Simple precautions can shield home caregivers from HIV

The first thing you should know is that the chance of contracting HIV by caring for someone at home is extremely small. More than 361,000 Americans have AIDS, many of whom require home care. And yet only eight instances have been documented where HIV may have been transmitted from one person to another in a household setting.

HIV cannot live outside body

How, then, can you get HIV?

To answer this question, you should consider it as two separate problems.

First, in what body fluids is HIV found?

How HIV enters your body

• through a needlestick, if the needle is contaminated with blood from a person with HIV;
• by sharing a toothbrush or razor with someone with HIV, since both can cause tiny breaks in the skin, through which blood can enter;
• through any other break in the skin, including open sore, cuts, abrasions, scrapes, or oozing rashes;
• through mucous membranes, including those of the eyes, nose, and mouth.

To be safe, you can adopt a few simple routines to use when you are caring for someone with AIDS, says Mike Tanner, RN, MN, AIDS health services coordinator of the Visiting Nurse Health Systems in Atlanta. These rules are known as "universal precautions" because they apply to every conceivable situation in which HIV, or any other germs someone with AIDS might carry, could be transmitted, Tanner explains.

• If it's wet and it's not yours, wear gloves.

• If it spews or splatters, wear goggles, and shut your mouth.

According to Caring for Someone with AIDS, there are a few additional steps you should take:

• Cover any breaks in your skin when you might come into contact with blood or blood-tinged fluids.
• Handle hypodermic needles with extreme care. Pick up used needles by the barrel only. Never attempt to remove a needle from the barrel, and never recap a used needle. Always place used needles into a puncture-proof container (a coffee can will do). Discard the container before it is overflowing. Keep it out of the reach of children, in a place where it will not get knocked over.
• Do not share a toothbrush of a razor with a person who has HIV.
• To clean spills, including blood or other body fluids, make a solution containing one part household bleach, or Clorox, with 100 parts of water (for example, one tablespoon bleach per quart of water). Use this to clean reusable gloves as well as spills. Discard it after 24 hours, and make a fresh solution.
• Wrap all bandages and wound dressings in plastic garbage bags and put into the regular trash, unless your local sanitation department says you must follow additional steps.
• Launder clothes and wash dishes as you normally would. Linens should be washed in hot soapy water using one cup of bleach per normal load and dried in the hot cycle. Linens soiled with blood and body fluids should be separated from other linen, which can be washed as usual.

Diet: An Important Ingredient

Caregivers must thwart infections

• Avoid being around someone with AIDS if you have a cold, flu, or stomach flu.
• Make sure all your childhood immunizations are up to date. Check with your doctor; some of the shots may not have been available when you were a child.
• If you or someone in the household must have a polio shot, let your doctor know that you are caring for someone with AIDS. There is a special form of polio vaccine you should take to protect the person with AIDS.
• If you or someone in the house has chicken pox or shingles (also called herpes zoster), you or that person should avoid being in the same room as the AIDS patient until all the chicken pox or shingles have crusted over completely.
• If you or someone else accidentally exposes a person with AIDS to shingles, chicken pox, or measles, tell your doctor within 24 hours. There is a special shot that may help the person with AIDS not to get sick.

For the same reasons that they are more susceptible to disease, people with AIDS must be especially careful about eating food contaminated with harmful bacteria. Always take sensible precautions when you prepare food for a person with AIDS. Cook or pasteurize all food that comes from animal sources. This means:

• thoroughly cook all fish, shellfish, and other kinds of meat;
• never offer unpasteurized milk;
• never serve anything with raw eggs.

Avoid cross-contamination of food by using a separate cutting board and utensils to prepare raw meat. Disinfect utensils and countertops thoroughly.

A person with AIDS can have other infections besides HIV. By adopting the recommendations listed below, along with the "universal precautions" listed previously, you will be safe from these other infections.

• If people with AIDS are exposed to tuberculosis, they are more likely than others to get TB. Be alert to signs of TB; have a doctor check a person who has a cough that lasts more than a week of two.
• People who have contracted HIV by sharing needles may have hepatitis. If the person you are caring for has hepatitis or carries it, tell your doctor. There may be a vaccine to protect you.
• Some AIDS patients have viral infections caused by one of the herpes family of viruses. These viruses include those that cause cold sores, genital sores, and chicken pox (which causes shingles in an adult). If a person with AIDS has sores around the mouth, you should avoid touching or kissing the person around the mouth.

VITAE worldwide AIDS prevention effort