Chapter 3
Preventing the Spread of HIV and Other Infections
Overview of the Home Care Plan for Preventing the Spread of HIV and Other Infections
1. Understanding the Problem
Fears about the transmission or spread of HIV
The known routes for the spread of HIV/AIDS
Your goals
2. When To Get Professional Help for Yourself
Medical emergencies
Symptoms that do not indicate an emergency but should be reported
Information to have ready when you call
What to say when you call
3. What You Can Do To Help
Prevent getting HIV yourself
Keep the home environment clean and safe
Deal with your fears of becoming infected
Prevent the spread of other infections to the person with HIV/AIDS
5. Carrying Out and Adjusting Your Plan
Checking on results
What to do if your plan does not work
Topics with an arrow (
) in front of them are actions you can take or symptoms you can look for.
Many people are concerned about the ways that HIV, the virus that causes AIDS, is spread. Caregivers need good information about the risk of acquiring HIV while helping someone who is HIV-positive or who has the disease AIDS.
Fears about the spread of HIV are usually greater than the actual degree of risk. HIV is spread through any of the following three known routes:
1. Contaminated blood and blood products
2. Sexual activity with a person who is HIV-positive
3. From an HIV-positive mother to her unborn or newborn child
The first route refers to receiving contaminated blood through a transfusion or from sharing contaminated needles that are used to inject medications such as steroids and insulin or to inject illicit drugs. There is no evidence that the AIDS virus is spread by insect bites, air, water, food, or close nonsexual contacts with a person who is HIV-positive. Caregivers of persons with HIV/AIDS are not at significant risk for becoming HIV-infected while caring for such individuals, provided that they take the proper precautions, which are described in this chapter.
The information in this home care plan fits most situations, but yours may be different.
If the doctor or nurse tells you to do something else, follow what he or she says.
If you think there may be a medical emergency, see the section "When To Get Professional Help for Yourself" on pp 30-31.
The Centers for Disease Control and Prevention has developed guidelines to prevent the spread of HIV infection. These guidelines are the basis of the recommendations in this chapter.
Another concern is spreading other infections to persons with HIV/AIDS. This will also be discussed in this chapter.
Your Goals
Know when to get professional help
Take care of yourself
Keep the home environment clean and safe
Deal with your fears of becoming infected
Prevent the spread of other infections to the person with HIV/AIDS
2. When To Get Professional Help for Yourself
Caregivers who develop symptoms similar to those of HIV/AIDS may wonder whether they have contracted the virus. Sometimes they are concerned because they have engaged in activities (such as needle sharing or unprotected sexual contact) that have put them at risk. Signs and symptoms of HIV/AIDS can be similar to those of other illnesses. Consulting a doctor or nurse can clear up any doubts.
Medical emergencies
Call a physician immediately if you have been accidentally stuck with a contaminated needle or other sharp object, or if contaminated material comes in contact with an open cut or damaged skin. The physician may prescribe a medication, such as AZT (zidovudine), which may reduce the risk of becoming infected with HIV.
Symptoms that do not indicate an emergency but should be reported
Call the doctor or nurse if you have had any of the following symptoms for a month or longer:
Temperatures of 99° to 101 °F not related to a cold or known infection
Unusual fatigue not caused by overwork, insomnia, depression, or stress
Weight loss not linked to dieting or an effort to lose weight
Bouts of unexplained diarrhea
Rash (cause unknown)
Profuse night sweats
Painless lumps in the groin, neck area, or armpits
Ulcers or soreness in the mouth or throat that make eating painful
Persistent vaginal "yeast" infections with white curdlike discharge and much itching.
White plaques on the roof of the mouth
If the doctor, nurse, or you are concerned that you may be HIV-infected, a simple blood test can be performed. However, unless you have engaged in behavior that has put you at risk, the chance that you will become HIV-infected while caring for someone with HIV/AIDS is extremely small.
When you call, have the answers ready to the following questions:
1. At what time(s) each day does your temperature tend to rise? What is your temperature at these times?
2. Does fatigue prevent you from working or from other everyday activities? Do you sleep well?
3. Have you lost weight? If so, how much?
4. If you have diarrhea, what are the amount, frequency, color, and consistency of the stools?
5. If you have a rash, where is it located? What does it look like, and how does it feel?
6. Do you have night sweats every night? If so, how excessive is the sweating? (For example, do you have to change bed clothes during the night?)
7. If you have swollen lymph lands, where are they located? How many are there? Are they painful?
8. How does the throat, tongue, and inner portion of the mouth look? How painful is swallowing?
9. If you have a yeast infection, have you tried any over-the-counter medications?
Here is an example of what you might say when calling for professional help:
"I am John Davis, Adam Smith's caregiver. Adam is a patient of Dr. Black. Adam tested positive for HIV 6 months ago. Now I'm not feeling well. Each evening my temperature is 100 °F. I believe my fever breaks during the night because I sweat a great deal while I sleep and wake up exhausted each morning. I believe I may become HIV-infected myself, and would like to schedule an appointment for HIV testing."
Here are four steps you can take to make caregiving easier and safer both for yourself and for the person you are caring for:
Prevent getting HIV yourself
Keep the home environment clean and safe
Deal with your fears of becoming infected
Prevent the spread of other infections to the person with HIV/AIDS
Prevent getting HIV yourself
Use a proper container to dispose of sharp objects used by the person with HIV/AIDS.
Place used needles, razors, and other sharp objects that may be contaminated with the AIDS virus into a rigid, nonbreakable, puncture-proof container. A coffee can with a lid or a sturdy detergent bottle will do. When the container is full, place a solution of one part bleach and 10 parts water into it to decontaminate the contents. Keep the lid on and tape it closed. Place the full container in the garbage can on the day of pickup. Be sure to keep the container out of reach of children and away from other adults.
Dispose of contaminated dressings properly.
Dressings that have blood-stained drainage on them are contaminated. Place them in a sturdy plastic bag immediately and then into a second plastic bag before disposing of them in the garbage.
Wash your hands with soap and warm water after coming into contact with the body fluids of the person with HIV/AIDS.
Hand washing is the most important means of preventing the spread of infection to yourself. Proper hand washing includes the use of warm water, plenty of soap, rubbing over all surfaces of both hands, and thorough rinsing. Wash hands immediately after being in contact with the body fluids of the person with HIV/AIDS, especially if these fluids contain the blood of the person with HIV/AIDS.
Wear disposable latex gloves when caring for the patient if you foresee that you will come in contact with blood or body fluids.
Body fluids known to transmit HIV infection are blood, semen, vaginal secretions, and breast milk.
Wear rubber gloves when cleaning the bathroom.
Rubber gloves protect your skin from coming into contact with any HIV-infected body fluids. Rinse the outside of the gloves after you remove them.
Special note for protecting babies of mothers with HIV/AIDS.
HIV-positive mothers of newborn infants should not breastfeed their children because the virus can be transmitted through breast milk.
Keep yourself in good health.
Caring for someone with HIV/AIDS can be physically and psychologically taxing.
Caring for yourself is therefore very important. To provide the best care, you need to be healthy and alert. Make sure you get enough rest, eat healthy foods, exercise, and have time away from the person you are caring for. Take time for relaxation and fun so that you do not "burn out."
Keep the home environment clean and safe
A clean, safe home environment will protect both family members and the person with HIV/AIDS from contracting infections.
Keep the home well ventilated.
Open the windows to allow fresh air into the home. A stuffy, damp home invites the growth of mold and fungus. These may be a source of infection to the person with HIV/AIDS. Fresh air and room deodorizers may also eliminate the smell of urine, vomit, and diarrhea.
Wash all laundry with detergent in hot or warm water.
Washing clothes in this manner will destroy viruses. Clothes of the person with HIV/AIDS do not necessarily have to be washed separately. If linens and personal clothes are soiled with blood or other body fluids, add bleach to the soapy water.
Keep toothbrushes, towels, and razors of the person you are caring for separate from those of family members.
The person with HIV/AIDS should have his or her own towel, washcloth, razor, and toothbrush to protect himself or herself from infections and also to protect family members from coming into contact with the HIV/AIDS virus. If there are others in the household who are HIV-positive, they should also have their own towels, washcloths, razors, and toothbrushes.
Wash dishes in hot, soapy water to protect everyone from infections.
The person with HIV/AIDS does not need special dishes or utensils, nor do these need to be disposable. Routine washing of all dishes in the household with hot, soapy water will destroy viruses. Family members should not eat with the same unwashed utensils or drink from the same unwashed glass as the person with HIV/AIDS because they can easily transfer germs to the person with HIV/AIDS.
Clean up spills quickly and properly, especially if they include bloody drainage or other potentially infectious body fluids.
Gloves can be worn when cleaning up spills of potentially infectious body fluids, especially when the spills cover large areas. Use paper towels to absorb the spill, and put them into a double plastic bag immediately. Wipe the area with a solution of 1 part bleach and 10 parts water. Have a container of this solution prepared and readily available for use. It is also wise to wipe down surfaces in the kitchen, bathroom, and bedroom often with the diluted bleach solution or disinfectant cleaners such as Lysol.
Keep the garbage can covered, and empty it often if contaminated materials have been placed in it.
Keep a plastic lining or bag in the garbage can. Keep the lid on to keep mice, ants, flies, and roaches from attacking its contents. Empty the household garbage can whenever it is full and place contaminated contents in the outside garbage immediately.
Dispose of sanitary napkins and tampons (of the person with HIV/AIDS) in containers with tight lids or double-bag them with plastic bags.
Deal with your fears of becoming infected
As the caregiver of a person with HIV/AIDS, you may worry that you have become infected with the virus. Such fears are usually unfounded unless:
You have had sexual relations with a person who has HIV/AIDS and did not use a condom
You have received a transfusion of a blood product that was untested and perhaps contaminated
You have injected yourself with drugs using a contaminated syringe or needle
You have had blood, bloody drainage, or saliva from the person with HIV/AIDS enter a cut or open area on your skin, mouth, or other body part
You have been injured by a sharp object like a razor or needle used by the person with HIV/AIDS
The last two items are rarely the reason for acquiring HIV.
If any of the conditions listed above occur, you may want to be tested for HIV. The results of this blood test may ease your mind. Often persons who have been exposed to the AIDS virus, in one way or another, may need to be tested again in 3 months. Having two negative test results over a 6-month period usually means that you have not been infected with HIV. If you are still worried that you may have contracted the virus, talk to the doctor or nurse about your concerns. about becoming infected with HIV/AIDS.
Prevent the spread of other infections to the person with HIV/AIDS
The person with HIV/AIDS has poor ability to fight off new infections because of his or her failing immune system. You, the caregiver, can help reduce the risk of exposing the person with HIV/AIDS to new infections.
If you have a cold, try to arrange for someone else to provide care.
Persons with HIV/AIDS are very susceptible to respiratory infections. If at all possible, try to arrange for someone else to provide care when you have a cold or other infection. If you cannot get someone else to provide care, be careful to avoid the person you are caring for when you are coughing, sneezing, or blowing your nose. Also, wash your hands after you cough, sneeze, or blow your nose. This will help prevent passing on the germs to him or her.
Keep other people who have infections of any type away from the person with HIV/AIDS.
Decrease the number of visitors during the flu season. Remember that children acquire infections easily from schoolmates and can transmit them just as easily to the person with HIV/AIDS. Children with infectious conditions such as colds, chickenpox, and ear infections should be kept away from the person with HIV/AIDS or should be cared for in the home of a relative until they are well.
Vaccinate against common problems.
Consider influenza and pneumococcal vaccinations for both the person you are caring for and for yourself. These vaccinations reduce the chance of catching the flu and pneumonia. (Consult with your doctor about these vaccinations because they can sometimes cause illness.)
Wash hands often.
It is important that both you, the caregiver, and the person with HIV/AIDS wash your hands frequently to prevent infections. It is especially important that you wash your hands after using the toilet, after having your hands in soil, after handling pets or their toys, and before, as well as after, preparing food. Also, keep fingernails clean and do not bite them.
Check with the doctor before having the children or adults in your home receive immunizations or booster shots.
Check with the doctor before having a child with HIV/AIDS receive immunizations or booster shots because these can sometimes cause illness. Also, check with the doctor before children or adults who live with a person with HIV/AIDS are vaccinated because they may "shed" vaccine strains of germs that could cause illness in the person with HIV/AIDS.
Use plastic and washable toys for children with HIV/AIDS and their friends who visit.
Encourage the person with HIV/AIDS to avoid using "recreational drugs" and having unprotected sex.
Needles, pipes, and other drug equipment can spread other infections to the person with HIV/AIDS, as can unprotected sex.
Discourage the person with HIV/AIDS from eating raw, unwashed fruits and vegetables, raw and undercooked meat, poultry, and fish, and from drinking unpasteurized milk.
Bacteria found in raw and undercooked foods can cause various infections in the person with HIV/AIDS. Wash meat, poultry, and fish before cooking, and clean off surfaces that they have touched. (See also the home care plans "Opportunistic Infections" [Chapter 4] and "Fever and Infection" [Chapter 5].)
Have household pets cared for by persons other than the person with HIV/AIDS.
Pet droppings contain high levels of bacteria and fungi that can be easily transmitted to the person you are caring for. (See also the home care plans "Opportunistic Infections" [Chapter 4] and "Fever and Infection" [Chapter 5].)
4. Possible Obstacles to Caregiving
Here are some attitudes, fears, and misconceptions that could prevent you from carrying out your plan:
"I can't take care of my son because I'm too afraid of getting AIDS from him."
Response: The AIDS virus is not spread by caring for someone with HIV/AIDS. Most often it is sexual contact or contact with the blood of a person with HIV/AIDS that spreads the virus. However, whether or not HIV/AIDS is transmitted through saliva is still unknown. Cooking, washing, cleaning, talking, touching, or helping the person with HIV/AIDS does not usually involve contact with blood or saliva, so these fears are usually unfounded.
"We've limited visitors in our home since my daughter came down with AIDS, because I would hate for a friend or neighbor to catch AIDS because of her illness."
Response: Visitors do not need to stay away and family members do not need to live in fear of contracting AIDS by simply being in the presence of someone who is HIV-positive or has AIDS. Have them read this chapter so that they understand how HIV/AIDS is spread.
Think of other obstacles
Identify additional roadblocks that could keep you from following the recommendations of this home care plan.
- Will the person I am caring for cooperate?
- Will other people help?
- How can I explain my needs to other people?
- Do I have the time and energy to carry out my plan?
You need to develop strategies for getting around roadblocks. Use the four COPE ideas (Creativity, Optimism, Planning, and Expert information) to help you to develop new plans. See pp 4-8 for a discussion on how to use the four COPE ideas in overcoming your obstacles.
5. Carrying Out and Adjusting Your Plan
Checking on results
Review this chapter regularly to be sure that you are doing everything you can to prevent the spread of HIV/AIDS and the spread of other infections to the person you are caring for.
What to do if your plan does not work
1. Review this chapter.
2. If you find that you have skipped something, try it now.
3. Ask the doctor for further guidance if you continue to be worried about spreading infections or the HIV/AIDS virus.
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