QUALITY STD CARE TRAINING MODULE
Item
- Title
-
QUALITY STD CARE
TRAINING MODULE - extracted text
-
(
QUALITY STD CARE
I
TRAINING MODULE
- Wi
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I
For Nurses & ANMs
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USAID
APAC project is administered by Voluntary Health Services, Chennai
with financial assistance from United States Agency for International
Development under bilateral agreement with the Government of India.
★★★★★★★
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APAC-VHS
Chennai
TRAINING MODULE
For
Nurses & ANMS
March 2000
AIDS Prevention And Control Project
Voluntary Health services
Contents
Page
Part -1
Sexually Transmitted Diseases (STDs)
7
Part - Il
HIV/AIDS
16
part - III
Sexually Transmitted Diseases and care
21
Part - IV
STD/HIV/AIDS - problems, misconceptions & beliefs
24
Part - v
Control Of STD/HIV/AIDS
28
Part - vi
Universal precautions
36
Part - Vll
Role of anms in std/hiv/aids control
40
Foreword
HIV/AIDS, the epidemic that is threatening the entire world, has also invaded India and
is widespread in most of the Indian states. This epidemic has seriously affected the state of
Tamil Nadu. The universal consensus is that Sexually Transmitted Diseases (STDs) form an
important co-factor in the transmission of HIV infections. While hiv/aids do not have a cure
now, most of the STDs are curable. To control the spread of hiv/aids infection, the aids
Prevention And Control Project (APAC) of Voluntary Health Services has initiated multi
pronged interventions, of which prevention and control of Sexually Transmitted Diseases
forms an integral part.
The anms and nurses have a major role to play in the control of std/hiv/aids. They Can
integrate the control measures of std/hiv/aids with their routine nursing activities by
imparting health education and counselling to STD patients, referring the patient and
his/her partner to qualified medical practitioners, stressing the importance of taking
complete treatment and explaining the need for use of condom concomitantly with
treatment. Having realised this role of ANMs and nurses, APAC project of vhs had come
forward to train the anms and nurses in Quality STD Care and the purpose of bringing out
this anm module is to fulfil their training requirements.
The Tamil version of the anm module was well received and had good impact on the
nursing communities who are being trained by APAC project's Continuing Education and
Training Centres. There had been a consistent demand for an English version of this module
from ANMs/nurses working in the bordering areas of Tamil Nadu and hence we have
brought out this English module to cater to their needs.
We are thankful to tnvha for their initial efforts in bringing out this module. This
module was updated in association with apac project by Dr. vasantha Elango of PSC
institute of Medical science and Research (PSCISMR) and Dr. Ravi Raj William of Christian
Council for Rural Development and Research (CCOORR). Our thanks are due to Dr. Rani
Kandasamy, Principal, Govt. College of Education, Vellore for translating this module from
the original Tamil script.
Dr. Bimal Charles
Project Director
APAC Project
*
5
PART - I
sexually Transmitted Diseases (STDs)
introduction
Sexually Transmitted Diseases (STDs) have been in existence from time immemorial. With
the advent of hiv/aids, stds have gained more importance. They are not only dangerous
but also pose a challenge for effective delivery of health care services. This part of the
module deals with stds in general, their modes of spread and effective measures to
control them.
Are STDs common diseases?
♦
Contrary to public opinion, STDs are common diseases affecting all sections of the
society.
Why do we say that they are common diseases?
STDs have been found to occur both in villages and in the cities
♦
They affect both males and females
♦
An STD infected expectant mother passes on the infection to the baby
STDs are transmitted to men and women through sexual intercourse
in Tamil Nadu, out of every 100 adults, 9.7 are affected by STDs.
Are STDs becoming more common now-a-days?
Yes. The number of people infected with STDs is increasing all over the world. There are
many reasons why STD is becoming more common:
7
♦
Nowadays, many people travel frequently to far
off places, in these places, their Identity is not
known.
This
anonymity
creates
more
opportunities and more temptations to have
sexual relations with strangers.
*
Girls and boys attain maturity and become
sexually active at young age. Nowadays, many
youths go for higher studies resulting in late
marriages. Therefore, there is a wide age gap
between attaining maturity and marriage. Very
often, youngsters live outside their home during
higher education. All these factors tempt many
unmarried young people to have more social and
sexual contacts.
♦
Nowadays, very often, both parents are employed
and are away from home. They do not have
enough time to counsel their children about sex.
These uncared children indulge in unhealthy sex
practices.
♦
The easy availability of money to the young also
predisposes the youth to experiment with
different types of sexual encounters.
♦
8
♦
The free availability of pornographic films and
books, especially among the young people,
stimulates their sensations and contributes to
more sex and STDs.
Many youth feel compelled by their friends to
experience sexual encounters before marriage.
They feel this will prove that they are fit for
marriage. Having many sexual partners is also
something some men would like to boast about.
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♦
Many teenage boys and young men experience
'wet dreams'. Many of them also masturbate at
this age. Both these are normal phenomenon.
However, these men are often led to believe that
this can weaken their system. They are therefore
advised sexual intercourse to counter this
weakness.
Many untrained persons give inadequate and
improper medicines to treat STDs. Many people
buy medicines directly from the shops.
Therefore, the STD conditions of many may not
be fully cured and as a result, STDs are increasing.
9
There are many reasons why STDs remain hidden. Some of these
reasons are:
♦
At times STDs may not cause signs and symptoms;
especially in women. Men who mostly exhibit
signs get treated while women who have STDs
may not have clear visible signs and they cannot
do self examination of their genital parts and
hence remain untreated.
♦
Health workers and patients are often very shy to
discuss anything related to the genitals.
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♦ The signs and symptoms of STD are usually not
visible to others. Therefore, usually one does not
worry about being detected by others,
consequently, the disease gets neglected, and
the treatment gets postponed as much as
possible.
c
♦
There is a fear that if one is detected to have STD,
he/she will be labelled as one with 'low or loose
morals'.
♦
The "decision-makers" at home i.e., the mothersin-law, grand mothers, and elders often prevent
younger women from reporting STD symptoms.
9
10
♦
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Similarly, symptoms of STD are considered to be a
result of ’heat' and as 'normal' to that particular
lifestyle or occupation (eg. lorry/bus drivers feel
that the heat from the engine is what that causes
the symptoms).
Many women feel that any discharge from their
genitals is "normal". They therefore do not
complain about it. They do not see the need for
treatment for it.
Because of the social stigma attached to STD,
people often go to traditional practitioners, as
they believe in traditional remedies, and these
practitioners usually do not reveal the identity of
cases harbouring STDs.
♦
*
There is a firm belief that STDs occur only among
the very poor, uneducated and socially backward
classes of people. They believe that people from
so-called "good" families do not get STDs.
They believe that "clean" girls do not transmit
STDs. Hence, sexual relations with "clean" girls will
not lead them to sexually transmitted infections.
♦
People do not die immediately of sexually transmitted diseases. Hence STDs are not
considered very important by the patient or the health worker.
«
11
How are STDs spread?
♦
There are may types of germs which cause STDs. These germs live in a person who has STDs.
♦
STDs are spread when an infected person has unprotected sexual intercourse with
another person. Sexual intercourse may be of different types.
♦
Even one single unprotected sexual contact with an STD infected person is sufficient to
cause STD.
♦
Young ones born to STD infected mothers have greater risk of contracting the disease.
Syphilis and HIV infections are transmitted from the mother to the child.
♦
in case of blood transfusion, the blood should be tested for hiv, syphilis, Hepatitis-B
infections, in the absence of such a screening, there is the risk of transmission of these
diseases through infected blood transfusion.
STDs are not spread by:
Shaking hands
Eating or drinking from
the same plate or glass
Swimming or bathing
together
Using public toilets
Playing together
insect bites
Hugging or kissing
Sharing of clothes
(except underclothes)
Dancing together
Coughing or sneezing
12
»
Who gets STD?
Anyone and everyone can get STD.
♦
Anyone who indulges in unsafe sexual behaviour is at risk of getting STDs.
Unsafe sexual behaviour is having sexual intercourse with multiple partners, without
using condoms.
unsafe sexual behaviour is also having sexual contact with single known infected
partner without using condoms (the spouse remains infected as long as he/she is not
fully treated)
♦
STDs are not restricted only to those with so-called high-risk behaviours.
♦
A person with high risk behaviour (eg. a person with multiple sex partners) may pick up
the infection and he/she will spread the STDs to his/her partner, who may not have the
same behaviour.
Persons at risk of getting STDs
Commercial sex workers
Clients of commercial sex workers
♦
Men whose jobs involve frequent travels and are lured into sexual indulgence
♦
People who indulge in unprotected sexual intercourse with multiple partners
13
Women are more prone to STDs than men. The important reasons
could be
Due to the hidden nature of the reproductive organs of women, the symptoms are
revealed much later or not at all, and naturally if at all they seek treatment they do so
at a late stage. STD lesions in women are asymptomatic in 50% of the cases.
White discharge is considered natural and women are ignorant that some of the white
discharges could be STDs.
Many women may not have the facility of separate toilets/bathrooms to examine
themselves.
What physical damages do STDs cause?
STDs cause a lot of damage which is often not noticed
STDs begin with signs such as ulcer, discharge, sometimes associated with pain.
They also can cause long term complications.
Abortion, birth of a still born child or death of
the child after delivery, are common in women
with STDs.
The child may be born with severe eye infections.
This can cause permanent blindness to the child.
Congenital syphilis of the new born is another
complication.
14
e
Women harbouring certain STDs may suffer from
chronic pain in the lower abdomen. Ectopic (outof-place) pregnancy is also common. This can lead
to rupture of the tube and result in death of the
mother. STDs may cause infertility in many
women. STDs may also cause cervical cancer.
certain STDs cause urethral
infertility in men also.
stricture and
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Are there any other ill-effects?
Besides physical damage to the body, STDs can lead to serious social problems.
STDs may lead to marital discord. Women may suffer
from beatings, divorce or abandonment on account of
the symptoms or because of infertility.
Remember
Anyone who indulges in unsafe/unprotected sexual behaviour is at risk of getting STDs.
Even a single unsafe/unprotected sexual contact is sufficient to cause STD. Mutually faithful
couple will not get this disease.
15
Part - Il
Human immuno-Deficiency Virus (HIV)
&
Acquired immuno-Deficiency Syndrome (AIDS)
innumerable diseases affect mankind worldwide. The most commonly spoken disease of
this century is a sexually transmitted disease called aids, it is a fast spreading disease not
only in India but throughout the world. The first AIDS case in India was registered in
Mumbai in 1986. in the same year, the first HIV positive case was also registered in Chennai.
Since then, the number of infected persons has been rapidly increasing, in this section of
the module, you will come to know more about HIV/AIDS.
Status of hiv/aids in Tamil Nadu
350000
300000 250000 200000 -
150000 -
100000 50000 0 -J—
I
I
1988
1990
1996
1994
1992
1998
2000
2002
1988
1990
1992
1994
1996
1998
2000
2002
-O-H.I.V
43
3014
23721
76589
153566
232141
294996
337108
-□-AIDS
0
7
243
2362
10793
30968
65781
113474
0
4
147
1608
8111
25053
56158
100897
DEATHS
16
hiv/aids and stds
hiv/aids and STDs are related in many ways. There are many misconceptions about the way
these diseases are related. The facts are that,
♦
HIV infection is also an STD. in fact, it is becoming one of the most fast spreading STDs
worldwide.
in Sept.- oct. 1997, apac-vhs had undertaken a research study, it was on the prevalence of
STD/HIV/AIDS in Tamil Nadu. The research findings revealed that 1.8% of men and women in
the age group 15-45 years have hiv/aids infection. This is also prevalent in the rural areas.
Is there any relationship between HIV/AIDS and STD?
♦
AIDS is also an STD. in fact, it is now one of the most common and fast spreading STDs.
♦
75% of hiv/aids cases in India have spread through sexual route, in addition, hiv/aids is
also transmitted through HIV infected blood transfusions, HIV infected needles,
syringes and instruments, and from HIV infected mother to the child.
♦
A person with STD is five to nine times more likely to acquire HIV infection while having
sex with HIV infected person. This is because the presence of an ulcer or wound caused
by the STD makes it easier for the HIV to enter the person's body.
♦
There is no complete cure for AIDS. However other STDs can be treated.
♦
Effective and timely treatment of STD will reduce HIV transmission.
HIV - The AIDS causing virus
AIDS is caused by a virus known as HIV - "human immuno deficiency virus". HIV is not visible
to the naked eye or under ordinary microscope, it belongs to the family of Retro-viruses.
There are two types of human immuno deficiency virus: HIV Type 1 and HIV Type 2. Both
types are prevalent in India. However, Type 1 is more frequently reported. HIV
Type 1 is a more virulent pathogen than Type 2.
17
How HIV affects the human body
The virus, after entering the human body, infects a certain variety of white blood corpuscles
called lymphocytes. White blood corpuscles are the soldiers that fight against infections, in
the human body. When HIV disables or destroys the white blood cells, the immune system
gets damaged allowing other infective organisms to enter the human body. This leads to
opportunistic infections of different kinds and cancer, ultimately resulting in death.
>
HpM envelope
P18
P24
RNA
3
0
Reverse
Transcriptase
Glycoprotein G P
120
Different stages of the disease
The following table describes the different stages of the disease:
Window Period
6 weeks - 3 months from the day of infection
Latency Period/HIV infection
From the day of infection to the
manifestation of symptoms
AIDS
2 to 10 years from the day of
infection
The period between the entry of Hiv into the body
and the appearance of their antibodies in the blood is
termed window period
HIV has entered the body. Antibodies
are also present in the blood. But there
are no symptoms of the disease
The blood is positive when tested.
Symptoms of opportunistic
diseases also manifest.
The patient is negative to Hiv tests like ELISA and
western Blot during this period
The patient is positive to hiv tests
during this period
HIV positivity persists.
Lymphocytes decrease in
number
The patient transmits the disease to
others through his/her activities
Advanced stage of disease
resulting in death
All universal precautions are to be
observed while handling body fluids
especially the blood
Take necessary precautions
while disposing off the dead
bodies
The patient transmits the disease to others through
his/her activities
Even though patients undergoing Hiv tests report Hiv
negative during this period, all precautions should be
taken while handling body fluids especially their blood
18
<
Symptoms of AIDS
Important symptoms:
♦
Over 10% weight loss without any specific reason.
Persistent fever for over a month
Persistent diarrhoea for more than a month
Other symptoms:
♦
Persistent cough for over a month
♦
Swelling of lymphatic glands
Skin diseases
♦
candidiasis of mouth, throat or other parts
Routes of transmission
♦
unprotected sex with an hiv infected person
Transfusion of HIV infected blood
From an Hiv infected mother to her baby
♦
intravenous drug users sharing needles with an hiv infected person.
Use of Hiv contaminated needles/syringes.
Blood Product
Infusion 0.8%
*
Spouse
infection
1.3%
I
Homo
sexual 0.7%
Blood
transfusion 6.9%
Others
■
4 ft.
Hetro-Sexual
■>- intercourse 73.1
-
ivd user 8.2%
19
High risk behaviours
people with multiple sex partners
People who have sexual contact with commercial sex workers.
Men who are away from their families for long periods (eg: lorry drivers) are lured into
sexual indulgence.
intravenous drug addicts sharing their needles
Homosexual males.
20
Part - ill
Sexually Transmitted Diseases and Care
*
introduction
A clear knowledge of STDs is essential to provide the necessary information and care to the
patients of stds.
Some important information about STDs
♦ STD is "NOT A single disease" - There are many STDs.
♦ Different STDs are caused by different germs - virus, bacteria, fungi
♦ STDs appear in different forms:
V
Some present as ulcers
Some present as discharges
some present with burning sensation while passing urine
Some present as inguinal swelling
■®" Some present as painful scrotal swelling
STDs do not show up easily in women because of their partly concealed genitalia. STDs In
females could also be present as genital discharge. Many women do not seek treatment in
the early stages of genital discharge. Only when the discharge is persistent, and copious,
they may report for medical treatment.
»
STDs - their classification
Though there are more than 25 different STD conditions, only some of them are more
prevalent. They could be classified as follows by their symptoms:
♦ urethral discharge in the male
♦ vaginal discharge in the female
21
Genital ulcers - both male and female
inguinal swelling/abscess - male and female
Lower abdominal pain in females
Painful scrotal swelling in male.
The first four groups are more prevalent. The other two symptoms may appear in other
diseases also, besides STDs.
Urethral Discharge in male
♦
IT
Pus/white discharge from penis appears a few
days after sexual intercourse with an infected
person.
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Burning and pain while passing urine.
Vaginal Discharge in female
Excessive white discharge
itching in the genitals
f®?
Burning and pain while passing urine
Burning and pain during intercourse
Genital ulcers in male and female
Ulcers appear from a few days to few weeks after sexual intercourse
♦
Single painless ulcer appears without any symptoms and disappears after a few days.
Multiple, painful ulcers appear on the genitals.
♦
Associated painful swellings on either side of the groin.
22
«
inguinal swellings
A few days after sexual intercourse, swelling on
either side of the groin appear which may rupture
and present as ulcers/abscess.
-
Lower abdominal pain in female
If treatment is not taken for abnormal white
discharge, vaginal ulcers, etc., the reproductive
organs get affected causing chronic pain in the
lower abdomen.
Painful scrotal swelling
If treatment is not given for urethral discharge in
the males, it leads to painful scrotal swelling.
Referral and counselling
The STD patient should be immediately referred to a trained doctor for
treatment
Sexual partners of STD patients should also be referred for treatment
They should be counselled on the importance of taking complete treatment
The need for use of condom to prevent STD infection should be emphasised.
23
Part ■ iv
STD/HIV/AIDS - Problems, Misconceptions and Beliefs
introduction
Several baseless myths, misconceptions and beliefs about disease exist in our
country. These are the barriers for disease control. It is therefore important that the ANMs
have a knowledge of these, in order to effectively tackle the problem.
Misconceptions/Beliefs
-f
STDs gets cured without medical treatment.
Drinking lime juice will clean the uterus and also
cure diseases of the reproductive system.
washing the genital organs with lime juice
prevents STDs.
hiv/aids
is spread only by commercial sex
workers.
/
Having sexual contact with a girl who does not
have any symptoms of STDs will not cause STDs.
1
Having sex with a virgin will cure STD.
Treatment can be stopped as soon as the
symptoms disappear.
Men should not see used sanitary napkins, if they
happen to see, it will have evil effects.
All white discharges in women are normal; they
require no treatment.
24
/
/
9
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♦
A single sexual contact will not lead to pregnancy or cause STD infection in women.
♦
if treatment is taken for an STD once, it will not occur again even after unprotected sex.
♦
White discharge is a woman's fate.
♦
white discharge will weaken the body.
♦
ulcer in the female genital organ will get cured on its own.
♦
Reproductive diseases like white discharge/other
discharges are caused by "heat" due to working
in the hot sun or travelling or driving for a long
distance.
♦
White discharge is caused because of copper-T
fixation.
♦
Ulcer in the genital organ is caused by 'evil eyes’.
♦
Tubectomy or use of contraceptive like the loop affect the uterus leading to excessive
haemorrhage and foul-smelling white discharge.
Socio-cultural problems
4
♦
Double standards in society: men governed by separate code - behaviour of men having
sex with several women affect health of their spouses
♦
Since women get married earlier than men, women are more susceptible to STDs in
their early age itself.
♦
women are dependent on other members of the family. They have no money or right
to take decision. They have to get others' consent. They are controlled by the husband
and mother-in-law.
♦
Backwardness of women in education and experience contributes to their ignorance
of the diseases and their symptoms.
♦
ignorance of the importance of early appropriate treatment
25
♦
Wife has no right to question the husband. She is afraid of disclosing her disease. She
is afraid of questioning him about his disease for fear of the family being neglected by
him. She is afraid of the mother-in-law.
♦
Women have no right over their own body. They cannot insist on the husband using
condom during intercourse. Neither can they insist him to seek treatment for his
ailment.
♦
if the husband is an alcoholic, it is all the more difficult for the wife to question him for
fear of getting beaten up. Since she needs his earnings to run the family,
she bears everything patiently.
♦
Economic dependence and family burden force some women into prostitution.
Problems in seeking/offering treatment
♦
Delay in seeking the required, proper treatment
♦
They do not go to qualified medical doctors.
♦
They do not complete the full course of treatment
♦
They do not bring their partners for treatment
♦
There is no follow-up and so doctors do not know the progress of the disease or any
other problems that may arise during treatment.
♦
STDs are not a single entity disease but a group of diseases. Each disease condition has
specific treatment of its own and investigation procedures, ignorance of this fact leads
to a belief that all STDs require a uniform treatment only, self medication and across
the counter treatment, etc., further add to this problem.
♦
Mostly treatment is given without physical examination. This may be due to lack of
facilities or the present attitude of health care providers.
26
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Beliefs of Health workers
STD affects an individual's behaviour and attitude. Therefore this problem should be
handled with care. The attitude of the anm should not only be supportive but also infuse
confidence in the patient, anms should encourage the patient to seek medical treatment
and complete the full course of it. Some misbeliefs of the ANMs that are briefed below
prevent them from guiding the STD patients properly for further management.
women are uneducated and so will not take advice from them.
women do not care for personal hygiene
Sex workers are the main reason for the spread of STDs. Therefore they should stop this
practice
All STD patients have multiple sexual partners.
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27
1
Creating a rapport
introduce yourself
Greet and welcome the patient
Find out the name, confirm it
♦
Be seated in such a way that you see eye-to-eye with the patient
♦
Appreciate the patient for the visit and encourage further visits
Discuss general issues
Observe emotional changes
♦
Act according to emotions like anxiety, anger, frustration
♦
Assure that confidentiality of the patient will be strictly maintained.
Eliciting and disseminating information
Maintain a conducive and pleasant atmosphere
♦
Allow the patient to talk freely while you listen with attention
♦
Maintaining silence in between is good, it will provide an opportunity to the patient
for introspection
However, prolonged silence is not good. Silence may be broken by encouraging
continuation of talk
If the patient is unwilling or unable to speak, suggest that the meeting could be held
on another day
♦
Continue probing and ask open-ended questions until you get the required
information
t
r
Keep encouraging the patient
♦
V
CONFIDENTIALITY - Ensure the patient of the confidentiality of the conversation
between you and him/her.
a
After obtaining the patient's consent, send him/her for medical examination
4
30
Termination
The counsellor and the patient should realise that they have taken the right
decision
Condom promotion
AlMMs had been playing an important role in family welfare programmes and condom
promotion for the past several years. Through condom promotion, anms, besides birth
control, can also prevent and control the spread of std/hiv/aids. anms have proximity to
the community in general and women in particular. These women can bring about an
attitudinal change in their husbands to use condoms, anms should adopt the following
methods to promote condom use:
provide information
Demonstration
Counselling
information on condom
What is a condom?
A condom is a sheath made of latex, it looks like long, thin, latex rubber tube when rolled
out. At the lower end it is closed and has a teat which collects the semen, condom prevents
the sperms and STD causing germs from entering into the vagina and vice versa.
What are the advantages of using condom?
♦
unwanted pregnancy can be avoided
Both the male and female partners can be protected against std/hiv/aids infections.
Who should use condom?
Those belonging to the reproductive age group
Those having multi-sex partners (hetero and homo-sexuals)
Those having sexual contacts with commercial sex workers
31
0650C
Where condoms are available?
•MM
]
Free condoms are available at Primary Health
Centres (PHCs), Government Hospitals and
from NGOs. Condoms can be bought from
Pharmacies. Even pan shops, petty shops and
provision stores sell condoms. But due to
shyness, many do not go and get condoms
themselves, anms can get the condoms from
PHCs and other welfare centres and distribute
them to those who need them and
encourage them to buy condoms from shops
when further need arises.
. ......... ......................... ..... ........... ..
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What are the names of condoms?
1.
Nlrodh
2.
Deluxe Nirodh
3.
Super Deluxe Nirodh
4.
Moods
5.
Kohinoor
6.
Sajan
7.
us tad
8.
Fiesta
9.
Kama Sutra
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10. Tonight etc.
Most condoms are lubricated and
they come in different colours, some
are scented. Some are designed as
dotted or ribbed. Some companies
also give concessions on bulk
purchase of condoms.
32
How is the quality of Indian condoms?
Indian condoms are of good quality. However ensure the following:
is it lubricated?
is it undamaged?
♦
Is It within the expiry date?
Is the packing intact?
These facts should be made clear to women and also to men. People will be motivated to
use condom by clearing doubts and misconceptions through proper information and
health education.
How to store condoms?
♦
Store condoms in a cool, dark place, as heat, light and moisture can damage them
♦
Be careful while handling condoms as finger nails or rings can tear them
♦
Check the date of expiry on the pack when you buy it. If it has crossed the expiry date,
do not buy it. (As it is not possible to check the date at the time of usage, check it at
the time of purchase itself)
How many times can a condom be used?
Once only
Reasons for not using condom and misconceptions about using condom
Belief
Reason
using condom during sex is irritating
Use of lubricated condom will not cause irritation
Condom reduces sexual pleasure
A variety of condoms are now available (dotted, ribbed,
spiral, etc.). These in fact Increase sexual pleasure
By keeping the condom readily available and
wearing it quickly will solve this problem
Erection ceases before
condom is worn and used
33
instructions for proper use of condom
Open the condom pack only when the penis is fully erect.
♦ Open the pack carefully without damaging the condom.
♦
Press the tip of the condom to squeeze out the air before use.
♦ Do not unroll the condom before putting it on.
♦ Place the condom on the tip of the erect penis, while still holding its tip, unroll the
condom over the full length of the penis.
♦ During intercourse, make sure that the condom stays in place.
♦ immediately after ejaculation, the penis must be withdrawn when it is erect by holding
the condom in place.
♦ The condom should be slipped off the penis with the reservoir tip pointing downward
to avoid spillage.
♦ Dispose off the used condom promptly, tying it up and rolling it in a piece of paper and
throwing it into the garbage or burying it.
DO NOT RE-USE THE SAME CONDOM.
34
Proper usage of Condom
•y
1 open the pack carefully
without damaging the
condom.
Wear
the
condom only after penis
becomes fully erect
y
2 Press the tip of the
condom and fix it on the
erect penis
3 Hold the tip of the
condom and slowly unroll
it to full length so that the
penis
is
completely
^covered
y
4. Ensure that the condom is
in
position
before
commencement of sexual
intercourse
5 After ejaculation hold the
bottom of the condom
and gently withdraw the
penis
6 Remove the condom
carefully without spilling
the semen
Always use condom during sexual intercourse
Dispose off used condoms and do not reuse them
Use condoms within the expiry date
7 Dispose off the used
condom in the garbage
bin. do not reuse
Before use ensure that the condom is intact and
undamaged
35
Part-vi
Universal Precautions
Universal precautions are based on the assumption that all blood and body fluids are
potentially infectious regardless of whether they are from any patient or health care
worker.
Principles
Use of protective barriers
Prevention of accidents
Proper use of disinfection and sterilization techniques.
l
Protective Barriers
Depends on the risk of exposure
wound dressings
tow risk
Cloves helpful but not
essential
vaginal examination,
Medium risk
Cloves, gown and apron
Handling lab specimens,
are essential
insertion/removal of
cannula l.v. needles,
large open wounds
uncontrolled bleeding -
High risk
Cloves, apron, mask, eye
while surgery, delivering
wear
a baby
36
Use of gloves
While performing invasive
Use of gloves which had been sterilised
methodologies and surgeries
Non-invasive procedures
Sterilization of gloves is not essential
Don't use gloves with holes or tears
Thick rubber gloves to be worn while cleaning instruments and handling soiled linen
ll
Prevention of Accidents
Safe handling and disposal of sharp instruments, needles is a must
Recapping needles is discouraged
Puncture resistant disposal containers must be available for storing used needles
The used syringes kept in containers are to be disinfected by appropriate disinfectants
Disposable items must be incinerated wherever and whenever possible
Containers should not be overfilled
Never pass needles from one person to another
Protect fingers from injury by using forceps and needle holders when suturing is being
done.
Keep disposal containers close to the work-spot.
Never bend or break disposable needles
Management of Accidents
1.
Needle pricks, cuts, scratches, bites:
Encourage bleeding by squeezing
wash with soap and clean water
Cover with waterproof dressing eg: Band-Aid
37
2. Splash to mouth/eyes:
♦
Rinse thoroughly with plenty of running water
III. Sterilisation and techniques
Hands
washing with soap and water is best
Autoclave
121° c for 15 minutes at 15 pound
pressure (linen, glassware , etc)
Hot air oven
Oils, powders, glass ware, sharp instruments
if autoclave is not available, boiling for 20 minutes is acceptable.
Disinfectants:
HIV can be destroyed by
Boiling
Keeping in 70% Ethanol for 1 hour
Keeping in 1.1% Sodium Hypochlorite
Keeping in 5% Formaldehyde for 1 hour
Placing in 2% Glutaraldehyde for 1 hour
Keeping in 0.5% Lysol for 1 hour
General Safety Measures:
Hand washing
While drawing blood use sterile lancets
Always use tourniquet for venepuncture
Puncture site should not be closed with finger, to use cottonwool
Avoid spillage while transferring blood from syringes to test tubes
38
♦
Blood spill
cover the area with disposable gauze/towels socked in 10% chlorine (sodium
hypochlorite). Leave it for 5 minutes. Workers who handle this should wear thick
rubber gloves.
Labour board, examination tables, operation tables, floor and work surfaces should
be cleaned with 10% sodium hypochlorite solution. Tablespreads should be
changed at the end of each procedure and should be cleaned with 10% sodium
hypochlorite solution before reuse.
Points to be remembered by nurses/ANMs for self-protection
♦
See that the universal precautions are followed
by her as well as her co-workers
♦
When a nurse incurs a needle prick, or gets
exposed to splash of blood or body fluids over
her skin or mucous membrane surfaces, she
should report this matter immediately to the
concerned medical officer/authorities
♦
Open wounds caused to the anm by such
accidents should be immediately covered with a
dressing and if this is not possible, she is not
supposed to continue to attend on the patients.
Pregnant nurses/ANMs should follow these
precautions with greater care.
39
i;'
■W
Part - Vll
The Role of anms in std/hiv/aids Control
introduction
anms should integrate STD/HIV control procedures in their regular activities:
The role of anms while dealing with STD patients
impart Health Education and counselling
Refer the patient and his/her partner to a
qualified medical practitioner
Stress the importance of taking complete
treatment
Explain the need for use
concomitantly with treatment.
of
condom
/7
Health education and counselling
what you should tell the patient?
Explain the following to the patients who come to you with STD symptoms:
Take immediate treatment.
Stress the importance of taking appropriate treatment. Discontinuing the medicines
on slight improvement or disappearance of symptoms is harmful.
Do not spread STDs.
do not have sex until you are completely cured.
Concurrent partner treatment is important to prevent re-infection.
To confirm that you are fully cured, visit the doctor again.
Practise safe sex behaviour. Have sex with your spouse only.
40
Use condom and protect yourself from STD infections.
Always insist on the use of condom by the pre/extra-marital partners.
Help prevent aids.
Caution them on the easy entry of Hiv into STD patients. By taking immediate and
complete treatment for STDs, hiv/aids can be prevented.
Provide total protection to your offsprings.
Advise the men to send their wives for ante-natal check-ups during the first three
months of pregnancy and subsequent regular ante-natal check-ups. This can prevent
the child from getting sexually transmitted infections.
Children born with eye infections or those who contract eye infection soon after birth
should be referred to a qualified physician along with the parents.
ANMs advise on the usage of prescribed drugs
4
Emphasise on the importance of taking all the medicines for the complete course as
advised by the doctor.
instruct the patients to take the medicines at the stipulated time every day.
Read the prescription and advice given by the doctor. Explain it several times to the
patient.
Ensure that the patient has understood the course of treatment by making him/her
repeat what you have explained.
if a patient has discontinued the treatment half-way, find out the reason for it. Help
him/her to continue the treatment further.
Clarify any doubts he/she may have in this regard.
Patient and the partner should remind each other to take the medicines at the proper
time and regularly.
Even if the symptoms have disappeared, the patient should continue the medicines as
per doctor's advice.
41
ANMs ■ To bear in mind the Following while you are in clinics/hospital
Out patient clinic
Take self protective precautions
Perform your daily duties effectively
While dealing with an STD patient take all universal precautions mentioned earlier
Patients waiting in small groups may be given health education
CF3
Display effectively information and communication materials.
Ante-natal clinic
Adopt all aforesaid procedures.
It is important to find out whether there is any genital ulcer or discharge every
time the patient comes for a check-up.
Labour/MTP room
Adopt all aforesaid methods.
Look for ulcers, discharges in the genital area.
Family Welfare Centres
Adopt all aforesaid procedures.
Post-natal care (ward) or mother & child room (ward)
Adopt all aforesaid procedures.
if the child has any eye infection, refer to the doctor immediately.
During house visits
a. Information on STDs can be collected/disseminated during house visits of ANMs.
b. infected person can be examined.
«
42
c. Give health education on STD and encourage the
patient to seek immediate medical treatment.
d. While meeting them on another occasion, you can
enquire about their health and their partner's health.
e. Distributing condoms to infected persons.
f. Encouraging
concurrently.
the
partner
to
take
treatment
g. Everyone should be encouraged to use condom.
women's Club
a. Health Education with special reference to STD should be given.
b. Break their silence and bring them out of their shyness.
c. Clear their doubts and misconceptions, eg. STDs are caused by "heat", weakness, instead,
explain them that STDs are caused by germs.
d. Explain the steps to be taken to control STDs.
e. Encourage them to tell out their symptoms and to take timely medical treatment.
f. Create an awareness on personal hygiene with special reference to menstruation cycle.
g. Encourage building of community toilets and bathing rooms for women.
Health education for young girls
a. Sex education
b. Protected sex
c. Personal hygiene
d. STDs and risky methods of abortion to be explained.
<
43
Patient registration and reporting
The number of STD/mv/AlDS cases in India has been increasing steadily. Everyone who is
concerned with the control of these diseases have to carefully supervise and monitor
them, it is therefore essential to maintain registers containing necessary details of these
diseases. The following details should find a place in such registers.
List of patients who approach you with STD symptoms - syndromes - wise
The number of persons whom you suspect to have this disease
Details of patients whom you had referred
Details of patients who had taken complete treatment
Details of sexual partners who had undergone treatment
♦
Details of persons who had been given condoms and those who use it
Besides these, the number of persons you counselled / counselled by others and given
health education.
you should also encourage your colleagues and physicians to maintain such registers. The
above details collected/compiled by you should be furnished to all private organisations
and government health centres who are concerned with the control of this disease.
*
44
>
*
>
■ aPac-
O
4
AIDS Prevention
And Control Project
voluntary Health Services
Adyar, Chennai 600 113. INDIA
Phone:2352965, 2355048
Fax: 91-44-2355018
e-mail: apacvhs@vsnl.com
4
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