|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, or something to apply to the skin.
|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.
|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[i][ii]: (a) The best way is to steam them under pressure in an autoclave, which is like 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 (“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 like 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 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. 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. However, you can expect that many will appreciate your interest for at least two reasons.
- They want your trust. 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!”
- They are also worried they might get HIV from 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?
Your biggest risk during health care is that reused instruments will pass HIV from a previous patient to you. 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 then bled into and infected the patient. We do not further discuss this very small risk here.
Suppose that while you are in a doctor’s office waiting for an injection or other procedure, you see something that doesn’t look safe. What can 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. Alternately, you might avoid confrontation by simply leaving, as if you had an emergency.
We’d like to hear how you deal skin-piercing procedures in healthcare. Comments and advice welcome!
[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).
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If you are not a victim please do not play with Hiv because it is an enemy of goodhealth!! I appreciate the researcher
As a professional using sterile equipment I feel I Have to point out that you CANNOT sterilise anything by burning, boiling or wiping alcohol over it. This will make something hygienically clean but not sterile. This is because many pathogens can survive in even the most extreme of temperatures (i.e. inside volcanoes or nuclear blasts). The only way to really sterilise something is to use temperature combined with pressure over a period of time which causes the cells to ‘collapse’ – this is what an autoclave does. It is not really possible to do this in a pressure cooker because you cannot be sure the correct pressure and temperature is applied constantly, you also cannot insure the item is dry when it comes out – meaning air borne bacteria can get in to the item (re-infecting it) as soon as the lid is taken off the cooker…
If you could use a cooker i’m sure many scientists, doctors and dentists would be slashing their medical budgets by investing in pressure cookers rather than expensive autoclaves!
Dear anonymous professional,
Thanks for your comment. This website advises patients about what they can do to protect themselves when they cannot be certain that health staff sterilize equipment (with the care you advise).
National surveys of random samples of health facilities in 7 African countries from 2002-200 reported that 17%-83% did not have equipment to sterilize instruments by any means (including boiling, which as you point out is not ideal); see: https://dontgetstuck.wordpress.com/hiv-and-risk-in-africa/
There is a lot to do. Please continue advise and insist on proper sterile procedures.
I think we should find out or start to establish a dental care service where doctor use instruments from the patients but where can doctors agree with this? the instruments are not expensive to some normal treatment such as removing tartar, pulling out the teeth,…. we can even buy a car so i think it is not expensive and this is good way if we can sterilize instruments by ourself and use them for our family or next times. In Viet Nam, i think also in other countries, patients don’t have to show the test if they have hiv so the risks are higher while other operations requires this kind of test. I have seen here, some doctors and a few hospital refuse operations to hiv patients, It means that if anyone who is infected with Hiv from healthcare service is really much more horrible than they can die while they are only victims of this completely.
Hi Jade, thank you for your comment, it would be great if these things could be guaranteed! However, the aim of our site is to make patients aware that they should check levels of safety in health facilities and if they are not convinced, they should go elsewhere. Given that those visiting health facilities in most countries are not compelled to reveal their health status, it would be preferable for health professionals to ensure that conditions are not such that bloodborne and other pathogens can be transmitted. In other words, health facilities should be safe places, not places where the pathogens from one patient can be transmitted to other patients. These things should be a foregone conclusion in professionally run health facilities, but not everyone is lucky enough to live in areas where healthcare safety is guaranteed and there have been outbreaks and exposures in many wealthy countries, not just in poorer countries.
Hi David, yes, sometimes people just a link or their name is hyperlinked, in this instance to a site called kinky dot alt dotcom, I’m not clicking on it, but I have removed it anyway. Some rubbish postings are only there to put some link up, I doubt if it is anything but a nuisance! Cheers Simon
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Can you receive hiv if someone wipes blood from an injection that was just administered
If you get HIV infected blood on your skin, unless your skin is broken, you will not be infected. If you get it on broken skin, it is theoretically possible, but not very likely. If there is a lot of blood involved and you have an open or infected wound, perhaps it’s possible. But if you are worried that you may have been infected you should visit a specialist for advice.
Thank you so much for this information