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Health care settings with guidelines and practices for prevention of accidental HIV transmission

Export Indicator

Percent of health care facilities in a facility survey that have guidelines to prevent nosocomial transmission of HIV, adequate sterilisation procedures, and surgical gloves in stock
What it measures

As HIV prevalence rises among patients seen at health facilities, the danger of accidental transmission of HIV between health care provider and patient or from one patient to another also rises. This transmission may occur because of improper sterilisation or careless disposal of supplies or equipment that have come into contact with body fluids, or through accidental injury with equipment during surgery or routine care. The risk of accidental transmission can be reduced by the routine use of surgical gloves in all caring functions, by the proper sterilisation of medical equipment, and by careful handling, storage and disposal of equipment. This indicator gives an idea of the proportion of health care facilities meeting these minimum conditions for the reduction of accidental transmission of HIV.

Rationale
Numerator

Number of randomly selected primary, secondary and tertiary healthcare facilities surveyed, which have guidelines to prevent nosocomial transmission of HIV, adequate sterilisation procedures, and surgical gloves in stock

Denominator

Total number of health facilities surveyed

Calculation
Method of measurement

In a survey of randomly selected health facilities at the primary, secondary and tertiary levels, service providers are asked to show written guidelines for avoiding the accidental transmission of HIV. A stock check is also carried out for surgical gloves and sterilisation equipment. Sterilisation practices should be observed to see that they conform with these guidelines. In the absence of written guidelines, sterilisation practices should conform to national (and, failing that, international) standards. If there is no opportunity to observe sterilisation practices, health workers can be asked. Such interview data are more likely to be biased. Those facilities with written standards on safe practices, with adequate sterilisation practices and with surgical gloves currently in stock form the numerator of the indicator. Facilities that do not score positively on all three conditions are not included in the numerator. The denominator is all facilities surveyed.

Measurement frequency
Disaggregation

Education: N/A

Gender: N/A

Geographic location: N/A

Pregnancy status: N/A

Sector: N/A

Target: N/A

Time period: N/A

Type of orphan: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator has the virtue of being relatively easy to construct during routine health facility surveys undertaken for the monitoring of care and support services. This is an indirect measure of the risk of HIV transmission in health care settings. The existence of guidelines does not necessarily mean that the guidelines are routinely followed. Nor does the presence of gloves mean that gloves are always worn in situations where their use could minimise HIV transmission. Indeed, in some settings where the risk of transmission is low, service providers deliberately avoid wearing gloves in order to avoid stigmatising HIV-positive patients. The extent to which practice conforms to existing guidelines will be reflected in the score on the sterilisation component, which is measured through observation of practice against a checklist derived from local, national or international standards. A record of actual incidents carrying a risk of HIV transmission – for example, needlestick injuries, gloves ripped during surgery – might give a more direct measure of risky practices in health care settings. However, experience suggests that completeness of reporting of such events varies widely. In countries where HIV is both common and highly stigmatised, service providers frequently choose not to report injuries because of policies enforcing HIV tests for those affected. (These tests are often required as a precursor to providing postexposure prophylactic treatment with antiretrovirals.) Reported accidents also fail to reflect the danger of transmission between patients. For programme purposes, the indicator should be disaggregated by component, as well as by level of health facility.

Further information