HIV and Surgeon (UPLOADED).pptx

Lecture notes for medical students

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.

2. Surgical issues in hiv infection

3. Surgical issues in hiv infection Ethically and legally we cannot refused indicated surgical care of HIV patients.

4. Surgical issues in hiv infection Elective Caesarean section has been recommended in HIV-infected women with viral loads greater than 1000 copies/mL based upon evidence that it reduces the risk of neonatal transmission Organ transplantation in HIV-infected patients has become more common in the past few years with the advent of effective combination antiretroviral therapy and improvement in life expectancy.

5. Surgical issues in hiv infection I nformed consent O perative risk in HIV/AIDS patient Effect of operation on HIV disease.. O ccupational risk to the health care workers U niversal and specific precaution V ariations in operative technique E thics .

6. I nformed consent

7. I nformed consent AIDS patients that they are more prone to perioperative complications . HIV/AIDS patients fear social recognition and rejection and frequently request doctors to perform unnecessary surgery such as removal of ‘tell-tale’ cervical lymph nodes or parotidectomy for DILS. management of terminal HIV/AIDS patients. Some patients (and their families) refuse surgery in desperate situations (such as bowel perforation) as they want an end to the suffering .

8. O perative risk in HIV/AIDS patients

9. O perative risk in HIV/AIDS patients Mechanisms of unfavourable outcome I mmunosuppression , M alnutrition, Infections N eoplasms

10. Drug-drug interactions

11. Drug-drug interactions Protease inhibitors and non-nucleoside reverse transcriptase inhibitors have significant drug-drug interactions, and some agents are contraindicated for coadministration (eg, midazolam and ritonavir)

12. Antimicrobial Prophylaxis

13. Antimicrobial Prophylaxis Patients with advanced immune dysfunction should also be on appropriate antimicrobial prophylaxis for opportunistic infections.

14. Effect of operation on HIV disease

15. Effect of operation on HIV disease There are no data showing that major surgery influences HIV disease progression. Two case-control studies reported no difference between HIV-infected patients who underwent surgery and those who did not

16. O perative risk in HIV/AIDS patients

17. O perative risk in HIV/AIDS patients Patients with early HIV infection have an operative risk almost equal to HIV-negative patients. Advanced disease dictate that the magnitude of the surgery be scaled down to an acceptable and safe level .

18. Operative risk in HIV/AIDS patients Risk Assessment Best predictors are scores that measure general health such as ASA (American Society of Anaesthesiology) risk classes. Studies of the value of viral loads and CD4 counts (alone or in combination) in predicting operative morbidity and mortality did not produce conclusive results. These tests are not ideal for everyday practical use.

19. O perative risk in HIV/AIDS patients Risk Assessment best predictors are scores that measure general health such as ASA (American Society of Anaesthesiology) risk classes. Studies of the value of viral loads and CD4 counts (alone or in combination) in predicting operative morbidity and mortality did not produce conclusive results. These tests are not ideal for everyday practical use.

20. O perative risk in HIV/AIDS patients Risk Assessment There are some data suggesting an increased risk of atherosclerotic disease in HIV-infected patients. The surgical team needs to be knowledgeable about management of diabetes mellitus and dyslipidaemia, which are increasingly common in HIV-infected patients on long-term antiretroviral therapy.

21. O ccupational risk to the health care workers

22. O ccupational risk to the health care workers Transmission is by Needle-stick Injury.

23. O ccupational risk to the health care workers Factors affecting risk hollow Vs. opposed to a solid needle if the needle injury was a deep soft-tissue penetration, if there was visible blood on the needle, if the patient is in the early viraemia stage patient has advanced AIDS in case of prolonged exposure (blood inside a glove).

24. O ccupational risk to the health care workers If possible, postponing elective operations with the aim of starting the patient on antiretroviral medication In case of exposure, the post-exposure prophylaxis (PEP) should be taken as early as possible. It is wise for doctors to have a personal PEP kit readily available.

25. U niversal and specific precaution

26. U niversal and specific precaution Make these a way of life. All bodily fluids of all patients should be regarded as hazardous substances. Disposable equipment should be used whenever available. All patients should be encouraged to undergo HIV testing. We can’t force.

27. U niversal and specific precaution Protective eyewear , Gloves water-impermeable gowns Wearing two pairs of gloves reduces the risk of exposure, as 98% of blood from the penetrating needle will be removed. The ill-fated practice of ‘looking’ for the suturing needle with the index finger of the left hand is very irresponsible

28. Variations in operative technique

29. Variations in operative technique cutting with electrocautery. avoidance of hand-to-hand passage of sharps hands should never be used as tissue retractors . Laparoscopic surgery Natural orifice trans-endoscopic surgery (NOTES )

30. V ariations in operative technique Less invasive management of most surgical diseases is an ever-expanding spectrum, e.g. banding of haemorrhoids and varies, percutaneous drainage of abscesses and percutaneous ablations of tumours .

31. V ariations in operative technique Sharpness Surgery Cut with cautery Suture with stapler.

32. Safe suturing

33. Safe suturing Use curved needle. Takeout needle from pack with needle holder. Not with fingers. Pass needle to and fro between needle holder & thumb forceps without catching needle in hand.  Use thumb forceps in left hand during suturing .  Don’t catch needle while knotting. -

34. How to suture safely

35. HIV Transmission from Provider to Patient

36. HIV Transmission from Provider to Patient Provider-to-patient HIV transmission is therefore a possible but rare event . T he risk of HIV transmission from a HCW to a patient during a surgical procedure is between one in 2.4 million to 24 million .

37. HIV Transmission from Provider to Patient T he expert panel recommended allowing the surgeon to return to work with no restrictions on the types of procedures he performed, provided that the following criteria were met: Completion of instruction by infection control personnel regarding standard precautions Adherence to routine HIV RNA monitoring to confirm on-going viral suppression on antiretroviral therapy.

38. Prevent HIV IN OT Do’s Don’ts -Cut with cautery even skin. Handle sharps with instruments .   -Pass sharps to each other via kidney tray .   - Takeout needle from pack with needle holder. -Pass needle to and fro between needle holder & thumb forceps without catching needle in hand .   -Use thumb forceps in left hand during suturing .   -Use instrument for retraction. -Wear goggles during surgery .   -Throw sharps into sharp collector .   -Use skin stapler ., GI Stapler. -Wear gumboots in O.T .   -Report needle pricks to ART center .   -Soak used instruments in bleach before washing. -Watch “How to suture” on You tube channel of Dr. Pradeep Pande -Avoid knife. Do not Catch needle with hands   -Do not Pass sharps hand to hand .   -Do not Recap used needles . Do not Use straight needle for suturing .   -Do not Use hands for retraction . Don't - Takeout needle from pack with fingers

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40. Get this ppt in mobile

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