The Institute for Advanced Therapeutics, Inc

AN OVERVIEW FOR THE HEALTH CARE PROFESSIONAL 2ND Edition Florida Board of Massage CE Broker Provider # 50-1997 Florida Massage CE Broker Course Tracking #20-6753 NCBTMB Approved Provider #154019-00 Florida Dental CE Broker Provider # 50-1997 Florida Dental CE Broker Course Tracking # 20-6753

The Institute for Advanced Therapeutics, Inc. HIV/AIDS

AN OVERVIEW FOR THE HEALTH CARE PROFESSIONAL 2nd Edition

Consultant:

Mark D. Blum, D.D.S.

Research and Development:

Charles Edwin Cook, L.M. T., C.R.T.

Renee J. Demmery

Renee J. Demmery Copyright,  2005All Rights Reserved

2 HIV/AIDS

AN OVERVIEW FOR THE HEALTH CARE PROFESSIONAL 2nd Edition

Published By:

The Institute for Advanced Therapeutics, Inc. P.O. Box 848152 Pembroke Pines, Florida 33084 1-954-441-9553 tel 1-954-432-1824 fax

This course was developed to help expand the knowledge and skills of massage therapists with respect to the subject of HIV/AIDS. The information in this course has been derived from various professional sources including but not limited to Laws and Rules Chapter 480, Massage Practice, Florida Statutes published by Florida Department of Health Division of Medical Quality Assurance Board of Massage Therapy 2004, Laws and Rules Chapter 456, Health Professions and Occupations: General Provisions. Florida Statutes published by Florida Department of Health Division of Medical Quality Assurance Board of Massage Therapy 2004, and Rule Chapter 64B7, Florida Administrative Code published by Florida Department of Health Division of Medical Quality Assurance Board of Massage Therapy, 2004.

It is the responsibility of the massage therapist to determine which principles and theories contained herein are appropriate with respect to his/her personal limitations and scope of practice.

The information in this course has been carefully researched and is generally accepted as factual at the time of publication. The Institute for Advanced Therapeutics, Inc. disclaims responsibility for any contradictory data prior to the publication of the next revision of this course.

NOTE: In this book and test, the use of the words patient and client can be interchanged. In this book and test, the use of the words massage therapist, therapist, and practitioner can be interchanged.

The images used herein were obtained from IMSI's MasterClips® and MasterPhotos Premium Image Collection, 1895 Francisco Blvd. East, San Rafael, CA 94901-5506, USA.

3 TABLE OF CONTENTS

COURSE DIRECTIONS

MAILING INSTRUCTIONS

COURSE OBJECTIVES

WHAT IS HIV/AIDS?

PREVENTION

REDUCING RISK IN THE WORKPLACE

HIV/AIDS TEST

TEST ANSWER CARD/COURSE EVALUATION

REFERENCES

4 COURSE DIRECTIONS HOW TO BEST PROCEED WITH THIS COURSE

Each chapter should be approached systematically in a careful and objective manner. It is important to master each chapter before going on to the next. Relax, take your time, and go at your own pace. As 1 credit of continuing education is rewarded after successfully completing this course, the reading of this manual and completion of the test questions should not take less than 1 hour. Only after you have successfully mastered all the material in the course should you proceed to the test questions.

COMPLETING THE TEST Before beginning, please clearly write your name, address, zip code, and license number on your professional ethics test answer card. Read each question carefully before answering. Please use a #2 pencil to fill-in your answers on the answer card by completely shading your choice. Keep in mind that each question has only one correct answer. The test consists of 12 questions. For a passing grade, you must correctly answer 9 questions. We encourage your input and would welcome any suggestions to improve our course or test questions. Please feel free to note your suggestions or comments on the course evaluation found at the bottom of the test answer card.

INFORMATION FOR CERTIFICATION In order to receive your 1 hour of HIV/AIDS continuing education credit, you must be a registered purchaser of this course. Only one person per purchase of this course is eligible to receive credit. Please notify us of any address or name changes as we keep permanent records for certification and licensure.

MAILING INSTRUCTIONS Please send your completed test answer card/course evaluation to:

The Institute for Advanced Therapeutics, Inc. P .0. Box 848152 Pembroke Pines, Florida 33084

If you have any questions regarding this course, please contact our Customer Service Department at 1-954-441-9553 or fax us at 1-954-432- 1824.

5 COURSE OBJECTIVES

Upon completion of this course, you will be able to:

1. Understand how HIV/AIDS is acquired.

2. Recognize signs of early HIV infection.

3. Identify behavior known to increase risk of infection.

4. Learn ways to reduce risk in the workplace.

6 ? WHAT IS HIV/AIDS?

Acquired Immunodeficiency Syndrome (AIDS) has climbed to epidemic proportions worldwide. According to the Centers for Disease Control and Prevention (CDC), the cumulative estimated number of diagnoses of AIDS through 2003 in the United States is 929,985. Approximately 43,000 people contract HIV in the United States annually. Women are now accounting for approximately 25% to 40% of new cases of HIV infection in the United States. According to the Joint Nations Programme on HIV/AIDS, there are 39.4 million people estimated to be living with HIV/AIDS worldwide today. During 2004, there were an estimated 4.9 million new HIV infections globally. During 2004, an estimated 3.1 million people died worldwide as a result of AIDS. In the United States, men who have sex with men (MSM) are at highest risk for infection representing the largest proportion of new infections. Unfortunately, to this date, there is no cure and the disease is 100% fatal. As frightening as these statistics are, HIV/AIDS is largely preventable. HIV is a virus so tiny it can only be seen with a special electron microscope. The virus looks like a marble covered with spikes. As the virus enters the bloodstream, these spikes attach themselves to receptors on T-4 helper cells.

7 Next, the cell membrane begins to swallow the virus at the receptor site by fusing into the plasma membrane of the T-cell.

Once inside the T-cell, the virus tricks the T-cell into making copies of it’s HIV genes.

When the HIV copies finally leave the T -cell, thousands of copies of the original virus pop through the T -cell membrane and float into the bloodstream and eventually attach to other cells. This process causes the helper T -cell to die.

8 Since T-4 helper cells are responsible for producing many of the body’s immune responses, reduction of these cells results in opportunistic infections and loss of immune defenses – thus the name human immunodeficiency virus (HIV).

As the immune system weakens, the HIV-infected victim begins presenting with flu-like symptoms. In the early stages of the disease, many patients suffer from:

1. Fever.

2. Swollen lymph glands.

3. Fatigue.

4. Diarrhea.

5. Weight loss.

These symptoms then temporarily disappear and the patient feels much better. Months or years may go by before they begin to feel sick again. Unfortunately, as the virus spreads, patients become even sicker, develop more serious infections, and eventually die.

Normally, the human body has 1000 T cells per milliliter of blood. As T helper cells (CD4 cells) are destroyed, HIV eventually progresses to AIDS.

A diagnosis of AIDS is made by a physician using specific clinical or laboratory standards.

9 People with AIDS die from opportunistic infections caused by a weakened immune system. The following are a few conditions that often develop in people infected with AIDS.

1. Pneumocystis carinii pneumonia. 2. Kaposi’s sarcoma. 3. Extrapulmonary cryptococcosis. 4. Candidiasis of bronchi, trachea, lungs, or esophagus. 5. Tuberculosis. 6. Non-Hodgkin’s lymphoma. 7. Invasive cervical cancer. 8. Disseminated or extrapulmonary histoplasmosis. 9. Progressive multifocal leukoencephalopathy. 10. Toxoplasmosis of the brain. 11. Disseminated or extrapulmonary coccidioidomycosis. 12. Cytomegalovirus (excluding liver, spleen, or nodes).

10 PREVENTION

Education is the best prevention against the spread of HIV/AIDS infection. There are many behaviors that result in transmission of the disease. As HIV/AIDS is transmitted through blood and body fluids, avoidance of the exchange of these substances can help prevent the spread of infection.

There are several groups of people most at risk for HIV/AIDS based on their high risk behavior:

1. Homosexual men.

2. Intravenous drug users.

3. Prostitutes (male or female).

4. Hemophiliacs or those with coagulation disorders (via blood transfusions).

Homosexual men are considered at risk because of the tendency towards having multiple sex partners and engaging in anal intercourse. Lack of lubrication during anal intercourse can lead to micro-abrasions in the anal canal and on the penis allowing for easier admission of contaminated blood and/ or body fluids into the bloodstream.

Prostitutes are also at high risk because of multiple partners. This increases the chance of coming in contact with an HIV- infected individual. Prostitutes also have a tendency to be users of intravenous drugs and engage in anal intercourse. They also tend to have sexually-transmitted diseases that cause lesions thereby leaving an opening for the HIV virus to enter the body.

11 Intravenous drug users who share needles and syringes are at high risk of contracting HIV by inadvertently using blood-tinged syringes infected with the HIV virus. Also, the use of mind- altering drugs may inhibit good judgment leading to unprotected sex and other high risk behaviors.

Hemophiliacs and persons with coagulation disorders that have frequent blood transfusions increase the chance of receiving blood from an HIV-infected donor. This is becoming less likely, however, as donated blood is now tested for HIV among other diseases. Unfortunately however, the risk is still there because HIV-infected donors who have recently acquired the virus may not yet have HIV antibodies detected in the blood.

The following behaviors are considered low risk.

1. Sex with a limited number of partners.

2. Proper latex condom use along with spermicide containing nonoxynol-9.

3. Sex with partners testing negative for HIV.

4. The use of appropriate protective barriers among health care professionals who may come in contact with blood and/or body fluids.

The following are considered no risk behavior.

1. Sexual abstinence.

2. Avoidance of blood and/or body fluids of other individuals.

3. Mutual monogamy when both partners are HIV negative.

12 Some individuals may falsely believe that proper latex condom use completely eliminates the risk of HIV infection. While it may be true that latex condom use greatly reduces the risk of HIV transmission, condoms sometimes break, leak, or slip off during intercourse.

Another misconception is having one's sexual partner test negative for HIV completely eliminates the risk of contracting HIV. The truth is, newly infected individuals may test negative for HIV antibodies for up to several months after acquiring the virus. REDUCING RISK IN THE WORKPLACE

As health care professionals, there are precautions we can take to avoid infection. First, we must treat every patient as if they are HIV-infected. Many persons with HIV/AIDS do not exhibit obvious symptoms of the disease and may appear to be healthy. Precautions should even be taken with patients who deny being infected with HIV, as they may not realize they are infected or they may be concealing their disease for fear of discrimination.

THE BARRIER METHOD

Today, health care professionals have a wide variety of physical barrier devices available. These devices are designed to reduce or prevent contact with blood and/or body fluids of patients who may be infected with the HIV virus or other communicable diseases. Some examples of protective gear include:

1. Gloves.

13 2. Protective face shields or safety glasses.

3. Face masks.

4. Gowns and aprons.

Gloves should always be worn on practitioners with dry, chapped hands or cuts on the hands. Patients may have minute breaks in the skin which may allow for easy transfer of the HIV virus. Gloves should never be re-used. They should be removed by rolling them off the hands inside out and discarded in a container for infectious waste.

Contaminated gowns and aprons should be placed in an appropriately labeled covered container and undergo a sterilization process before being reused. The water temperature should reach at least 140° F. The heat generated in most dryers will usually be sufficient for decontamination.

Protective face shields or safety glasses prevent blood or body fluids from getting into the eyes, which is one of the most vulnerable openings in the body.

NEEDLES AND SHARP INSTRUMENTS

Needles and sharp instruments should be handled with care. Needles should never be recapped or transported out of the treatment room. They must be discarded in a puncture resistant container visibly labeled for biomedical infectious waste. Heavy duty gloves and appropriate face protection should be worn when giving patients injections or drawing blood.

14 DISINFECTION AND STERILIZATION

Before coming in contact with each patient, each health care worker should wash their hands with antibacterial soap and water. Soaps containing 4% chlorhexidine gluconate or 3% parachlorometaxylenol (PCMX) are considered the best. If unprotected skin should come in contact with a patient's body fluids or blood, a solution of 70% alcohol or povidone iodine (Betadine) is recommended to disinfect the skin.

If blood or body fluids should spill, disinfection can be accomplished using a solution of sodium hypochlorite (1 part household bleach to 99 parts water or 1/4 cup bleach to 1 gallon of water) prepared daily. Bleach, however, is corrosive to metals (especially aluminum) and should not be used to decontaminate medical instruments with metallic parts.

Gloves should always be worn during cleaning and decontaminating procedures.

Disinfect all equipment and surfaces in the workplace after contact with each patient using the above technique. Keeping a sanitary work environment will reduce the risk of HIV and other infectious diseases.

END OF COURSE

15 REFERENCES

1. Laws and Rules Chapter 381, Public Health: General Provisions, The 2004 Florida Statutes.

2. HIV/AIDS Surveillance Reports December 2003, Centers for Disease Control and Prevention.

3. “Laundry”. Division of Healthcare Quality Promotion, Issues in Healthcare Settings. November 2000.

4. “ Surveillance of Health Care Workers with HIV/AIDS”. Centers for Disease Control and Prevention. February 2002.

5. “Can I Get HIV From Oral Sex?” Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. December 2003.

6. “ Can I Get HIV From Vaginal Sex?” Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. December 2003.

7. “ Can I Get HIV From Anal Sex?” Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. December 2003.

8. “ How Effective are Latex Condoms in Preventing HIV?” Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. December 2003.

9. “Can I Get HIV From Kissing?” Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. December 2003.

10. “How is HIV Passed from One Person to Another?” Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. December 2003.

16 11. “How Does HIV Cause AIDS?” Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. December 2003.

12. “ Sterilization of Disinfection of Medical Devices: General Principles”. Division of Healthcare Quality Promotion, Issues in Healthcare Settings. August 2002.

13. “What is HIV?” Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. December 2003.

14. “What is AIDS? What Causes AIDS?” Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. December 2003.

15. “Why Do Some People Make Statements that HIV Does Not Cause AIDS?” Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. December 2003.

16. “How Long Does it Take for HIV to Cause AIDS?” Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. December 2003.

17. “ How Can I Tell if I’m Infected with HIV? Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. December 2003.

18. “ Preventing Occupational HIV Transmission to Healthcare Personnel.” Centers for Disease Control and Prevention. Divisions of HIV/AIDS Prevention. February 2002.

19. “Sterilization of Disinfection of Patient-Care Equipment: HIV Related”. Division of Healthcare Quality Promotion, Issues in Healthcare Settings. November 2000.

17 20. “ Appendix A. Practice Recommendations for Health-Care Facilities Implementing the U.S. Public Health Service Guidelines for Management of Occupational Exposures to Bloodborne Pathogens”. MMWR Recommendations and Reports June 29, 2001 / 50(RR11);43-44.

21. “ Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis”. MMWR Recommendations and Reports. U.S. Department of Health and Human Services. June 29, 2001 / Vol. 50 / No. RR-11.

22. Larson, Elaine and 1992, 1993, and 1994 APIC Guidelines Committee Association for Professionals in Infection Control and Epidemiology, Inc. “APIC Guideline for Hand Washing and Hand Antisepsis in Health-Care Settings”. APIC, Inc. 1995.

23. “Exposure To Blood: What Healthcare Personnel Need To Know.” National Center for Infectious Diseases. Centers for Disease Control and Prevention. July 2003.

24. Joint Nations Programme on HIV/AIDS 2004. www.unaids.org.