STATEMENT ON AIDS AND THE UNIVERSITY

1. Introduction
2. Transmission of the Human Immunodeficiency Virus
   2.1 Transmission by Blood
   2.2 Transmission during Sex
   2.3 Transmission at Birth
   2.4 Summary of the current situation
3. Implications for non-infected Staff or Students
   3.1 Ordinary Social Contact
   3.2 Contact with Blood
   3.3 The use of Human Blood and Tissues in Practical Classes and Research Laboratories
   a) Practical Classes
   b) Research Laboratories
   c) Risk to Clinical Students during Training
4. Students and Staff infected with HIV
   4.1 Students
   4.2 Staff
5. Precautions for Contact with Human Blood
   5.1 Choice of Technique
   5.2 Waste Disposal
   5.3 Accidents
   5.4 Disinfectants
6. Common Disinfectants for Hospital Use
   6.1 Phenolics
   6.2 Halogens
   6.3 Alcohols
   6.4 Aldehydes
   6.5 Emergency Decontamination of Instruments
7. List of Contact Points for Advice on AIDS and Related Problems
8. Notice - Precautions for Contact with Human Blood
   8.1 Precautions to Prevent Contact
   8.2 What to do after Accidental Contact with Human Blood

AIDS, or the Acquired Immune-Deficiency Syndrome, was first described in 1981, and itmerits its description as a pandemic disease with approximately half a million cases of "full-blown" AIDS (see below for definition) reported to the World Health Organization from 163 countries in 1991. However, statistics from 2006 reveal that the number of individuals infected has risen to approximately 39.5 million. Scientific progress has been remarkably rapid, with the discovery of the putative causative agent - human immunodeficiency virus (HIV) - in 1983-4 and the subsequent development of an antibody test to detect infection. We now know that AIDS (colloquially known as "full-blown" AIDS) is the end result of infection with HIV which causes progressive damage to the immune system. Initial infection sometimes causes minor indisposition, like glandular fever, but after recovery from this phase the virus persists and over 5-10 years (see below) the person loses the normal ability to resist infection or to control the development of tumours. Once this stage of the illness is reached the individual is said to have AIDS, and is likely:

1. to suffer from life threatening episodes of infection due to "opportunistic" micro-organisms, which are harmless to people with effective immune responses, and
2. to develop a variety of unusual malignant tumours.

HIV also infects the nervous system and may cause dementia. Laboratory tests for antibody to HIV in the blood become positive 6-8 weeks after infection and remain positive for the rest of the patient's life. Infective virus also persists in the circulation despite this antibody.

Although no cure has been found for AIDS, drugs such as zidovudine delay the progression of HIV, particularly in the later stages of the disease. Other treatments are available to prevent and control some of the more common opportunistic infections such as Pneumocystis carinii. Nevertheless, it appears that most individuals who are infected with HIV will progress to AIDS, and subsequently die of the disease. The figures in 1992 show that after 10 years of infection approximately 50% have progressed to AIDS. After a diagnosis of AIDS, median life-expectancy is about two years. Certain groups such as infants, people over forty, and residents of sub-Saharan Africa appear to have a quicker than usual progression to disease.

Although considerable progress has been made towards the development of a vaccine against HIV, many obstacles remain, and the most optimistic researchers do not anticipate a successful vaccine to be widely available in the next 5, or even 10 years.

Extensive epidemiological investigations have shown that HIV is transmitted by three major routes:

1. by blood
2. during sex and
3. at, or immediately after, birth.

In different countries the prevalence of the infection in particular sections of the population reflects the different social behaviours which carry risk of exposure to the virus.

2.1 TRANSMISSION BY BLOOD

This is the most efficient method of spread, particularly if the virus is inoculated directly into the bloodstream. In Australia blood transfusion had transmitted infection before effective screening of blood donations was instituted in 1985. Transmission of infection by blood, however, remains of great concern to:

1. recipients of contaminated blood or blood products in countries where screening of blood is not yet routine
2. injecting drug users, and
3. occasionally victims of accidental needle-stick injury, although the risk in the last category is small (see below).

2.2 TRANSMISSION DURING SEX

Any kind of penetrative sex including ordinary vaginal sex - with so-called "exchange of body fluids" carries a risk of transmission of the virus. Certain factors are known to increase the risk of transmission:

1. the practise of anal intercourse, particularly for the receptive partner
2. having a large number of different sexual partners
3. the presence in either partner of other sexually transmitted infections
4. and where the index case is particularly infectious (this occurs early in infection and late in infection).

2.3 TRANSMISSION AT BIRTH

HIV can be transmitted before birth (across the placenta), during the birth process, or after birth (through breast milk).

2.4 SUMMARY OF THE CURRENT SITUATION

The current situation in Australia (to the end of September 2006) can be summarised as follows: there have been 9, 940 cases of AIDS reported (with 6, 658 deaths) and there are 23, 065 people known to be infected with HIV. However, the actual number of people in both categories is likely to be much higher. Although at least 90% of infections world-wide are known to be transmitted via heterosexual intercourse, in Australia the most frequent diagnosis of AIDS or HIV infection ("prevalence") continues to be in homosexual/bisexual men, but new cases ("incidence") include not only the former group, but importantly, injecting drug users, their partners, and heterosexual persons. In all of these groups one of the most significant factors is risk taking sexual behaviour and the most reliable form of protection against sexual transmission is regular use of condoms. This cannot be over-emphasised in the context of a University campus where most persons are adolescents or young adults, a group often characterised by a new- found sense of independence, experimentation with sex and sometimes drugs, and a feeling of invincibility.

Although HIV has been found in saliva and tears, there is no evidence of HIV being acquired from transmission by these routes. There is no evidence of HIV being acquired via cutlery, crockery, the air, swimming pools, drinking fountains, sharing telephones or casual contact with AIDS patients or members of risk groups. Similarly, the risk of infection from mouth to mouth resuscitation is negligible unless local bleeding is obvious and there is no need to withhold emergency aid from any person in need of it.

3.1 ORDINARY SOCIAL CONTACT

Ordinary social contact such as that which occurs in lectures and practical classes, in the refectories and residential colleges, is not associated with a risk of transmission of virus from infected individuals. This is supported by studies in the USA and elsewhere of thousands of households of AIDS patients. Spread of the infection is confined to:

• sexual partners of the infected individual
• babies of infected mothers
• in the case of injecting drug users, those who share needles contaminated with their infected blood.

3.2 CONTACT WITH BLOOD

Contact with blood may occur following accidents or injuries, including sporting injuries on campus. Although infection from contact with HIV-infected blood in these circumstances is rare (if it occurs at all), cases of external bleeding should be handled carefully. For example, an injured player should not be allowed to continue in a game of `contact' sport until the bleeding has stopped, and all traces of blood removed. It should be remembered that infections such as Hepatitis B can also be transmitted through contact with infected blood. Such exposure to Hepatitis B virus carries a much higher risk of infection (up to 20%).

Section 5 summarises precautions which should be observed after blood contact.

3.3 THE USE OF HUMAN BLOOD AND TISSUES IN PRACTICAL CLASSES AND RESEARCH LABORATORIES

As an alternative to the use of animal experimentation in undergraduate courses, exercises using human tissue, particularly blood, have been devised. Other body fluids eg., saliva or urine are also obtained from students or patients. In addition, blood and tissue samples from volunteer staff, students and patients are used frequently in research laboratories.

(a) PRACTICAL CLASSES

• Blood: When patient blood samples are used, they shall be screened as for Blood Bank blood. To meet the standards required for blood transfusion, this means patient blood should be tested for syphilis, Hepatitis B and C, and HIV, prior to use in undergraduate classes. If student blood samples are used, individual students should use their own blood.
• Other tissues and body fluids: It is desirable that tissue samples be derived from patients who meet blood bank standards. 'Body fluids' such as urine and faecal samples do not pose a risk, unless they are visibly contaminated with blood.

(b) RESEARCH LABORATORIES
Infectivity risks of blood and tissue should be considered in developing research protocols and reference should be made to guidelines issued by the NSW Health Department in Policy Directive 2007_036 (23 May 2007): Infection Control Policy.

(c) RISK TO CLINICAL STUDENTS DURING TRAINING
These students will almost certainly encounter patients infected with HIV - some patients with disease and other patients without symptoms who are not yet known to be infected. Fortunately, contact of any health care worker with infected patients seems to pose little risk, even in the event of an inoculation injury involving blood from a patient with active disease. Thousands of health care workers in the USA who reported needlestick injuries involving HIV positive material have been followed prospectively for evidence of infection with HIV. Of those workers who did not already belong to conventional high- risk groups, only 0.3% (three per thousand) have been infected with HIV. This very small risk nevertheless implies that utmost caution needs to be taken in dealing with body fluids, especially blood. NSW Health Department Policy Directive 2005_311 (27 January 2005): Management of Health Care Workers Potentially Exposed to HIV, Hepatitis B or Hepatitis C gives information on the classification of exposures according to risk.
There have been rare instances of laboratory workers becoming infected in the absence of reported needlestick injury. These have all been in laboratories where HIV has been cultured in high concentrations (thousands of times greater than in nature), but still underscore the need for caution.

The opposite route of infection i.e. from an infected health care worker to a patient appears remote, and at time of writing has only been suggested in one instance. This case, widely reported in 1990, concerned a dentist with AIDS in Florida U.S.A., in which there is substantial scientific evidence that HIV was transmitted to at least five of his patients during a series of dental procedures. However, it is believed that in this instance, routine standards of hygiene were not observed in his surgery. Moreover, no further cases have been reported, even in hundreds of patients operated on by three surgeons known to have been infected with HIV.

Information on hospital policies for precautions to be observed when taking blood samples and handling infected secretions is available from hospital infection control staff and from OHS & Injury Management at the University of Sydney (see also Section 5). General guidelines are given in the NSW Health Department Policy Directive 2007_036 (23 May 2007): Infection Control Policy and specific guidelines for dentistry are given in the NSW Health Department Policy Guideline 2005_037 (27 January 2005): Infection Control Guidelines for Oral Health Care Settings.

HIV status of non-clinical students and staff is of concern to the University only in so far as the University is concerned generally for the health and well-being of all members of the University community. Nevertheless, in the case of clinical students/staff, the University follows the policy outlined in the documents entitled Health Care Workers Infected with HIV, Hepatitis B or Hepatitis C and NSW Health Department Policy Directive 2007_006 (1 February 2007): Occupational Assessment, Screening and Vaccination Against Infectious Diseases.

4.1 STUDENTS

Students who have been infected by the AIDS virus should not be excluded from any programme and can continue to attend classes. Students are expected in this instance to exercise their duty of care, particularly with respect to other students. In the case of clinical students, the onus is on the individual students to know their HIV status and comply with NSW Health Department requirements as set out in NSW Health Department Policy Directive 2005_162 (25 January 2005): Health Care Workers Infected with HIV, Hepatitis B or Hepatitis C and NSW Health Department Policy Directive 2007_006 (1 February 2007): Occupational Assessment, Screening and Vaccination Against Infectious Diseases.
These students are not obliged by law to inform the University of their condition.

4.2 STAFF

Staff who have been infected by the AIDS virus are not obliged to notify the University that they have been infected by the AIDS virus, nor may there be any general need for changes in their work activities. They should be particularly aware of the dangers to others of accidental transmission through blood from cuts and abrasions. The guidelines current in the teaching hospital or other unit, or those of their professional organisation should be followed by individuals involved in exposure prone procedures, as well as any advice from their treating physician (see NSW Health Department Policy Directive 2005_162 (25 January 2005): Health Care Workers Infected with HIV, Hepatitis B or Hepatitis C and NSW Health Department Policy Directive 2005_338 (27 January 2005: Occupational Screening, Assessment, Screening and Vaccination Against Infectious Diseases.)


When any member of staff becomes seriously ill because of the AIDS virus, the usual procedure regarding sick leave entitlements will apply. The appropriate leave application and accompanying medical certificate should be submitted. The Staff Office will advise, should retirement due to ill health be appropriate.

5.1 CHOICE OF TECHNIQUE

1. Procedures should be adopted that minimise the chance of accidental injury by needles and other sharp instruments. The most important are:
   - to avoid re-capping needles
   - the safe disposal of sharps.
2. Avoid contact with blood if your own hands or lower arms have open cuts, unhealed wounds or dermatitis. If contact with blood is even remotely possible, wear disposable gloves and protective gowns. If your eyes are likely to be splashed with blood, wear protective spectacles or goggles. Additional precautions may be needed in particular circumstances - seek advice from the Infection Control Unit in the institution concerned. At the conclusion of the procedure, wash down blood contaminated bench tops and other surfaces with disinfectant (household bleach [sodium hypochlorite] freshly diluted 1:5 in water is effective), discard gloves into contaminated waste bag, place protective clothing in contaminated laundry bag and wash your hands thoroughly with soap and water.

5.2 WASTE DISPOSAL

Place waste materials contaminated with blood or other body fluids in a plastic bag for contaminated waste, seal and label, then arrange for disposal or incineration through the usual procedure in place in your building.

Place sharps for disposal in designated containers for removal and/or decontamination through the usual procedure in your building.

Consult your local Infection Control Unit or OHS & Injury Management for further information on decontamination and disposal procedures for sharps and other contaminated wastes.

5.3 ACCIDENTS

Report any accident involving blood immediately to your supervisor or staff member in charge of the area or class where the accident occurs. For needlestick injuries involving blood, proceed to the University Health Service (in office hours), or nearest hospital casualty department (for example, Royal Prince Alfred Hospital or Westmead Hospital). This should be done without delay so the incident can be assessed and treatment offered within 24 hours if warranted.

All incidents are to be reported to OHS & Injury Management within 24 hours of the incident occurring.

See also NSW Health Department Policy Directive 2005_311 (27 January 2005): Mangement of Health Care Workers Potentially Exposed to HIV, Hepatitis B or Hepatitis C.

NSW Needlestick Hotline: 1800 804 823

5.4 DISINFECTANTS

Section 6 lists some commonly used disinfectants. The effectiveness of disinfectants depends on appropriate concentration/dilution and contact time for the concentration of protein encountered in the particular situation. If you require specific disinfection advice contact OHS & Injury Management (or your Infection Control Unit if you are located in a hospital).

N.B. Always check manufacturers' labels for instructions for use.

6.1 PHENOLICS

1. Examples and usage: clear-soluble phenolic compounds, white fluids; 1.5 % solutions; leave in contact for 1 hour.
2. Advantages and disadvantages: good general purpose disinfectants, not readily inactivated by organic matter, active against wide range of organisms (including mycobacteria), but not sporicidal.

6.2 HALOGENS

1. Examples and usage: hypochlorites (chloramine) eg "Milton", "Domestos"; bleaches. Strong (2% Cl) to weak (0.02% Cl) concentrations used according to degree of blood contamination; leave in contact for 30 minutes.
2. Advantages and disadvantages: cheap, effective, act by release of free chlorine, active against viruses and therefore recommended for disinfection of equipment soiled with blood (because of HIV and hepatitis risk), but rapidly inactivated by organic material and corrosive to metals.

6.3 ALCOHOLS

1. Examples and usage: ethyl alcohol (ethanol), isopropyl alcohol (isopropanol).
2. Advantages and disadvantages: good choice for skin disinfection and for cleaning surfaces, sometimes used in combination with iodine or chlorhexidine. Water must be present for bacterial killing (ie., 70% ethanol best). Isopropanol is preferred for skin and articles in contact with patient.

6.4 ALDEHYDES

1. Examples and usage: glutaraldehyde ("Wavicide", "Aidel"); 1% solution, leave in contact for 30 minutes.
2. Advantages and disadvantages: kills vegetative organisms including mycobacteria slowly but effectively. More active, less toxic than formaldehyde, sporicidal (within 6 hours when fresh), irritant, used in alkaline solution which is stable 1-2 weeks, expensive, limited use eg., disinfection of endoscopes.

6.5 EMERGENCY DECONTAMINATION OF INSTRUMENTS

As a routine, instruments such as scalpels and scissors are heat sterilised or decontaminated using non-corrosive disinfectants. In an emergency, decontamination can be achieved by soaking for 30 minutes in household bleach (which contains chlorine) at the concentration recommended on the label. However, this will seriously damage most instruments.

PDF version of the Disinfectants information for printing out as a handy reference.

UNIVERSITY HEALTH SERVICE
Wentworth Building G01
University of Sydney 2006
(02) 9351 3484

ALBION CENTRE HOTLINE
150-154 Albion Street
Surry Hills 2010
(02) 9332 4000 (8.00am to 6.00pm)
Freecall 1800 451 600

AIDS COUNCIL OF NSW
9 Commonwealth Street
Surry Hills 2010
(02) 9206 2000
Freecall 1800 063 060
ACON internet site

GAY AND LESBIAN COUNSELLING SERVICE OF NSW
providing a free, anonymous and confidential
telephone counselling, information and
referral service across NSW on sexuality
and life issues.

SYDNEY SEXUAL HEALTH CENTRE
Sydney Hospital
(02) 9382 7440
Freecall 1800 451 624

8.1 PRECAUTIONS TO PREVENT CONTACT

• Wear disposable gloves whenever contact with human blood is likely or possible. Avoid contact with blood particularly if your own hands or lower arms have open cuts or unhealed wounds.
• Handle and dispose of needles and sharp instruments correctly, eg don't re-cap needles; dispose of used sharps in sharps containers.

8.2 WHAT TO DO AFTER ACCIDENTAL CONTACT WITH HUMAN BLOOD

• Wash hands, lower arms and any other bodily parts in contact with, or splashed by blood. Thorough washing with soap and water is adequate.
• Rinse eyes gently but thoroughly with water while the eyes are open.
• If blood gets in the mouth, spit it out and then rinse the mouth with water several times.
• In the case of a needlestick injury involving exposure to human blood, proceed without delay to the University Health Service or nearest large hospital casualty department for risk assessment and treatment.
• Place blood-stained waste materials in a plastic bag and seal for disposal or incineration.
  In an emergency, instruments can be effectively decontaminated by soaking them for 30 minutes in household bleach. (See manufacturer's instructions on label for appropriate concentration for disinfection).
• Wipe down desks, equipment or other bloodied areas with cold tap water and then with household bleach (sodium hypochlorite) freshly diluted 1 to 5 with water.

PDF version of Notice for printing out as a handy reference.

NSW Health Department Policy Directive 2005_311 (27 January 2005): Mangement of Health Care Workers Potentially Exposed to HIV, Hepatitis B or Hepatitis C.

NSW Health Department Policy Directive 2007_036 (23 May 2007):
Infection Control Policy

NSW Health Department Policy Directive 2007_006 (1 February 2007): Occupational Screening and Vaccination Against Infectious Diseases.

NSW Needlestick Hotline: 1800 804 823

Authorised by the Vice-Chancellor (2/5/94) and endorsed by the Infectious Diseases Committee

Internet version revised and references updated: 27/02/0
Links updated: 06/06/05
By: Leanne Mumford
Revised and updated: 13 August 2007
By: Sean Gaudron