Health care instruments that could infect you with HIV include not only skin-piercing instruments such as needles, but also attached tubes and syringes, as well as instruments that come into contact with sores. The 4-part POST strategy allows you, the patient, to see for yourself that instruments are sterile (see box: POST general principles, below). For procedures not discussed in these Sections, you can work out for yourself and with your health care providers what to do. We’d like to hear how you deal with other procedures. Please tell us about your experiences and suggestions by using the ‘Leave a Comment’ link at the top right of this page.
|POST general principles
|1. Avoid skin-piercing procedures
||For some conditions, you can go without treatment, or ask for alternate treatment – such as pills or syrups, something to inhale, something to apply to the skin, or other treatment.
|2. Use new disposable instruments
||This works for procedures with low cost instruments – such as injections, for which you can buy a new disposable syringe and needle for each injection.
|3. You sterilize the instruments
||You can buy and keep your own instruments at home, sterilize them yourself, and bring them for providers to use. To sterilize instruments at home, first wash them, then boil them. As soon as water boils, HIV is dead, but boiling for 20 minutes is needed to kill other pathogens (that cause disease). You can sterilize some things, such as razors and pins, by holding them in a flame until they are red hot. You can also do this for your provider’s razors or pins, because it takes only a minute to sterilize and cool them.
|4. Ask providers how they sterilize instruments
||For some procedures, instruments are too expensive to buy and keep for your own use. You will have to ask providers how they sterilize such instruments. Your providers should have equipment to sterilize instruments with one or more of the following methods, and should use it regularly[i][ii](a) The best way to sterilize instruments is to steam them under pressure in an autoclave, which is similar to a pressure cooker. (The standard temperature and time are: 121 degrees centigrade for 30 minutes, or 134 degrees centigrade for 13 minutes.)(b) Boiling for 20 minutes is another common method. This is not safe if instruments are continuously added and removed from the pot.(c) Chemical sterilization (more accurately called “high-level chemical disinfection”) is needed for instruments that cannot take too much heat. This involves soaking or misting instruments for specified numbers of minutes in closed containers with special chemicals such as formaldehyde, povidine iodine, glutaraldehyde, or others.(d) Dry heat is another option; this is similar to baking instruments in an oven. (The standard temperature and time are: 160 degrees centigrade for 120 minutes; or 170 degrees centigrade for 60 minutes.)If you or your providers have questions about how to sterilize instruments, you can find links to more information in additional resources.
Cleaning methods that do not reliably kill HIV
Bleach is useful to clean blood spills and blood-stained cloth which might come into contact with your intact skin, but don’t rely on bleach to kill HIV on skin-piercing instruments. Although bleach and alcohol kill HIV, wiping instruments is not enough, and even soaking them in bleach or alcohol in open pans is unreliable, because solutions weaken over time, and weaken also with use.
Detergents and common antiseptics such as Dettol, Lysol, and Savlon are even less effective against HIV.
What will your health care providers think about all this?
When you ask your health care provider how they sterilize instruments, will he or she be irritated? Some may be, while others may be surprised or confused, and not know what to think. However, you can expect that many will appreciate your interest for at least two reasons.
First, they want your trust. They are no doubt aware that some clinics do not always use sterile instruments – so how can they get people to see their clinics are safe? Private sector health care providers want business, and they know that people talk. If they are smart, they will “use” you and your interest as an opportunity to get out the message: “This clinic will not infect you with HIV!”
Second, health care providers are worried they might get HIV from their patients’ blood through needlestick accidents. Your concern to protect yourself from HIV-contaminated blood is the same concern they have, so many will understand and respect your worry.
If your provider will not talk and work with you, what can you do? Your life is at stake, so you have a right to straight answers. If they get upset or won’t discuss your concerns, can you go to another provider?
Two final points
Your biggest risk during health care is that reused instruments will pass HIV from a previous patient to you. That is the risk we focus on here. Passage of HIV from an infected provider to a patient is extremely rare. (Very few cases have been reported where an HIV-infected doctor received a needlestick accident during surgery, and bled into and infected the patient.) We do not further discuss this very small risk in this book.
Suppose that while you are in a doctor’s office waiting for an injection or other procedure, you see something that does not look safe. What do you do? We recommend that you prepare an escape strategy in advance. You might say exactly what you are worried about – for example, that you don’t know if the syringe is sterile. And you can offer to buy and bring a new one. Alternately, you might avoid confrontation by simply leaving, as if you had an emergency.
[ii] WHO. Guidelines on sterilization and disinfection methods effective against human immunodeficiency virus, 2nd edition. WHO AIDS Series 2. Geneva: WHO, 1989. Available at: http://whqlibdoc.who.int/aids/WHO_AIDS_2.pdf (accessed 11 January 2011).