reported. Although HIV has been found in saliva, it is present in extremely small quantities and no cases have been reported in which transmission has been shown to have occurred through saliva.
Although it has never been substantiated, there is a theoretical risk that HIV could be transmitted if the person in need of resuscitation is bleeding from the mouth. First aiders should use a clean cloth or handkerchief, when available, to wipe away any blood from the person's mouth.
Mouth-pieces, resuscitation bags, or other ventilation devices should only be used by people specially trained to use them.
They are not recommended for use by general first aiders as incorrect use may lead to further injury and bleeding. The absence of such equipment should not be used as a reason to withhold mouth-to-mouth resuscitation.
Bleeding
Workers who are bleeding require immediate attention. The first aider must not hesitate to help them as some wounds may be life-threatening (e.g. a spurting artery).
Whenever feasible, the first aider should instruct the person bleeding to apply pressure to the wound himself or herself, using a clean thick cloth. If he or she is unconscious or uncooperative, or if the wound is too large or is located in a place the person cannot reach, the first aider should apply pressure to the wound with a clean cloth or another barrier, avoiding direct contact with blood.
Gloves should be used if available; if not available, another barrier such as a cloth or clothes should be used to prevent skin contact with blood. However, since bleeding may be life-threatening, the absence of gloves should not be used as a reason to withhold first aid.
Special care should be taken to prevent blood from coming into contact with broken skin or the mucous membranes of the first aider. If the first aider's hand are contaminated with blood, he or she should take care not to touch his or her own eyes or mouth.
Hands should always be washed with soap and water as soon as possible after administering first aid.
Cleaning up blood spills
Spilt blood should be soaked up with absorbent material such as a cloth, rag, paper towel or sawdust, direct skin contact with the blood being avoided. The blood-soaked absorbent material should then be disposed of in a plastic bag, burnt in an incinerator, or buried. The area contaminated with the blood should then be washed with a disinfectant (preferably sodium hypochlorite (household bleach) diluted 1:10 with water, to give 0.1-0.5 per cent available chlorine) to clean up remaining blood. Rubber household gloves should be worn if available when spilt blood is being cleaned up. If gloves are not available, another barrier such as a large wad of paper towels should be used to avoid direct skin contact with the blood. Hands should always be washed with soap and water after cleaning up blood or other body fluids.
Clothes or cloths that are visibly contaminated with blood should be handled as little as possible. Rubber household gloves should be worn if available, and the clothes or cloths should be placed in and transported in leakproof bags. They should be washed with detergent and hot water (at least 70oC (160oF) for 25 minutes; or if in cooler water (less than 70oC (160oF)), with a detergent suitable for cold water washing.
Additional measures
First aiders should be careful with broken glass and other sharp objects that may be in the accident area. They should also ensure that any open cuts or wounds they have are covered to prevent exposure to blood while they are providing first aid.
Workers who have been exposed to blood
If the guidelines give here are adhered to, the risk of acquiring bloodborne infection, including HIV, will be significantly reduced. Even so, it is not possible to guarantee that exposure will not occur. Workplaces should therefore develop policies to meet those situations where first aiders are injured or are exposed to blood while administering first aid.
If first aiders are exposed to blood on skin that is not intact, they should wash the affected area with soap and water as soon as possible. Exposed mucous membranes should be washed with water.
A first aider who is injured by a sharp object that is contaminated with blood (e.g. a used needle) should encourage bleeding, wash the wound thoroughly with soap and water and, if appropriate, apply a dressing. To determine whether further action is needed, the injury should be assessed for the type and severity of the wound - puncture, surface or deep laceration, contamination of non-intact skin or mucous membrane - and for the extent to which the wound may be contaminated with blood.
Obviously, the more severe the wound the greater the concern should be, not only for HIV infection but for all bloodborne infections. The decision whether additional evaluation is necessary should be made by the first aider jointly with the health care provider concerned.
In rare instances, a first aider may sustain injuries of sufficient severity to warrant further investigation, including assay of the first aider's blood for HIV and other infections such as hepatitis B.
If a first aider requests HIV antibody testing, this should be performed as soon as possible after the exposure. If the initial test is negative, follow-up testing should be performed three and six months later. In the interim, counselling should be available to the first aider and should deal with the low risk of acquiring infection as well as the first aider's concerns. He or she should be counselled on the need to prevent possible transmission of HIV during this period through, inter alia, sexual intercourse, the use of intravenous drugs, and pregnancy. If a worker becomes HIV antibody positive at any point, continuing counselling should be provided. If the test immediately after the exposure is positive, it cannot be a result of the exposure: the person must have been infected with HIV previously. He or she should be referred for counselling, which should include advice on how to prevent transmission of HIV.
First aid training provides an opportunity to disseminate accurate
information on HIV infection and AIDS to members of the community. People who
receive training in first aid will subsequently be able further to disseminate
accurate information within the community. First aid training in the workplace should include clear
instruction on the ways in which HIV is and is not transmitted. This is
especially important, since the myths surrounding this topic may interfere with
potentially life-saving first aid measures. First aid training should emphasize that, even after parenteral
exposure to HIV-infected blood, the risk of acquiring infection is extremely
low, about one in 250 exposures. First aiders should be taught the precautions
needed to avoid contact with blood or body fluids, since such precautions
significantly reduce the risk of bloodborne infection. First aid is generally given to alleviate suffering and in a
spirit of compassion. This should be stressed. The first aider should be urged
to weigh the extremely small and so far theoretical risk of acquiring HIV
infection in providing first aid against the benefit gained by the person
receiving first aid. A number of organizations in many countries train large numbers of
first aiders both within and outside the workplace. Employers should be
encouraged to utilize the expertise of those organizations in planning first
aid training courses or first aid interventions within the workplace. Organisational
Control Measures A
supportive environment is vital to the success of programmes to prevent the
sexual transmission of HIV. Experience has shown that individuals are more
likely to adopt safer sexual practices when these are perceived as the norms
prevailing in their peer group or community. It is thus crucial to encourage
the adoption, readopting or retention of protective social norms, such as
mutual fidelity, moral responsibility for not endangering others, and the
appropriate use of condoms. A supportive social environment for preventive
programmes also means one in which there are no legal or other barriers to the
dissemination of frank and informative messages about sexual health (e.g. laws
prohibiting the promotion of condoms), and likewise no barriers that would
hinder people from receiving and acting on prevention messages (e.g. the
enforcement of laws against mutually voluntary sexual activity between adult
males). What if a worker is exposed at work? A written policy stating what to do and whom to contact in case of
exposure should be developed in all workplaces where workers may be exposed to
blood or other body fluids. Workers should be familiar with the policy, and it
should be posted where everyone can see it. If a worker is exposed to blood or
other potentially infectious fluids: Wash the wound with clean water and soap. If splashed in the eyes, wash the eyes with a sterile eye wash
solution (or clean water). If splashed in the mouth, rinse the mouth immediately with a large
volume of clean water. Fill out an accident report. The report should include the date,
time, place of the incident and a detailed description of circumstances. Get referrals for proper medical assessment and/or treatment
and/or counselling. Note: All procedures must protect the confidentiality of the
exposed worker. If workers suspect that the process is not completely
confidential, they may be reluctant to report the injury, or to seek needed
treatment and counselling. Engineering controls Engineering controls should be the first choice to control hazards
in the workplace. Engineering controls remove the hazard, rather than require
the worker to use special protective equipment or follow special work
procedures. Engineering controls are available to protect workers against
needlesticks. For example, some unions are asking health care employers to get new
devices like “self-sheathing needles” that allow the needle to remain covered
before, during and after it is used. They are also pressing for
other types of safer procedures and equipment which have become available.
Proper worker training in good housekeeping practices is also vital for the
prevention of needlesticks. Infection control plans Experts and some regulatory agencies recommend that every employer
prepare an infection control plan designed to reduce or eliminate exposure if
the workers face possible occupational exposure to HIV and HBV. The infection
control plan should have specific procedures for specific categories of workers
and job tasks and, most important, it should be supported and followed by all
supervisors. Is there ever a reason to know if someone is infected with HIV? In situations where there is a real risk of exposure, such as in a
hospital, the best solution is to assume that anyone could be infected and take
the same precautions for everyone. Since it is impossible to know everyone who
is infected, workers must be especially careful when handling all blood and
certain body fluids. The workplace is an important environment for promoting the health
of all workers as well as for disseminating information and education about the
transmission and prevention of HIV/AIDS. Education in the workplace is
particularly important since many people express fear about having contact with
people who have HIV infection and AIDS. At work, these fears can affect
workers' attitudes towards co-workers with AIDS or even towards workers
suspected of being in “high-risk groups”. Co-workers may have serious concerns when they learn that a worker
has AIDS or is infected with HIV. They may ask for absolute proof that AIDS
cannot be transmitted casually. Fears about contamination may surface. Workers
may think about requesting transfers, or not using the same telephones, drinking
fountains or workplace equipment. Some workers may be
convinced that they are at risk just by being near an infected co-worker.
Unions must take action to fight prejudice or discrimination. The best solution to these problems is a worker education programme
to decrease fears and to make sure everyone has accurate information about
AIDS. To be most effective, workplace educational programmes on
HIV/AIDS should be developed cooperatively between management, workers and
their representatives and the occupational health service, if there is one. Unfortunately, workers with HIV or AIDS often face discrimination
in the workplace. This can include loss of job, violations of confidentiality,
unnecessary restrictions placed on infected workers, and being passed over for
promotions, better work assignments, and other rights. There are several tools that unions can use to fight
discrimination, including: The contract: Even if there is no specific language on AIDS discrimination in
the union contract, there may be general language prohibiting discrimination,
or more specific language forbidding discrimination based on physical handicap,
medical condition or sexual orientation. Community support: Building community support for a
worker with HIV infection or AIDS can also help. Some unions have defended the
rights of members with AIDS in this way. Laws: If no laws exist in your country to protect sick or disabled
workers, your union may want to put pressure on government officials to develop
such laws. Role
of the Health and Safety Representative As
a health and safety representative, your co-workers will bring many problems to
you. It may happen that a union member will confidentially tell you that he or
she is infected with HIV and needs your help. There will be many issues for you
to deal with in such a situation: The worker will probably want to keep working. You may need to
work together with the union to make sure that the worker continues to work as
long as he or she is physically able. You may have to confront possible discrimination against the
infected worker, as well as the fears of management and co-workers. You may need to get information for the worker regarding medical
treatment, possible special employment options, benefits, insurance, etc. You may have to confront issues of confidentiality. It is not easy to be a health and safety representative under the
best of circumstances. Helping members who have life-threatening diseases can
be stressful. Dealing with other members who are afraid, uninformed, or even
prejudiced can also create stress. It is also important to recognize your own
fears and prejudices. If you feel uncomfortable or overwhelmed dealing with the
issue of AIDS, try to find support from others in the union, or from members working
on the health and safety or grievance committees, for example. Remember that the World Health Organization's Global AIDS
Programme can lend assistance to you, including providing you with AIDS
information pamphlets - available in a number of different languages - which
you can distribute in your workplace and union. The local and regional offices
of the World Health Organization and the International Labour Office are other
resources for assistance. AIDS
and the Workplace Policy Issues In many workplaces, employees and management have worked together
to develop a joint policy on HIV/AIDS and other chronic illnesses. If such a
policy is developed, it should be circulated widely and all management and
workers should understand it. The policy could be incorporated into existing
contract language. When developing HIV/AIDS-related policy and educational programmes
for the workplace, employers and trade unions should utilize the expertise of
any relevant non-governmental and community-based organizations. This type of
collaboration can save time and effort by helping to share knowledge and
procedures that are known to be effective. Policy development and implementation is a dynamic process.
Therefore, HIV/AIDS workplace policies should be:
The following are some recommended points for workplace policy for HIV/AIDS.
Screening: Since HIV infection by itself does not affect a worker's ability to perform a job, and an infected person cannot transmit infection to co-workers from casual contact, employment or pre-employment testing or screening for HIV is unnecessary and should not be required.
(Screening in this setting means either a direct method, such as the blood test, or an indirect method, such as asking a job applicant about his or her risk behaviours or previous blood tests for HIV.)
Confidentiality: Like all medical information, information on whether someone is infected with HIV or has AIDS must be kept confidential. Again, there is no risk of becoming infected from co-workers unless you have sexual intercourse or share needles with them.
Informing employers: There should be no obligation for a worker to inform the employer about his or her HIV/AIDS status. An HIV-infected person does not normally pose a risk to others in the workplace.
Work arrangements or assignments: Since being infected with HIV does not limit a person's ability to work, no changes in working arrangements are necessary. However, if a worker becomes impaired by illness related to HIV, reasonable alternative work arrangements should be made to help the worker stay at work. Ideally such job modifications might include: flexible work time, job sharing, more breaks, and working from the home if the worker wishes.
Continuation of employment relationship: HIV infection is not a reason for terminating employment. People with HIV-related illnesses should be able to work as long as they are medically fit for available, appropriate work.
Benefits: HIV-infected workers should receive standard work-related remuneration and allowances, including social security and social insurance benefits.
Education: Because information and education are vital in the fight against AIDS, workers and their families should have access to information and educational programmes on HIV and AIDS free of charge. They should also have access to appropriate counselling and referral to other courses of assistance and information about HIV and AIDS.
Protection of workers: Workers who are HIV-infected, or who are believed to be HIV-infected, must be protected from any discrimination by co-workers, unions or employers. Information and education are essential to help prevent prejudice against HIV-infected workers. There is no reason to fear people who are HIV-infected or have AIDS. They need support to help them with the physical and emotional difficulties they face.
Workplace policy: Workers should be consulted by employers in the development and implementation of policy in relation to HIV infection and AIDS.
First aid: In any situation requiring first aid in the workplace, precautions need to be taken to reduce the risk of transmitting bloodborne infections, including hepatitis B. These standard precautions will be equally effective against HIV infection.
Training: Employers and unions should jointly establish initial and periodic training programmes for workers in jobs that either normally or occasionally place them at risk of exposure to HIV-infected materials.
Follow the laws: In dealing with workers who have such chronic illnesses, the employer should follow all applicable laws and all relevant provisions of the union contract.