Disease transmission in a first-aid situation is an issue that concerns many people. Nowadays, people worry about the possibility of catching a disease while giving first aid. This is especially true as a result of the AIDS epidemic. Although this concern is understandable, the actual risk of catching a disease when giving first aid is far less than you may think.

Giving first aid does not mean that you will automatically catch a disease – in fact it is extremely unlikely.

The first guidelines on AIDS were developed for Red Cross and Red Crescent first-aid teams, in collaboration with the World Health Organization. The current guidelines are strengthening those that already exist at country level.

Hygiene practised at all times is the basic and best thing to do. Remember that disease transmission works both ways.

The guidelines do not represent any new procedures, but merely highlight the necessity of practising existing routine hygiene measures at all times, for example, hand washing (before and immediately after giving first aid) and using protective barriers (i.e., wearing gloves). It prevents microbial contamination of the hands, protecting both you and the casualty from cross-infection. This concern about hygiene and protection from infections applies in both directions: the first aider should not consider his or her own personal risk, but the risk that unhygienic practices pose to the person needing assistance. There could be cases when it is the first aider who is HIV-positive but, as long as he/she takes basic hygiene measures, he/she can give assistance in the same way as any other first aider.

Remember that disease transmission works both ways.

Messages about HIV and AIDS

To date, no cases of infection with HIV have been reported from any part of the world as a result of giving first aid. Very few cases have been reported on HIV transmission in health-care or research-laboratory settings, due to specific conditions (e.g., exposure to the blood of an HIV-infected patient as a result of needle prick). The decision on whether any treatment is necessary after the exposure to HIV depends on assessing how high the risk of infection is and how infectious the source of exposure is.

First aiders should realize that the HIV virus is fragile. Once outside the body, it does not usually survive for long, and is easily and quickly killed by heat or external use of household chemicals such as bleach (sodium hypochlorite), alcohol and other common disinfectants. Once it is killed, you cannot reactivate the virus by adding water. Unbroken skin provides a good barrier to prevent the HIV virus from entering the body.

The ways HIV is transmitted should be absolutely clear to you, so that you can inform others.

Ways in which HIV is transmitted Through unprotected sexual intercourse (man-woman, woman-man, man-man). Through infected blood and blood products (such as receiving blood or blood products contaminated with HIV, use of contaminated needles and syringes, or other equipment that draws blood). From an infected mother to her child before or during birth, and through breastfeeding.

The risk of infection by HIV through any other means is extremely low. In a first-aid situation in which the rescuer comes into contact with a person’s blood, there is a higher risk of being infected with other diseases, such as hepatitis-B, than with HIV.

Ways in which HIV is not transmitted Sweat, coughing or sneezing, saliva, tears, urine, vomit*. Food and water. Air. Human touch (hugging, shaking hands, etc.). Toilets. Clothes and bedding. Giving blood, when equipment is sterile. Insects.

Reminder of basic hygiene measures

In emergency situations that involve contact with body fluids, such as bleeding, the possibility of transmitting diseases exists. There are simple things you can do to minimize the risk of infection. There are basic procedures to be used consistently with everyone regardless of their health status.

Generic measures

Wash your hands with soap and water before and immediately after giving first aid.

Avoid contact (e.g., touching or being splashed) with body fluids whenever possible and do not touch objects that may be soiled with blood or other body fluids. Be particularly careful when intervening in a violent situation.

Take care not to prick yourself with broken glass or any sharp objects found on or near the casualty, as well as preventing injuries when using, handling, cleaning and disposing of sharp instruments or devices.

Cover your cuts

As a matter of routine hygiene, cover any exposed cuts or other skin breaks with a waterproof dressing. For people with chronic skin conditions on their hands which cause open sores, it is best to avoid direct contact with any casualties who are bleeding or have open wounds unless clean gloves are available. In addition, hands must be washed before and after any action.

Protective barriers

Use protective barriers, such as disposable gloves or a clean, dry cloth, to prevent exposure to the victim’s blood and body fluids. The type of barrier used should be appropriate to the procedure being performed, the type of exposure anticipated and the material available. Examples of protective barriers include a piece of tissue, gloves, gowns, masks and protective eyewear. Gloves should reduce the incidence of hand contamination, but they cannot prevent penetrating injuries caused by needles or other sharp instruments, or bites. Unbroken gloves appear to be equally effective whether made of latex or vinyl. Change gloves between patient contacts, and do not wash or disinfect these gloves for reuse.

Specific areas of concern

First aiders must be particularly careful in the following situations:

giving mouth-to-mouth ventilation;
dealing with someone who is bleeding;
coming into contact with the casualty’s blood; and
cleaning up blood spills.

Mouth-to-mouth ventilation

It is a lifesaving procedure and should not be withheld through fear of contracting HIV or other infections. HIV transmission from mouth-to-mouth resuscitation has not been reported. Although it has never been substantiated, there is a theoretical risk that HIV could be transmitted if the person in need of resuscitation is bleeding from the mouth.

Use a clean cloth or handkerchief, when available, to wipe away any blood from the person’s mouth. It is part of the normal way to ensure clearing airways.

Rigid masks, mouthpieces, resuscitation bags or other ventilation devices should only be used by people specially trained to use them (e.g., Red Cross and Red Crescent first-aid teams). These special devices are not recommended for use by general first aiders as incorrect use may lead to further injury and bleeding or incorrect artificial ventilation procedure.

People who have bought mouth covers, face shields or similar equipment, would be unlikely to carry them at all times, on the remote chance that they may need to resuscitate someone. Furthermore, their use should be demonstrated during the first-aid training, and requires regular refresher courses (every year for example).

The absence of such equipment is not a valid reason to withhold mouth-to-mouth ventilation.

Dealing with someone who is bleeding

A person who is bleeding requires immediate action. The first aider must not hesitate to help him/her as some bleeding may be life-threatening. Safe handling of blood in a first-aid situation does not require ‘space suits’ or excessively high levels of protection. What is required is basic hygiene, a few basic precautions and good common sense.

Instruct, whenever feasible, the person bleeding to apply pressure to the wound himself or herself.

If he or she is unconscious, confused or uncooperative, or if the wound is too large or severe, or is located in a place the person cannot reach, apply pressure to the wound with a clean thick cloth, clothes or another barrier, avoiding direct contact with blood. Gloves could be used if available. However, since bleeding may be life-threatening, the absence of such barriers cannot be used as a reason to withhold first aid.

If you have been in contact with the casualty’s blood

If your hands are contaminated with blood, you should take care not to touch your eyes or mouth. Hands should always be washed with soap and water as soon as possible after stopping the bleeding.

If your eyes, nose, mouth or other skin surfaces are splashed by the casualty’s blood or body fluids, wash thoroughly with soap and water as soon as possible.

If you are injured by a sharp object that is contaminated with blood, you should encourage bleeding, wash the wound thoroughly with soap and water and, if appropriate, apply a dressing. To determine whether further action is required, the injury should be assessed for the type and the severity of the wound and for the extent to which the wound may be contaminated with blood.

If, after giving first aid, you are concerned that you have been in contact with infection of any sort, seek further medical advice.

Spilt blood should be soaked up with absorbent material such as a cloth, rag, paper towel or sawdust, direct skin contact with the blood being avoided. The blood-soaked absorbent material should then be disposed of in a plastic bag, burnt in an incinerator or buried.

Cleaning up blood spills

The area contaminated with the blood should then be washed with a disinfectant (preferably sodium hypochlorite (household bleach) diluted 1 part of bleach to ten parts of water (to give 0.1 – 0.5 per cent available chlorine) to clean up remaining blood.

Use general-purpose utility gloves (e.g., rubber household gloves) for housekeeping chores involving potential blood contact and to clean and decontaminate materials or devices. Utility gloves may be decontaminated and reused but should be discarded if they are peeling, cracked, discoloured, or if they have punctures, tears or other evidence of deterioration. If gloves are not available, use another barrier such as a large wad of paper towels or clothes, always to avoid direct skin contact with the blood.

Hands should always be washed with soap and water after cleaning up blood or other body fluids.

Cleaning clothes contaminated with blood

Clothes or cloths that are visibly contaminated with blood should be handled as little as possible. Rubber household gloves should be worn if available, and the clothes or cloths should be placed and transported in leak-proof bags. They should be washed with detergent and hot water (at least 70°C for 25 minutes); or, if in cooler water (less than 70°C), with a detergent suitable for cold-water washing. If washing is not possible, the clothes have to be burned or buried.

Be aware of and apply the policies for defining, collecting, storing, decontaminating and disposing of waste, determined by institutions in accordance with state and local regulations related to waste management.

Conclusion

Following these guidelines decreases your risk of getting or transmitting an infectious disease. Remember always to give first aid in ways that protect you and the victim from disease transmission.

Many people are excessively worried about remote or theoretical risks of contracting AIDS, such as the risk from giving first aid. At the same time, they may not think about the real risks they run because of, for example, inappropriate sexual behaviour. First aiders should be encouraged to focus on the real risks they may face and consider changing their behaviour if necessary.

To refuse first aid to someone in need because of the remote, theoretical risk of HIV transmission is inconsistent with Red Cross and Red Crescent principles.

Do not try to guess who might be infected. People infected with HIV may look and feel well. Treat everyone with the same high standards of assistance and respect.