Every event of occupational HIV transmission can be analysed for the purposes of prevention into five key components:

• A failure to assess risk accurately.
• A failure to identify protective procedures and supply what infection control resources (such as sharps containers and disposable equipment) are needed.
• A failure to implement effective procedures.
• A failure to evaluate working practices.
• A failure to develop procedures in the light of new information.

Consequently, avoiding infection involves preparing to avoid or minimise these risks in appropriate ways.

Accurate assessment of risks

This involves:

• Identifying real risks.
• Reassurance about groundless fears.

Identification of appropriate procedures

This involves:

• Identifying ineffective precautions such as testing.
• Identifying appropriate barriers such as gloves, goggles, etc.
• Identifying procedure specific risk reduction practices, such as goggle use in orthopaedic surgery.
• Establishment of reporting procedures for accidents in order to identify trouble spots.
• Identifying appropriate disinfection procedures. These will normally have three components: pre–cleaning/decontamination so there is no visible contamination; safe disposal of sharps and other disposable materials; and chemical or heat sterilisation of re–usable instruments, materials and surfaces.
• Identifying precautions to prevent accidents, such as avoiding the practice of re–sheathing needles.
• Identifying care procedures following accidents.

A strategy for the implementation of procedures

This involves:

• A commitment to planning and implementing universal precautions by managers: this can easily be subverted through reasons of cost, difficulty of implementation and monitoring, or failure to accept the necessity of universal precautions.
• Identifying the implications for existing working practices.
• Addressing resource implications: whether or not precautions are universally observed, the introduction of equipment with the best possible safety features, such as automatic safety devices, should be part of such a programme. However it should not be seen as a substitute for procedures.
• Training for all: studies consistently show that the failure to practise universal precautions is often the result of a lack of training.

Monitoring and review

This is to ensure compulsory precautions for all situations. Even after training, there is often a failure to practise the precautions for the reasons noted above. Strict monitoring of precautions, and the support of senior staff is necessary to ensure their successful adoption.

Development

This will involve:

• Keeping up-to-date with the scientific literature.
• Regular `refresher' courses and sessions for existing and new staff.
• Assessment and evaluation of the success of procedures.
• Infection control guidelines in developing countries.