Hiv Infected Healthcare Workers In New York State

Patients’ Rights To Information

Does fully informed consent imply that patients have the right to information discovered retrospectively? While informed consent may have been obtained at the time of treatment, is the subsequent emergence of additional information about the treatment relevant? A counter-argument to informing patients after inadvertent exposure to HIV or hepatitis B is that they cannot change their decision and withdraw consent to treatment already completed.

Obtaining fully informed consent is morally necessary in order to acknowledge and respect an individual patient’s autonomy. Truth disclosure is an integral part of this acknowledgement. Accusations of paternalism may arise from decisions to restrict information to patients.

Look back exercises may be costly and time-consuming and may erode confidence in the caring professions. However, failure to disclose might be regarded as a cover-up, especially where anxiety is caused after unplanned media disclosure.

The caring professions require patients’ trust in order to deliver care effectively. Being seen to foster a culture of openness may enhance patients’ trust in the professions while the appearance of concealment would certainly diminish it. In a society with an increasing culture of openness, and where the right to information from governments and official bodies is receiving attention, it would seem desirable to provide comprehensive information about risks.

Six Core Elements Of The Nysdoh Infection Control Curriculum:

Element I

– Recognize the benefit to patients and healthcare workers of adhering to scientifically accepted principles and practices of infection prevention and control- Recognize the professional’s responsibility to adhere to scientifically accepted infection prevention and control practices in all healthcare settings and the consequences of failing to comply, and- Recognize the professional’s responsibility to monitor infection prevention and control practices of those medical and ancillary personnel for whom he or she is responsible and intervene as necessary to assure compliance and safety

Element II

– Describe how pathogenic organisms are spread in healthcare settings- Identify the factors which influence the outcome of an exposure to pathogenic organisms in healthcare settings- List strategies for preventing transmission of pathogenic organisms, and- Describe how infection control concepts are applied in professional practice

Element III

Element IV

– Describe the circumstances that require the use of barriers and personal protective equipment to prevent patient or healthcare worker contact with potentially infectious material, and- Identify specific barriers or personal protective equipment for patient and healthcare worker protection from exposure to potentially infectious material

Element V

A Safe Environment: Cleaning Disinfecting And Sterilizing

ELEMENT V

Creation and maintenance of a safe environment for patient care in all healthcare settings through application of infection control principles and practices for cleaning, disinfection, and sterilization

The healthcare environment can easily become contaminated with pathogens. The potential for contamination exists in every area of the hospital or other healthcare facility. Contaminated patient-care equipment , invasive devices that were used in diagnosis and treatment , and environmental surfaces can act as vehicles for the transmission of infection to healthcare workers and/or patients. In addition, contamination depends on:

• The potential for external contamination
• The potential for internal contamination
• The physical composition, design, or configuration of an instrument, medical device, equipment, or environmental surface

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People Living With Hiv In New York State Faced Increased Burdens From Covid 19 In 2020

This study found that:

• In New York State, people living with HIV were more likely to be diagnosed with, hospitalized for, and die in hospital from COVID-19 than were people without HIV.
• People with more advanced HIV disease faced even greater risks from COVID19.

New York State has long been an epicenter of the U.S. HIV epidemic, and initially it was also an epicenter of the COVID-19 pandemic. Because HIV increases vulnerability to other infections, Dr. James M. Tesoriero and colleagues from the New York State Department of Health in Albany and the State University of New York, Rensselaer, investigated whether people living with HIV were more susceptible to coronavirus infection and to more severe COVID-19 disease than people without HIV. Their study demonstrated that compared with peers without HIV, people with a prior diagnosis of HIV in New York State were more likely to have a COVID-19 diagnosis, require hospitalization, or die from the disease during the first phase of the COVID-19 pandemic.

Occupationally Acquired Human Immunodeficiency Virus Infection: National Case Surveillance Data During 20 Years Of The Hiv Epidemic In The United States

Published online by Cambridge University Press: 02 January 2015

Ann N. Do*

Affiliation:Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

Carol A. Ciesielski

Affiliation:Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GeorgiaEpidemiology and Surveillance Branch, Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention

Russ P. Metler

Affiliation:Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GeorgiaOffice of the Director, Centers for Disease Control and Prevention

Teresa A. Hammett

Affiliation:Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

Jianmin Li

Affiliation:Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

Patricia L. Fleming

Affiliation:Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

*

Centers for Disease Control and Prevention ,

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Principles Of Sepsis Treatment

Patients with sepsis and septic shock require admission to the hospital. Early and aggressive treatment boosts a patients chances of surviving sepsis. Management principles of sepsis and septic shock include:

• Early recognition

• Recognizing early signs and symptoms of worsening infection and sepsis
• Seeking immediate care if signs and symptoms are present
• Ensuring relevant history is provided to clinicians

Healthcare Workers And Communicable Diseases

Healthcare workers are responsible for reporting to their supervisor or occupational health service when they have any signs or symptoms of a communicable disease. Symptoms requiring immediate evaluation by a licensed medical professional and possible restriction from patient care activities and return-to-work clearance may include:

• Fever or chills

Employees who report symptoms of illness should be removed from duty and medically evaluated to determine their ability to work and the duration of work restrictions.

Reporting of suspected or confirmed communicable diseases is mandated under the New York State Sanitary Code . Although physicians have primary responsibility for reporting, school nurses, laboratory directors, infection control practitioners, daycare center directors, healthcare facilities, state institutions, and any other individuals/locations providing healthcare services are also required to report communicable diseases.

Reports should be made to the local health department in the county in which the patient resides and must be submitted within 24 hours of diagnosis. However, some diseases warrant prompt action and must be reported immediately to local health departments by phone .

STRATEGIES FOR PREVENTION AND CONTROL OF BLOODBORNE PATHOGEN TRANSMISSION

Factors that may bear on the ability of the healthcare worker to provide healthcare include:

All matters related to evaluation must be handled confidentially.

IMMUNIZATIONS

Influenza

Hepatitis B

Other Vaccines

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Barriers And Personal Protective Equipment

ELEMENT IV

Selection and use of barriers and/or personal protective equipment for preventing patient and healthcare worker contact with potentially infectious material

Personal protective equipment includes a variety of barriers and respirators used alone or in combination to protect mucous membranes, airways, skin, and clothing from contact with infectious agents. The selection of PPE is based on the nature of the patient interaction and/or the likely mode or modes of transmission.

Mandatory Infection Prevention And Control Training For Hcp

New York State regulation requires all licensed health care facilities to train their staff in infection prevention and control techniques, to provide appropriate equipment, and to enforce use of Standard Precautions in situations involving potential exposure to blood or other body fluids. The NYSDOH also provides detailed infection prevention and control guidelines to all physicians and dentists practicing in New York State and makes such guidelines publicly available on the NYSDOH website.

In addition, Public Health Law § 239 and Education Law § 6505-b require licensed health care professionals to complete a course in infection control and barrier precautions on or before July 1, 1994, and every four years thereafter. As of 2008, PHL § 239 also requires medical students, medical residents, and physician assistant students to complete coursework or training in infection control practices. Required courses, tailored to the infection prevention and control training needs of specific health care specialties, include work practices and engineering controls, safe injection practices, and disinfection and sterilization procedures. The NYSDOH or New York State Education Department must approve the course syllabus and course providers.

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Occupational Exposure Risk Evaluation

PEP is indicated whenever an occupational exposure to blood, visibly bloody fluids, or other potentially infectious material occurs through percutaneous or mucocutaneous routes or through non-intact skin. , below, illustrates the steps in determining whether ongoing PEP is indicated after the first emergency dose.

Occupational exposures for which PEP is indicated include the following:

• Break in the skin by a sharp object that has been in the sources blood vessel or is contaminated with blood, visibly bloody fluid, or other potentially infectious material.
• Bite from a patient with visible bleeding in the mouth that causes bleeding in the exposed individual.

PEP is not indicated for an exposure to saliva, including from being spat on, in the absence of visible blood.

Access To The Latest Advances

At the Institute for Advanced Medicine, we provide treatment and services to those who are infected, while providing preventive services to those at risk. Because we are part of the Icahn School of Medicine at Mount Sinai, you have access to state-of-the-art knowledge and technology only available through a major academic medical center.

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Engineering And Work Practice Controls

ELEMENT III

Use of engineering and work practice controls to reduce the opportunity for patient and healthcare worker exposure to potentially infectious material in all healthcare settings

In addition to the precautions described above, other practices and controls can be employed to prevent and control infection. These include:

• Engineering controls
• Environmental controls

Infection Control Principles And Practices

ELEMENT I

Healthcare professionals have the responsibility to adhere to scientifically accepted principles and practices of infection control and to oversee and monitor the performance of those ancillary personnel for whom the professional is responsible.

Infection control practices can stop the spread of infection in healthcare settings.

Title 10, part 92 of the Official Compilation of Codes, Rules, and Regulations of New York and the Rules of the Board of Regents, Part 29.2, identifies professionals who must receive infection control training, and defines unprofessional conduct in the area of infection prevention and control as the failure to use scientifically accepted infection control practices to prevent transmission of disease pathogens as appropriate to each profession, including:

• Cleaning and sterilization or disinfection of instruments, devices, materials, and work surfaces
• Utilization of personal protective equipment
• Use of covers for contamination-prone equipment
• Safe handling of sharp instruments

The National Institute for Occupational Safety and Health is the federal agency that provides scientifically sound infection control recommendations. Other professional organizations and accrediting agencies that provide guidelines, standards, and recommended practices for infection prevention and control in healthcare settings include:

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Linens And Laundry Management

The risk of actual disease transmission from soiled laundry is negligible. However, the hands of healthcare workers may be contaminated by contact with patient bed linens. Thus, common sense hygienic practices for handling, processing, and storage of textiles are recommended. These practices include:

• Do not shake items or handle them in any way that may aerosolize the infectious agents.
• Avoid contact of ones own body and personal clothing with the soiled items being handled.
• Wear gloves and other protective equipment, as appropriate, when handling contaminated laundry.
• Contain soiled items in a laundry bag or designated bin at the location where they were used, minimizing leakage.
• Do not sort or rinse textiles in the location of use.
• Label or color-code bags or containers for contaminated waste.
• If laundry chutes are used:
• Ensure that laundry bags are securely closed before they are placed in the chute.
• Do not place loose items in the laundry chute.

OSHAs Bloodborne Pathogens Standard requires employers to ensure that employees who have contact with contaminated laundry wear protective gloves and other appropriate PPE.

Management Of The Exposed Site

Care of the exposure site should prioritize appropriate cleansing and infection preventive measures and minimize further trauma and irritation to the exposed wound site. The site of a wound or needlestick injury should be cleaned with soap and water only. It is best to avoid use of alcohol, hydrogen peroxide, povidone-iodine, or other chemical cleansers. Squeezing the wound may promote hyperemia and inflammation at the wound site, potentially increasing systemic exposure to HIV if present in the contaminating fluid. The use of surgical scrub brushes or other abrasive tools should be avoided, as they can cause further irritation and injury to the wound site. Eyes and other exposed mucous membranes should be flushed immediately with water or isotonic saline.

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Learn About Hiv And Aids

Today there are better treatments, more accurate tests and new ways to prevent HIV.

What are HIV and AIDS?

HIV is the virus that causes AIDS . HIV attacks the bodys immune system and makes the person more likely to get other infections. If not treated, HIV weakens the bodys immune system and can lead to AIDS.

The only way to know for sure if you have HIV is to get tested.

How does HIV spread?

During sex

• Your risk of HIV depends on what kind of sex you have and how much virus is in your partner’s body.
• People who are on HIV treatment and maintain an undetectable viral load do not transmit HIV through sex.

While injecting drugs

HIV can enter your bloodstream when you share a syringe, drug solution, or other injection equipment with someone that has HIV.

• If you inject drugs, always use a new syringe and never share injection equipment to prevent HIV and other viruses like hepatitis B and C. Learn about overdose prevention.

How HIV does NOT spread

Other human body fluids and wastelike saliva, sweat, tears, urine and fecesdo NOT contain enough HIV to infect you.

HIV does NOT spread through hugging, kissing, coughing, shaking hands, or sharing a toilet or drinking fountain.

What are the stages and symptoms of HIV?

Exposure

It takes a few days for an HIV infection to develop in your body. If you may have been exposed to HIV in the past 36 hours, immediately go to a clinic or emergency room and ask for PEP to prevent HIV.

Recent or Acute Infection

Chronic Infection

AIDS

Exposure To Hiv Is An Emergency

An HIV exposure is a medical emergency and rapid initiation of PEPideally within 2 hours and no later than 72 hours post exposureis essential to prevent infection. Therefore, this Committee encourages emergency departments, outpatient clinics, and urgent care centers to train triage staff to assign high priority to patients who report a potential exposure. In deciding whether to continue PEP beyond the first emergency dose, care providers must balance the benefits and risks. PEP can be discontinued later in the evaluation process if indicated.

Because the efficacy of PEP in preventing an established HIV infection diminishes rapidly, initiation as soon as possible after exposure is best . Animal models have consistently demonstrated improved outcomes at 12 to 36 hours post exposure compared with 72 hours . Consistent with these findings, the virus can be detected in the regional lymph nodes of SIV-infected rhesus macaques within 2 days of intravaginal exposure .

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Types Of Personal Protective Equipment

PPE must be readily accessible to employees and available in appropriate sizes. It is important to know which type of PPE is available at work and where it is stored. To protect themselves, healthcare providers must have a barrier between them and any potentially infectious material.

Types of PPE used in healthcare settings include:

Factors that influence the selection of appropriate PPE include:

• Type of exposure anticipated:
• Blood or body fluid splash/spray vs. touch
• Contact with minimal bleeding/drainage/body substances
• Contact with large volume bleeding/drainage/body substances that are likely to soak through the contact area
• Category of isolation precautions

GLOVES

Gloves are the most common type of PPE. They are used for patient care as well as environmental service. Gloves can be sterile or nonsterile and single use or reusable. Because of allergy concerns, latex products have been eliminated in many facilities, and materials used for gloves are mostly synthetics such as vinyl or nitrile.

Proper glove use includes:

GOWNS/APRONS

Clinical and laboratory coats or jackets worn over personal clothing are not considered PPE.

FACE AND EYE PROTECTION