Correcting Misconceptions

Health care workers at your facility may resist changes in infection prevention practices if they do not understand the basic facts about infection transmission. Before implementing changes in practices, it is important to first correct staff members' misconceptions about infections, infection transmission, and their own safety.

1. Misconceptions about the incidence of infections at the facility

Service providers and other staff often believe that the incidence of postprocedure infection is low in their facility and thus not of concern. In reality, incidence rates are not easy to know:

• Postprocedure infections may be difficult to identify, especially for outpatient services. For example, surgical-site infections do not occur until seven to 10 days postprocedure.
• Infections do not always cause problems serious enough to make the client seek medical attention, but may prolong the healing process, eventually resolving on their own. The facility may never discover that these infections occurred.
• Clients may seek treatment for postprocedure infections at another facility or a pharmacy.
• Clients and staff may attribute the infection to other factors and never realize that the infection was acquired as a result of service provision.
• Clients may not find out they are infected with HIV or the hepatitis viruses until years after the infection, when little connection to a past clinical procedure would be evident.

2. Misconceptions about the prevalence of infections in the community

Staff may believe that the prevalence of serious infections (such as HIV or hepatitis C) is low in their community. In actuality, the real prevalence may not be known:

• There is little reliable data on the prevalence of viruses such as HIV or the hepatitis viruses for many countries throughout the world.
• Because of perceived biases towards infection with HIV, infected persons may keep their condition secret and avoid treatment, thereby artificially lowering the number of known cases of infection within the community.
• It does not take many infected people to put the community at risk of infection. Few initial infections can lead to many other infections.

The time to institute effective infection prevention practices is now, so that if life-threatening infections are not already prevalent in the community, they do not become so.

3. Misconceptions about the ways infections are transmitted

Misconceptions about transmission of infections such as HIV and hepatitis B can influence how health care workers provide services to clients. Because of these misconceptions:

• Health care workers may deny services to some clients.
• Health care workers may be unnecessarily afraid of or worried about providing services to clients who have these infections.
• The practices of staff may place clients at an increased risk of infection.
• Health care workers may not take appropriate steps to protect themselves.

It is useful to hold broad orientations to infection prevention in which staff can receive information and ask questions about disease transmission. Staff should remember that most of the infections in health care settings are spread by direct contact, primarily by the hands of health care workers--not by airborne transmission or casual contact, as many people believe.

4. Misconceptions about HIV and hepatitis B

Because of widespread biases and misinformation, it is common for staff to have misconceptions about the transmission of these diseases. It is important to ensure that all staff in your facility know that HIV and hepatitis B are transmitted through:

• Blood/other body fluids: through contact with broken skin, or through injuries with contaminated needles and/or sharp instruments; through transfusion of infective blood or blood products; through IV drug use with shared needles and syringes; through splashes of contaminated body fluid into the mucous membranes of a health care worker; through use of contaminated razors; through tattooing.

Note: Point out to staff that hepatitis C, which may be passed through blood and other body fluids, is only rarely transmitted through sexual contact or from mother to child.

• Sexual contact: during both heterosexual and homosexual contact through unprotected vaginal or anal intercourse.
• Vertical transmission: these infections may be passed from mother to infant (during pregnancy, delivery, or breastfeeding).

There is no evidence of transmission through other modes. Point out that transmission of these infections does not occur:

• During casual social contact
• Through shared eating utensils
• From insect bites
• From donating blood
• From consumption of food or drink

NOTE: During discussion, staff members may mention that tears, saliva, and urine could contain the HIV virus. These body fluids do not contain high enough amounts of virus to cause infection, and no infections have ever been documented from these fluids. Blood, semen, and cervical/vaginal secretions are the only documented body fluids through which these viruses are transmitted.

Infrequently, cases of household transmission of hepatitis B have been documented. Household transmission refers to transmission of a virus without recognized blood, sexual, or perinatal exposure. In these cases, infection occurs primarily among young children who are exposed for long periods of time to family members who are persistent hepatitis B carriers--although it is likely that most of these cases are actually due to unrecognized exposure of mucous membranes, cuts, or other breaks in the skin to infectious blood or saliva. There are no documented cases of household transmission of either HIV or hepatitis C.

5. Misconceptions about the use of screening

Screening clients for HIV and HBV before providing clinical services (such as surgery) is not recommended because:

• Some bloodborne infections cannot be detected through testing.
• Test results may appear negative for a period of time after a person is infected. (The time period varies based on the type of infection and the test being used.)
• Screening is not possible during emergency situations. If infection prevention practices are not followed routinely, health care workers may not have the knowledge or supplies needed to follow them and protect themselves when emergencies occur.
• Screening is costly and may divert money away from needed training, supplies, and equipment.

If appropriate infection prevention practices are followed with every client, a client's infection status has no impact on the risk of infections to staff.

6. Misconceptions about the feasibility of following appropriate infection prevention practices

Many health care workers believe that effective infection prevention practices require fancy, expensive equipment or supplies, but this is not the case. The internationally accepted standards that are presented in this training course use low-tech approaches that are practical, simple, and inexpensive and use locally available supplies.

NOTE: The internationally accepted standards presented in this training course have been developed based on data accumulated over the years that demonstrate the effectiveness, importance, and usefulness of the recommended practices. It is just as possible to institute appropriate infection prevention practices in low-resource settings as in high-resource settings.

Some of the infection prevention practices recommended in this course are new, while others are existing practices done in a different way. It is important to keep in mind that because science and medicine are always evolving, recommended practices may change over time.

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