E-drug: Training, healthcare and HIV transmission
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[The HIV & needles controversy continues to generate debate. I am
pleased. Cross-posted from HIF-net at WHO / SIGNpost. With
thanks. HH]
I am attaching [below] a letter recently submitted to the International
Journal on STD and AIDS about the non-sexual transmission of HIV.
A group of Canadian researchers with colleagues in Nigeria, have just
submitted an application to study the prevention of nosocomial
transmission of HIV, HBV and HCV (and other organisms) in
hospitals, including in operating rooms. I bring the poster [1] and
letter to your attention because they are directly and indirectly related
to surgical training.
Sincerely,
Bernadette Stringer
Assistant Professor
Department of Epidemiology and Biostatistics
Faculty of Medicine and Dentistry
University of Western Ontario, London, Ontario, Canada
e-mail: bstringe@uwo.ca
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March 12, 2003
Re: Mounting anomalies in the epidemiology of HIV in Africa: cry the
beloved paradigm. Int J STD AIDS 2003; 14:144-147.
Dear Editor,
Do no Harm.
Controversy generated by the literature review regarding modes of
HIV transmission in Africa reminded me of the story about the 19th
century medical community's initial reaction to Florence Nightingale's
epidemiological assertions that conditions in her Crimean hospital
were the cause of much mortality. Similar outrage and denial seems
to have greeted these researchers, when in fact, the message should
be viewed as rather hopeful.
As a former infection control practitioner who was inspired by
Nightingale's life to become an epidemiologist, it is clear to me that
reducing nosocomial infection caused by reuse of dirty needles and
other activities of healthcare providers, is a much less daunting task
than changing the sexual behavior of an entire population.
While African health care systems have their own particular
conditions, we have many worldwide examples of successful infection
control programs that could be adapted to those conditions. If these
researchers are correct, then the methods to end a significant route
of African HIV infection suddenly become relatively obvious.
As well, HIV, HBV and HCV "travel together" so to speak. In my
research on prevention of operating room transmission of bloodborne
pathogens, through the use of a work practice (hands-free technique
[1]) it has become clear that accident prevention, occupational health
and medical errors (transmission related to contaminated needles)
are part of the same continuum. The possibility that a significant
portion of the African HIV epidemic may be attributed to the same
general area says to me that it is time that the medical community
takes another good hard look at one of our first principles: Do no
harm.
Bernadette Stringer
[1] HFT poster is available to 'HIF-net at WHO' subscribers from
<bstringe@uwo.ca>
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