dr@cs.columbia.edu (06/29/90)
First off, I'm not sure what the purpose of this news group is, but I assume that questions re: AIDS/HIV in general are allowed. If not, sorry! Q1) If AIDS is so fragile that it requires intimate physical contact, and one cannot catch it via food, toliet seats, kissing, etc, how come IV drug users need to worry about infected needles that have been "repackaged". It seems to me that if a needle is sitting out for several days that the virus should be dead????? Summary -- how does AIDS survive in a needle outside of the body? Q2) I've seen reference to safer sex and safe sex. Which term is more appropriate? Obviously, no activity (sexual or otherwise) is completely safe (one can sneeze while driving and drive off a cliff.....), but is sex w/ a condom considered safe (assuming the condom is used correctly)? Q3) Has HIV been isolated in saliva? There seems to be some controversy about this issue. Q4) (final question) Recently I had a check up and had a standard blood test using a standard method of blood withdrawl (I think it's called a vacutainer). Basically, the technician (or doctor) takes a plastic container (cyllindrical (sp?) and tapered at one end) and inserts a needle into the tapered end. Both ends of the needle are sharp. Then, the technician removes the cap on the end of the needle which is sticking out and inserts it into the patient's vein. At this point, he/she presses a "vacuum-filled" test-tube on to the end of the needle which is in the plastic container. The "back-end" of the needle punctures the rubber seal on the test-tube that is maintaining the integrity of the vacuum. Blood is then sucked into the tube. When the tube is filled, the suction action is reduced, and the technician places a gauze pad over the wound and removes the needle. Basically, this procedure seemed to have three major flaws (two based on the actions of the particular technician with whom I dealt). One) The technician used an alcohol swab to clean the skin. Alcohol, although it probably will kill HIV on contact, does not necessarily kill hepatitis. Two) The technician rubbed the swab back and forth, instead of in the spiral motion (from the center outwards) which is standard sterile technique. Three) The technician wore the same pair of gloves for me as he did for the previous (and probably) subsequent victims. It protects him, but not us! Finally, the vacutainer container has been known to fill up with blood. However, these plastic tubes were re-used from patient to patient. How to improve the situation IMHO: 1) train technicians (and doctors/nurses) to put on new gloves with every patient. 2) Use iodine compounds to clean skin before taking blood (I was told that people can develop a sensitivity to iodine-compounds, maybe this is a problem) 3) Clean vacutainer tubes between uses in dilute chlorine bleach. I imagine that many people who draw blood not highly trained nor supervised. Of course I estimate that the potential danger to me, personally, is very low, even if an HIV infected person was immediately before me in line, when applied to an entire population it could be significant. Does anybody out there know of any studies documenting the effectiveness of vacutainers in preventing the spread of blood-borne diseases from patient to patient? Thanks for the information, Dave ---------------------------------------------------------------- David Robinowitz dr@beach.cs.columbia.edu Home: Bronx, NY (212) 601-1586 Research Staff Associate, Columbia University (212) 854-8348 Computer Science Department -- ---------------------------------------------------------------- David Robinowitz dr@cunixb.cc.columbia.edu Home: Bronx, NY (212) 601-1586 Research Staff Associate, Columbia University (212) 854-8348
Richard.DeWald@f70.n382.z1.fidonet.org (Richard DeWald) (07/02/90)
In an article of <29 Jun 90 06:27:11 GMT>, dr@cs.columbia.edu writes:
dA>Q1) If AIDS is so fragile that it requires intimate physical contact,
dA>and one cannot catch it via food, toliet seats, kissing, etc, how come
dA>IV drug users need to worry about infected needles that have been
dA>"repackaged". It seems to me that if a needle is sitting out for
dA>several days that the virus should be dead????? Summary -- how does
dA>AIDS survive in a needle outside of the body?
Addicts that share needles generally do so immediately. Technically, HIV
(Human Immunodeficieny Virus) does not "live" at all. We speak of virii as
"remaining viable" instead of living. A virus is just a protein-coated set of
chemical instructions for the "machinery" inside of a living cell to dutifully
carry out. These instructions generally focus on replication of the virus.
Specifically, HIV is a set of instructions for a specialized cell of the immune
system called a "T-cell" to carry out. This interrupts the normal work of that
cell, that causes the syndrome of illnesses we call AIDS.
The HIV virus seems to need the very narrowly-defined environment that is
present in the blood stream (or something as equally narrowly-defined that you
provide in a laboratory) in order to remain viable. HIV is very small, a very
little drop of blood is a relative great lake for the virus
dA>Q2) I've seen reference to safer sex and safe sex. Which term is more
dA>appropriate? Obviously, no activity (sexual or otherwise) is
dA>completely
dA>safe (one can sneeze while driving and drive off a cliff.....), but is
dA>sex w/ a condom considered safe (assuming the condom is used
dA>correctly)?
It is considered to be worth the risk, not absolutely safe, if you properly use
a condom. Forms of sexual intimacy that are less-likely to traumatize a condom
are considered "safer."
dA>
dA>Q3) Has HIV been isolated in saliva? There seems to be some
dA>controversy about this issue.
The controversy surrounds the viability of the HIV in saliva.
dA>technician with whom I dealt). One) The technician used an alcohol
dA>swab to clean the skin. Alcohol, although it probably will kill HIV on
dA>contact, does not necessarily kill hepatitis.
Neither of these virus strains would be present in a viable form on your
skin!!! The alcohol is used to kill BACTERIA and it does so rather
effectively, effectively enough for a needle stick. Only certain kinds of
bacteria are on your skin, those that can potenitially infect a clean needle
stick are instantly destroyed by alcohol.
dA>the swab back and forth, instead of in the spiral motion (from the
dA>center which is standard sterile technique.
Your technician was using what is known as "clean" technique, not sterile
technique. His or her technique is near perfect from the way you describe it.
dA>wore the same pair of gloves for me as he did for the previous (and
dA>probably)subsequent victims. It protects him, but not us!
The alcohol swab is to protect you.
dA>vacutainer container has been known to fill up with blood. However,
dA>these plastic tubes were re-used from patient to patient.
As long as the needles aren't used from patient to patient, this is acceptable
(if aesthetically displeasing) technique. None of the blood in the vacutainer
will ever get into a sample tube, or be introduced into the patient's
bloodstream, so what's the big deal. However, a dirty vacutainer would be
discarded just because no one likes to work with dirty equipment.
dA>1) train technicians (and doctors/nurses) to put on new gloves with
dA>every patient.
Generally we do. Phlebotemists generally leave their gloves on between
patients if they are sitting in one spot. Again, the gloves are to protect
them, you are correct.
dA>2) Use iodine compounds to clean skin before taking blood (I was told
dA>that people can develop a sensitivity to iodine-compounds, maybe this
dA>is a problem)
The needless greater expense is also a problem. Provodine (what you are really
referring to) scrubs are used if a needle is going to stay in place for any
length of time.
dA>3) Clean vacutainer tubes between uses in dilute chlorine bleach.
If we are referring to the same piece of equipment, what you are describing is
essentially a needle holder. It should be clean, but since it is never
introduced into a body and it shoudl never come into contact with bodily
fluids, it is not necessary to do anything other than keep it clean.
dA>I imagine that many people who draw blood not highly trained nor
dA>supervised. Of course I estimate that the potential danger to me,
dA>personally, is very low, even if an HIV infected person was immediately
dA>before me in line, when applied to an entire population it could be
dA>significant.
It doesn't take a rocket scientist to stick a vein. The ONLY danger you could
be in (rather than intense anxiety) from following an AIDS victim at the lab is
if the technician used the same needle. This is a mortal sin, this would lose
the facility it's license instantly and forever. If you ever see this happen,
you have an easy multi-million dollar lawsuit in your lap.
It is more likely that in your state of paranoia you didn't think this through
carefully enough. Your needle was sterile, your skin was clean. You were
safe.
dA>Does anybody out there know of any studies documenting the
dA>effectiveness of vacutainers in preventing the spread of blood-borne
dA>diseases patient to patient?
Vacutainers are designed to make taking blood samples from people easier. They
do not have as their mission the prevention of the spread of diseases.
Richard DeWald, BSN Student
Univ. of TX - Austin.
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