This PowerPoint presentation provides tips and guidelines for safely performing surgery on patients with HIV/AIDS. It discusses obtaining informed consent and assessing patient risk. Precautions like using protective equipment and safe sharps handling are emphasized. The presentation also addresses minimizing occupational risk to healthcare workers and variations in surgical techniques for enhanced safety. Key points covered include the low risk of provider-to-patient HIV transmission if precautions and antiretroviral therapy guidelines are followed.

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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
• Informed consent
• Operative risk in HIV/AIDS patient
• Effect of operation on HIV disease..
• Occupational risk to the health care workers
• Universal and specific precaution
• Variations in operative technique
• Ethics.

6. Informed consent

7. Informed consent
1. AIDS patients that they are more prone to
perioperative complications.
2. 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.
3. 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. Operative risk in HIV/AIDS
patients

9. Operative risk in HIV/AIDS
patients
Mechanisms of unfavourable outcome
• Immunosuppression,
• Malnutrition,
• Infections
• Neoplasms

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. Operative risk in HIV/AIDS
patients

17. Operative 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. 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.

20. Operative 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. Occupational risk to the health
care workers

22. Occupational risk to the health
care workers
• Transmission is by Needle-stick Injury.

23. Occupational 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. Occupational 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. Universal and specific precaution

26. Universal 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. Universal 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. Variations 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. Variations in operative technique
• Sharpness Surgery
– Cut with cautery
– Suture with stapler.

32. Safe suturing

33. Safe suturing
1. Use curved needle.
2. Takeout needle from pack with needle
holder. Not with fingers.
3. Pass needle to and fro between needle
holder & thumb forceps without catching
needle in hand.
4. Use thumb forceps in left hand during
suturing.
5. 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.
• The 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
• The 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
-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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