What You Need To Know About Nosocomial HIV Infection?

What you need to know about nosocomial HIV infection?

The Moscow Regional AIDS Center announced that a child was infected with HIV through a glass capillary for taking blood from a finger. Various cases of nosocomial transmission of infection are recorded in other regions of the country. The head of the Federal Center for the Fight against AIDS, Academician Vadim Pokrovsky

Academician Vadim Pokrovsky spoke about why there is still a chance of contracting HIV in the hospital. Photo: the-village.ru /

In March, in the Moscow region, for the first time in Russia, the use of reusable glass capillaries for taking blood from a finger was banned. This was done after the regional AIDS center was able to prove the connection between the nosocomial infection of a child with HIV infection using a capillary. Various cases of transmission of infection through non-sterile instruments are also recorded in other regions of the country. Vadim Pokrovsky, head of the Federal Scientific and Methodological Center for Prevention and Control of AIDS, RAS Academician Vadim Pokrovsky, told MedNovosti why there is still a chance of contracting HIV in the hospital and what is needed to bring it to zero.

According to Rospotrebnadzor, in 2007-2014 in Russia (excluding cases of infection through blood transfusion), 20 cases of HIV infection were registered in hospitals. Children were injured in 14 of them. Can this data be considered comprehensive?

- As for the children, I think so. Basically, all cases of nosocomial HIV infection are recorded in children. This is because, given the multifactorial nature of HIV transmission, it is much more difficult to prove nosocomial infection in adults than in children. When investigating adult cases, it is very difficult to exclude sexual transmission or drug use. Therefore, they are all automatically attributed to these factors. And children do not have such risk factors. And if the mother of the child is healthy, the suspicion of nosocomial infection immediately arises. But the presence of cases of infection of children tells us that they are among adults. We simply cannot identify them.

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The first emergency that shook the whole country happened 25 years ago, when people knew little about HIV at all. After that, it would seem, the situation was taken under control. But, as it turned out, not for long. What happened?

- The outbreak of nosocomial HIV infection, which we managed to uncover in 1989, began in Elista and then spread to Rostov and Volgograd. Then 200 children suffered. After that, the doctors were very scared. And in the country for 15 years there were no cases of infection associated with the provision of medical care. And then a generation of medical workers changed, other people came, and laxity began. In addition, our media stopped talking about HIV infection. On the contrary, there were continuous victorious reports that the spread of HIV in our country is only decreasing.

Read more: HIV detected in a million Russians

A million Russians are infected with HIV. The head of the Federal Scientific and Methodological Center for the Prevention and Control of AIDS of the Central Research Institute of Epidemiology of Rospotrebnadzor, Vadim Pokrovsky, said that “on January 20, the database on HIV-positive citizens of Russia, located in the Federal Scientific and Methodological Center for the Prevention and Control of AIDS, was officially introduced the millionth patient with HIV”.

And here's the result: the number of HIV-infected people in the country is dramatically increasing, and alertness is falling. Therefore, I strongly urge our doctors to strengthen control over all parenteral procedures. This is the only way to avoid the maximum number of infections. Especially when it comes to children who, unlike adults, cannot notice that they are being injected with a non-sterile syringe, and make a comment.

But now, disposable syringes are almost universally used

- It is not at all necessary to use only disposable instruments. The main thing is that all disinfection rules are followed. Moreover, plastic syringes are not actually disposable. You can use them several times, but you cannot sterilize them - they will melt. Therefore, it turned out that plastic tools did not fundamentally solve the problem. It got to the point of ridiculousness: somewhere in the 90s, I received a letter, the author of which was indignant at the fact that plastic syringes cannot be sterilized, since when heated, they immediately deform. So, the devastation is not in the syringes, but in the heads.

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In addition to syringes, there are other tools, and not all of them are disposable

- There is. The same capillary tubes are available in glass and plastic. But for reusable, there are sterilization rules. By the way, by themselves, these tubes are less dangerous in terms of transmission of infection, all cases of transmission of infection are mainly associated with injections. The fact is that the tubes only collect blood that flows from the finger. Cut wounds are generally less dangerous, since blood flows out, and itself plays a certain protective role. And with puncture wounds, blood does not flow, and when injected with a non-sterile syringe, the infectious material is brought inside. That is why the syringes that were used to inject a person with HIV or hepatitis are so dangerous.

Read more: The use of glass capillaries for blood sampling was banned in the Moscow region

Since March 4, 2016, by order of Nina Suslonova, Minister of Health of the Moscow Region, the use of Panchenkov's glass capillaries has been prohibited in the Moscow Region.

There was a lot of talk at one time about infection through dental instruments. True, it was about hepatitis

- Such an infection cannot be denied either, it is quite possible if the tool used does not change. In addition, the hepatitis B virus is more resistant than HIV. But I don’t know a single case of HIV infection in the world through the fault of a dentist that could be proved.

But if even disposable tools do not guarantee against infection, how can this problem be solved?

“We make a serious mistake when we use the term" disposable toolbox ". We need a self-destructive toolkit. Or one that locks up after a single use so that it cannot be reused (for example, if a syringe gets blocked). Such syringes are already available all over the world. In English they are called self-destruction.

And many of our domestic inventors have sent me their proposals. But such a toolkit costs a little more in production, and the industry is in no hurry to introduce it until there is a corresponding order from our supervisory authorities. But I think it should be done and gradually move over the years to tools that cannot be used twice.

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In addition to tools, there are also the hands of doctors. It is not uncommon to observe how the procedural nurses, who work with gloves, do not change them after changing the patient, at best they rinse under the tap

- This is definitely a violation. And such violations must be fought. The sanitary service cannot track everything. Therefore, it remains on the conscience of health workers and the vigilance of the patients themselves, who must make a comment if something, in their opinion, is being done wrong. It is, of course, very important to protect yourself for health workers. But still, their duty, first of all, is to protect patients.

During a recent discussion of a draft government HIV strategy, some objected to expanding mandatory HIV tests. Motivating this by the fact that the state signs in the absence of a system to protect the patient from infection when performing invasive interventions. At the same time, it must ensure that the biomaterial of one patient under no circumstances can get to another patient or doctor

- Don't confuse these things. Population testing is done for early diagnosis, not to protect doctors and other patients from HIV infection in the hospital. Moreover, one of the reasons for nosocomial outbreaks is that doctors think that patients with HIV infection are somewhere in AIDS centers or specialized hospitals. And such patients cannot get to them in gynecology or surgery.

We do not now hospitalize people for surgery without a certificate of the absence of HIV infection. And they ask for this certificate from some old man who has not thought about sex for 30 years - otherwise we will not take it for a heart bypass operation. We really don't need such testing. It should be carried out among those groups where the infection is most common, and these are now people aged 25 to 40 years. The level of HIV infection among sexually active adults is now very high and reaches 2%. This means that everyone can face HIV infection in their own bed.