3.1.9 HIV and Aids

Introduction
Hygiene Precautions

1. Introduction

HIV can only be transmitted by specific activities, and it may need to be considered in the following situations:

Penile penetration (vaginal and anal);
Oral sex (although this represents a much lower risk);
Used needles and syringes - therefore, it may be a rare consideration in assessment of risk where family members have a casual attitude to the disposal of such needles.

Injecting drugs by itself is not necessarily indicative of exposure to risk of HIV infection - it is the sharing of drug using equipment that is risky. Information relating to the nature and extent of the parent's drug use should be sought from the parent and from other agencies with the knowledge of the parents.

In circumstances where children and parents share concerns about HIV, these should be responded to by sensitive discussion of the reasons for their concern. If penetration or oral sex has not taken place, then reassurance can be given that it is highly unlikely that the child will have been exposed to HIV.

Where it is known that penetration or oral sex has taken place, it is still unlikely that the child has been exposed to HIV.

In either situation, the child and/or parents may require specialist advice and counselling to help them weigh up the potential risks and to make future decisions.

It should be borne in mind that children may not talk about the full extent of the abuse they have experienced, especially during the initial investigation.

The decision to have a HIV test is a major step and poses many moral dilemmas. Any such decision should only be made therefore after a balanced consideration of all advantages and disadvantages lead to the conclusion that it would be in the best interests of the child.

The advantages are

Knowledge of HIV status allows access to medical care and support;
If the child is not infected, it can remove doubt and prevent unnecessary stress and anxiety;
If the child is infected, the child and family can be helped to cope and be encouraged to respond constructively.

The disadvantages are

There is no cure for AIDS;
The side effects from treatment can be severe and have a profound effect on the child;
Awareness can be harmful to the emotional well-being of the child and family;
Knowledge of HIV status may lead to stigma and isolation;
There is an obligation to disclose the results of the test;
Testing for babies or young children is unlikely to be accurate or reliable particular in children under the age of 2;
Having been tested, regardless of the outcome, can cause difficulties later in life in obtaining insurance and some other services.

2. Hygiene Precautions

The following hygiene precautions are recommended as safe practice for all local authority staff and for all those who care for children. These are commonsense precautions that will protect against bloodborne viruses and other infections that may be transmitted via blood and body fluids.

They should be incorporated as standard practice in all settings at all times.

Standard infection control precautions

Always keep cuts or broken skin covered with waterproof dressings;
Avoid direct skin contact with blood or body fluids;
If blood is splashed onto skin, it should be washed off immediately with soap and water. Splashes of blood into eyes or mouth should be washed immediately with plenty of water;
If a sharps injury is sustained or blood splashed into eyes or mouth, or on a non-intact skin (e.g. eczema) medical advice should be sought promptly;
Wear disposable gloves when contact with blood or body fluids is likely;
Always wash and dry hands after removing gloves;
Always wash and dry hands before and after giving first aid;
Never share toothbrushes and razors;
Teach children about avoiding contact with other people's blood as soon as they are able to understand it;
Teach children to wash and dry their hands before meals and after using the toilet.

2.1 Spillages of blood or body fluids

Household grade gloves and a disposable plastic apron should be worn when cleaning splashes or spillages. Eye protection should be considered if there is a risk of splashing. Gloves should be washed with neutral detergent and hot water after use. Hands should always be washed and dried on removal of gloves.

Spillages of blood

Small spills or splashes of blood on floors or other hard surfaces should be cleaned with neutral detergent and hot water.

Large spills should be covered with sodium dichloroisocyanurate (NADCC) granules for two minutes. The spillage and granules should be removed with paper towels, which should be disposed of carefully into a waste bag. The area should be cleaned with hot water and neutral detergent.

NADCC granules should not be used on metal, wood or fabric as they may damage these surfaces.

Chlorine fumes will be released when NADCC granules are used, therefore it is important that the area is well ventilated. These granules should not be used on spillages of urine.

Spillages of body fluids

Small spills or splashes on floors or other hard surfaces should be cleaned with neutral detergent and hot water.

Large spillages should be covered with absorbent paper towels and the area then cleaned with hot water and neutral detergent. Paper towels should be disposed of carefully into a waste bag.

Carpets and upholstery

Remove the spillage as far as possible using absorbent paper towels, then clean with a fresh solution of neutral detergent and water.

Carpets and upholstery can then be cleaned using cleaner of choice.

Steam cleaning may be considered.

Crockery and cutlery

Crockery and cutlery can be cleaned in the normal way either by hand washing with hot soapy water or in a dishwasher.

Linen

Linen and clothing contaminated with blood and body fluids can be washed in a domestic machine and should be washed at the highest temperature the fabric can withstand. Household gloves and cold running water should be used to remove soil prior to washing if necessary, and any solid matter (i.e. faeces and vomit) should be flushed down the toilet.

Care should be taken to avoid splashing body fluids into the mouth or eyes. In residential/day care/special schools it is recommended that an industrial washing machine is used.

Soiled linen/clothing does not need to be sluiced in this instance with a sluice prewash programme.

Disposal of waste

Paper towels, together with gloves and aprons, should be put into a plastic waste sack prior to disposal, the top tied and placed in a household waste bag for collection.

Waste such as sanitary towels, nappies, tampons and incontinence pads should be wrapped adequately in newspaper to soak up excess fluid prior to disposal in a household waste bag.

Vomit, urine and faeces should be flushed down the toilet. Potties and nappy changing mats should be washed with neutral detergent and hot water, and dried with paper towels after each use.

It is important that standard infection control precautions, such as hand washing and the use of gloves, are followed when handling body fluids.

In some individual cases, a child's general practitioner may identify a specific infection risk associated with their medical condition and may make additional arrangements for disposal of waste via the local authority. This should be discussed with the general practitioner and local infection control team or paediatric community nursing service.

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