Standard precautions

One of the most common forms of discrimination reported by people with HIV is when health workers make unnecessary or unjustified changes to their practice and safety procedures when giving care.

HIV is a bloodborne virus and there are recognised protocols you should always follow when treating someone with this disease to ensure they receive the best possible care and you avoid accidental exposure.

  • Plan your care activity and gather the necessary equipment
  • Wear protective equipment (such as gloves and goggles) if the activity involves contact with potentially infected bodily fluids
  • Cover cuts and wounds with a waterproof dressing
  • Use disposable sterile needles and never re-use/or re-sheath them.
  • Ensure all equipment is properly sterilised.

For more information about the precautions you should take, download Guidance for clinical healthcare workers: protection against infection with bloodborne viruses (UK Health Departments, 1998).

Occupational exposure

Overall, in documented cases of occupational acquisition of HIV, the route of transmission was predominately associated with percutaneous exposures in 91% of cases.

In the unlikely event that you experience a percutaneous injury, follow your local occupational health protocol. This protocol should include the following guidance:

  • Immediately after any exposure, whether the HIV status of a patient is known or not, the site of the exposure (e.g. wound or non-intact skin) should be washed with soap and water but without scrubbing. Antiseptics and skin washes are not recommended.
  • You should encourage bleeding of any puncture wounds but they should not be sucked
  • Exposed mucous membranes, including conjunctivae, should be irrigated with water, before and after removing any contact lenses.

Post-exposure prophylaxis

The risk of acquiring HIV for healthcare workers following occupational exposure (for example a needlestick) is small. The Health Protection Agency estimates it to be around 0.3%.

Post Exposure Prophylaxis (PEP) is a short course (currently 28 days) of HIV medications that can reduce the likelihood of HIV infection after potential exposure, either occupationally or through sexual intercourse. Within the health sector, PEP should be provided as part of a comprehensive universal precautions package that reduces staff exposure to infectious hazards at work.

PEP is not guaranteed to work in 100% of situations. However, the anti-retroviral drugs can reduce by up to 80% of the risk of acquiring an HIV infection following accidental exposure.

Treatment should be started as soon as possible. Also, as it involves taking HIV treatment, it requires monitoring and follow up by specialist professionals. Every NHS employer should have a policy on the management of exposures, which should specify the local arrangements for risk assessment, advice and the provision of PEP.

More information about HIV post-exposure prophylaxis can be found in Guidance from the UK Chief Medical Officer's Expert Advisory Group on AIDS.