Intended for healthcare professionals

Rapid response to:

Letters

Labour care of women with HIV infection

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7206.381a (Published 07 August 1999) Cite this as: BMJ 1999;319:381

Rapid Response:

Adoption of "task related" precautions is recommended

Editor - Chamberlain and Steer (authors' response BMJ 319 382) have
highlighted a "fact of life" of safe practice in maternity care, namely
the widespread selective adoption, and indeed definition of "Universal
precautions" not just against HIV but other transmissible viruses.

Whereas
plastic aprons and gloves are generally adequate for protection in all
"statica spill situations, this is not true when there is a "dynamic" risk
of splashing and spraying in a frequently uncontrolled fashion. Most care
given to a woman in labour has only to cope with static spills.However,
during delivery of the baby and especially of the placenta (and its
examination and disposal) together with episiotomy, perineal repair and
indeed any procedure carried out in the lithotomy position body fluid loss
is highly dynamic- inspection of the spectacles worn by a perineal
operator will often confirm this! Both the Dept of Health and the Royal
Colleges recognize this in recommending the adoption of "task related"
precautions, with a view to avoiding all personal contact with blood.It
is,however,widely true that managers and clinical staff rationalize
avoidance at the time of delivery and the third stage of appropriate
universal precautions (especially mucous membraneprotection with eye
shield or spectacles and face mask and including gowns for forearm
protection) in situations that they consider "normal". The public accepts
that dentists now wear eye shields,masks and gloves.The "universal"
adoption of proper and sensible precautions only for the actual delivery
and third stage would in no way de-personalize a relationship built up
during the preceding hours of labour; nor would it impose the tedium and
discomfort of a "space suit".
Similar considerations apply to the containment and decontamination of
blood spills on furniture and floor, currently often inappropriately
managed unless the case has been labelled "high risk".

C.N.Hudson, Emeritus professor, Dept of Obstetrics & Gynaecology
St Bartholomew's & the Royal London School of Medicine & Dentistry

Chamberlain G & Steer P (1999) Auhors' reply BMJ 319 382
UK Health Depts (1990) Guidance for Clinical Health Care
Workers:protection against infection with HIV and Hepatitis viruses. HMSO

Working Party Report(3rd)HlV Infection in Maternity Care &
Gynaecology (1997) RCOG

The author was Chairman of the working party which produced the multi
-disciplinary report endorsed hy the Royal Colleges of
Midwives,Pathologists Paediatrics & Child Health and Anaesthetists.

Competing interests: No competing interests

10 August 1999
C N Hudson