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I J Pre Clin Dent Res 2014;1(3):42-47July-SeptemberAll rights reservedInternational Journal of Preventive &Clinical Dental ResearchManagement of HIV/HepatitisDr Ashish Vyas , Dr Deepika Vyas ,Patients in Oral andDr Divya Parakh , Dr Rajan Rajput ,Dr Utpal Mazumdar , Dr ChandniMaxillofacial SurgeryPurohit123456AbstractObjective: Hepatitis B virus (HBV) and Human ImmunodeficiencyVirus (HIV) remain the greatest threat to dental team which has highchances of unknowingly encountering patients who are infected withHIV/ and Hepatitis B virus. The present review is an attempt to collectand concise the information available on prevention and post exposureprophylaxis as a ready reference for the clinician.Key WordsHuman immunodeficiency virus; hepatitis B virus; post exposureprophylaxis; vaccination; preventionINTRODUCTIONHealth-care personnel (HCP) are defined as personswhose activities involve contact with patients orwith blood or other body fluids from patients in ahealth-care, laboratory, or public-safety setting.[1]The potential exists for blood and body fluidexposure to other workers, and the same principlesof exposure management could be applied to othersettings. An exposure that might place health carepersonnel at risk for HIV infection is defined as apercutaneous injury (e.g., a needle stick or cut witha sharp object) or contact of mucous membrane ornon-intact skin (e.g., exposed skin that is chapped,abraded, or afflicted with dermatitis) with blood,tissue, or other body fluids that are potentiallyinfectious.[2] The first published article related toAquired Immuno Deficiency Syndrome (AIDS) wasin 1981 by Michael Gottlieb. In 1982, the termAcquired Immune Deficiency Syndrome is used forthe first time. The name was designated by theCentre for Disease Control (CDC). Despiteadvances in therapy, the median survival followingthe diagnosis of AIDS is approximately two years.1Assistant Professor, Department of OralSurgery, Jodhpur Dental College and Hospital,Jodhpur, Rajasthan, India2Post Graduate Student, Department. ofPreventive & Community Dentistry, VyasDental College and Hospita, Jodhpur,Rajasthan, India3Post Graduate Student, Department. ofPreventive & Community Dentistry, VyasDental College and Hospita, Jodhpur,Rajasthan, India4Assistant Professor, Department of OralMedicine& Radiology, Jodhpur Dental Collegeand Hospital, Jodhpur, Rajasthan, India5Professor & Head, Department of OralSurgery, Jodhpur Dental College and Hospital,Jodhpur, Rajasthan, India6Tutor, Department of Oral Surgery, JodhpurDental College and Hospital, Jodhpur,Rajasthan, IndiaThe etiology of hepatitis was not identified until the1960 and only following the subsequentdevelopment of laboratory markers for infectionwas its significance as a major cause of morbidityand mortality worldwide fully appreciated. [3] Thedramatic increase in HIV/ Hepatitis cases and theircontinued poor prognosis has resulted in greatconcern regarding the risk of transmission ofdisease from patients to health care workers, hencemaking the precautionary measures an importantaspect of everyday care.PRECAUTIONSTOPREVENTTRANSMISSION OF HIV[4]Universal PrecautionsAll health-care workers should routinely useappropriate barrier precautions to prevent skin andmucous-membrane exposure when contact withblood or other body fluids of any patient isanticipated. Gloves should be worn for touchingblood and body fluids, mucous membranes, or nonintact skin of all patients, for handling items orsurfaces soiled with blood or body fluids, and forperforming venipuncture and other vascular access

43Management of HIV/Hepatitis patientsVyas A, Vyas D, Parakh D, Rajput R, Mazumdar U, Purohit CTable 1: Table1: Disinfectants and their Uses, Advantages and es(CIDEX )Alcohols(iso propyl alcohol)Iodophors(betadiene vantagesVerylimiteduseaschemisterilantActive in presence ofGaseousformusedtoorganic materialsdecontaminate laboratory safetycabinetsNoncorrosive to metalActive in presence of2% formulationshigh levelorganic materialdisinfection for heat sensitiveSterilization may beequipmentaccomplished in 6-10hoursIntermediate level disinfectantDisinfect thermometers, externalsurfaces of some equipment (e.g., Fast actingstethoscopes).No residueEquipment used for home health Non stainingcareUsed as a skin antisepticLow level disinfectant for hardsurfaces and equipment that doesnot touch mucous membranes(e.g., IV poles, wheelchairs, beds,call bells)Low level gesCarcinogenicToxicStrong irritantExtremely irritating and toxic to skinand mucous membranesShelf life shortens when diluted(effective for 14-30 days dependingon formulation)High costVolatileMay harden rubberdeterioration of gluesIntoxicatingorcauseCorrosive to metal unless combinedwith inhibitorsInactivated by organic materialsRapid actionMay stain fabrics and syntheticRelatively free ofmaterialstoxicity and irritancyNote: Antiseptic iodophors are NOTsuitable for use as hard surfacedisinfectantGenerallynonDO NOT use to disinfect instrumentsand irritating to handsLimited use as disinfectant becauseUsually have detergentof narrow microbiocidal spectrumpropertiesHigh level disinfectant oscopesHigher concentrations used aschemisterilantsStabilized hydrogen peroxide(0.5%) is used a high levelsurface disinfectantprocedures. Gloves should be changed after contactwith each patient. Masks and protective eyewear orface shields should be worn during procedures thatare likely to generate droplets of blood or otherbody fluids to prevent exposure of mucousmembranes of the mouth, nose, and eyes. Gowns oraprons should be worn during procedures that arelikely to generate splashes of blood or other bodyfluids. Hands and other skin surfaces should bewashedimmediatelyandthoroughlyifcontaminated with blood or other body fluids.Hands should be washed immediately after glovesare removed. All health-care workers should takeprecautions to prevent injuries caused by needles,Strong oxidantCan be corrosive to aluminum,Fast actingcopper, brass or zincBreaks down into Surface active with limited ability towater and oxygenpenetratescalpels, and other sharp instruments or devicesduring procedures; when cleaning used instruments;during disposal of used needles; and when handlingsharp instruments after procedures. To preventneedle stick injuries, needles should not berecapped, and must be purposely bent or broken byhand, or removed from disposable syringes, orotherwise manipulated by hand. After they are used,disposable syringes and needles, scalpel blades, andother sharp items should be placed in punctureresistant containers for disposal. Although salivahas not been implicated in HIV transmission, tominimize the need for emergency mouth-to-mouthresuscitation, mouth- pieces, resuscitation bags, or

44Management of HIV/Hepatitis patientsVyas A, Vyas D, Parakh D, Rajput R, Mazumdar U, Purohit CTable 2: Disinfectants Product and recommended useS. No.123Intended useCleanup blood spills*Surface Disinfection**Instruments/surfaces contaminated with infective tissue***Disinfectant0.5% Sodium hypochlorite0.1% Sodium hypochlorite2.5 to 5% Sodium hypochlorite* Contact time at least 10 minutes.** Contact time at least 5 minutes. Wet surface with bleach solution and allow drying.***Contact time 1 hour, then rinse. Instruments require sterilization following disinfection.Table 3: Recommendation for postexposure prophylaxis for percutaneous or permucosal exposure to Hepatitis B(HB) virusTreatment whenVaccination and antibodyTreatment when source is notHBsAg seropositivesource is HBsAgstatus of exposed persontested or status is unknownnegativeHepatitis B ImmunoglobulinInitiate HB vaccineUnvaccinated(HBIG*) 1 and initiate HBInitiate HBseriesvaccine seriesNo treatmentPreviously vaccinatedNo treatmentNo treatmentIf known high-risk source, treatKnown responder†HBIG* 2 or HBIG* 1 andNo treatmentas if source were HBsAgKnown non responderinitiate revaccinationpositiveTest exposed person for antiTest exposed person for antiHBs:HBs:Antibody response unknown If adequate,† no treatment;No treatmentIf adequate,† no treatment;If inadequate,† HBIG 1 andIfinadequate,†initiatevaccine boosterrevaccination*Dose 0.06 mg/kg IM.†Responder is defined as a person with adequate serum levels of anti-HBs ( 10 mIU/ml); inadequate vaccination defined as serum anti-HBs 10 mIU/mlother ventilation devices should be available for usein areas in which the need for resuscitation ispredictable. Health-care workers who haveexudative lesions or weeping dermatitis shouldrefrain from all direct patient care and fromhandling patient-care equipment until the conditionresolves.Precautions for Dentistry[4]In addition to wearing gloves for contact with oralmucous membranes of all patients, all dentalworkers should wear surgical masks and protectiveeyewear or chin-length plastic face shields duringdental procedures in which splashing or spatteringof blood, saliva, or gingival fluids is likely. Rubberdams, high-speed evacuation and proper patientpositioning, when appropriate, should be utilized tominimize generation of droplets and spatter.Handpieces should be sterilized after use with eachpatient, since blood, saliva, or gingival fluid ofpatients may be aspirated into the handpiece orwaterline. Handpieces that cannot be sterilizedshould at least be flushed, the outside surfacecleaned and wiped with a suitable chemicalgermicide, and then rinsed. Handpieces should beflushed at the beginning of the day and after usewith each patient. The same precautions should beused for ultrasonic scalers and air/water syringes.Blood and saliva should be thoroughly and carefullycleaned from material that has been used in themouth (e.g., impression materials, bite registration),especially before polishing and grinding intra-oraldevices. Contaminated materials, impressions, andintra-oral devices should also be cleaned anddisinfected before being handled in the dentallaboratory and before they are placed in the patient'smouth. Because of the increasing variety of dentalmaterials used intra-orally, dental workers shouldconsult with manufacturers as to the stability ofspecific materials when using disinfectionprocedures. Dental equipment and surfaces that aredifficult to disinfect (e.g., light handles or X-rayunit heads) and that may become contaminatedshould be wrapped with impervious-backed paper,aluminum foil, or clear plastic wrap. The coveringsshould be removed and discarded, and cleancoverings should be put in place after use with eachpatient.STERLIZATIONAll form of sterilization will destroy HIV/ HBV.Methods of sterilization recommended by worldHealth Organisation (WHO) (2000a) are; a) steam(or moist heat) under pressure (eg. autoclave orpressure cooker); b) dry heat (such as an oven) or;