21 November 1995
ADMINISTRATIVE ORDER
No. 18 series 1995
REVISED GUIDELINES IN THE MANAGEMENT OF HIV/AIDS
PATIENTS IN THE HOSPITAL
I. BACKGROUND
The
HIV/AIDS pandemic has been declared a worldwide emergency by the World Health
Organization. This situation has serious health, social, economic and political
implications for all countries. The Philippines is not spared of the problems
brought about by this pandemic as evidenced by the current national statistics
on AIDS.
In
response to the emerging needs for standardized procedure in the OPD
consultation and/or hospitalization of HIV/AIDS patients, the Department of
Health through the Hospital Operations and Management Service in collaboration
with the National AIDS/STD Prevention and Control Program issued Administrative
Order No. 27 last March 1994. Since then, the guidelines had been
disseminated to concerned hospitals through orientation seminars, and even
through other training workshops conducted by the National AIDS program.
More
than a year after its issuance, experience in field implementation had
gradually accumulated. With lessons learned, the need for the revision of this
guideline became evident.
II. OBJECTIVES
General
Objective:
To
strengthen the capability of the hospital in the prevention and control of HIV
infections / AIDS.
Specific
Objectives:
1. To organize an HIV/AIDS Core Team.
2. To formulate standardized guidelines in the management
of HIV/AIDS.
3. To provide holistic care to HIV–infected/AIDS
patients, their families and significant others including referrals and
networking with NGOs and GOs.
4. To develop human resources necessary to carry out the
provisions of this guidelines.
5. To implement and operationalize HIV/AIDS–related
programs in the hospital.
III. ORGANIZATIONAL
STRUCTURE
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IV. COMPOSITION
AND FUNCTION OF THE HACT
Each
DOH hospital shall organize an HIV/AIDS Core Team (HACT) which shall directly
report to the Chief of Hospital. It shall be composed of, but not limited to
the following: doctor(s), dentist(s), nurse(s), medical social worker(s), and
medical technologist(s) and have the following functions:
1. Formulate hospital guidelines on the comprehensive
care and management of HIV/AIDS patients.
2. Provide care and counseling to HIV/AIDS patients.
3. Promote prevention and control measures/strategies
such as health education and hospital infection control.
4. Facilities inter– and intra–departmental/agency
coordination including referral system and networking.
5. Performs training and research activities on HIV/AIDS.
6. Provide recommendations in hospital planning and
development related to HIV/AIDS.
7. Monitor compliance of ethico–moral guidelines for
HIV/AIDS including confidentiality of records and reports and release of
information.
8. Update records and submit reports to concerned
offices.
9. Conduct monitoring and evaluation activities.
A. SPECIFIC
FUNCTIONS OF EACH HACT MEMBER
1. PHYSICIAN
1.1.Acts as chairperson of HACT as designated by the Chief
of Hospital.
1.2.Coordinate with the Hospital Infection Control
Committee in the strict
Implementation
of prevention and infection control measure within the hospital.
1.3.In–charge of the medical management.
1.4.Ensures follow–up of patients and referral to other
specialties as
necessary.
1.5.Conducts training and research.
1.6.Submits reports of HIV infection/AIDS to the National
AIDS Registry.
1.7.Provides post–test counseling.
2. DENTIST
2.1.Coordinates with Hospital Infection Control Committee
in the strict
Implementation
of prevention and infection control measures within the dental clinic.
2.2.In–charge of the oral care and management.
2.3.Disseminates oral health information and counseling.
2.4.Ensures follow–up of dental patients and refers them
to specialist when
necessary.
2.5.Conducts training and research related to dental
field.
3. NURSES
3.1.In–charge of the nursing management.
3.2.Coordinates patient referrals within the hospital.
3.3.Promotes health education activities.
3.4.Manages training and research activities for nurses
and auxiliaries.
3.5.Ensures implementation of infection control
guidelines.
4. MEDICAL
SOCIAL WORKER
4.1.Provides psychosocial support services including
counseling to HIV–
infected/AIDS
patients and their families.
4.2.Coordinates and establishes linkages with GOs and NGOs
in order to:
4.2.1.
Identify existing
resources for efficient networking.
4.2.2.
Assist in
providing alternative source of income.
4.2.3.
Provide
continuing psychosocial support.
4.3.Provides health education.
4.4.Conducts home visits/follow–ups.
4.5.Conducts training and research related to social work
activities.
5. MEDICAL
TECHNOLOGIST
5.1.
Ensures
that pre–test counseling is provided with an oral
or
written informed consent.
5.2.
Performs
appropriate laboratory procedures according to
set
technical standards.
5.3.
Ensures
proper laboratory waste disposal.
5.4.
Implements
guidelines on laboratory safety and preparations.
5.5.
Ensures
that test results are reviewed and duly signed by
the
Laboratory Chief before releasing to HACT physician.
V. APPROACH
TO MANAGEMENT
1. Suspected or known HIV–infected patients shall be
referred to the HACT.
2. Initial assessment shall be done by HACT physician.
3. Suspected HIV cases shall undergo HIV antibody testing
with an informed consent after pre–test counseling. Post–test counseling shall
be provided to all patients who underwent HIV antibody testing.
4. The decision to admit known HIV–infected/AIDS case
shall be determined by the HACT doctor and shall be admitted to the appropriate
ward according to the presenting manifestation.
5. A multidisciplinary approach to the care and
counseling of HIV – infected patients shall be carried out by the HACT.
6. All HIV–infected/AIDS patients for discharge shall be
provided with written discharge instructions on home care and management.
7. Asymptomatic patients shall be followed–up every 3
months. Symptomatic patients shall be followed–up as necessary.
8. Referrals/networking with other hospitals/agencies
shall be done as necessary.
VI. RECORDS
AND REPORTS
1. HACT shall observe and monitor implementation of the
ethico–moral guidelines in record–keeping and release of information of
HIV/AIDS patients.
2. HACT shall ensure that the records of HIV/AIDS
patients are complete and regularly updated.
3. HACT shall submit to the Medical Records Office the
records of HIV/AIDS patients with coded names. The name should remain with HACT
for safekeeping. However, information related to such record shall be released
only upon authorization of Chief of Hospital unless otherwise delegates to the
HACT chairman.
4. HACT shall submit updated reports to concerned offices
for statistical purposes (DOH–National AIDS Registry).
VII. MONITORING
AND EVALUATION
1. HACT shall formulate monitoring tools and guidelines
for the HIV/AIDS program of the hospital.
2. HACT shall conduct annual evaluation of program
implementation and make necessary recommendations.
3. HACT shall submit annual report to NASPCP.
4. HACT shall conduct regular review of HIV/AIDS clinical
management protocol.
VIII. GENERAL
PROVISIONS
1. Confidentiality
All
HACT members shall ensure that all medical data and information of HIV/AIDS
patients are maintained with utmost confidentiality. HACT physicians are
required to report using the official HIV/AIDS reporting form (See ANNEX 3) any
HIV infection/AIDS case the HACT members attended to. In order to protect the
fundamental right of privacy of an individual with AIDS or infected with HIV,
the reporting must be limited to the number of AIDS cases and other statistics
without divulging the identity of the person unless the patient agrees in
writing to disclosure.
2. Counseling
All
HACT members should be able to provide counseling to all patients including pre
– and post–test counseling.
3. Right to
health care services
HIV/AIDS
patients have the right to avail of health care services in any health care
facility. One who has HIV infection/AIDS shall not be denied his right to
medical treatment.
4. Hospital
Implementing Procedure
The
HACT shall be responsible for formulating the implementing procedure of this
guidelines and such procedure shall be in accordance to the objectives and
provisions of this Administrative Order. The scope and limitations of the
Hospital
Implementing
Procedure shall be concurrent to the hospital set–up and capacity.
5. Case
Definition
Any
person with or without overt signs and symptoms of opportunistic infection and
gives a confirmed positive HIV antibody test result is diagnosed to be HIV–infected.
On the other hand, an AIDS case has one or more of the AIDS–defining conditions
(see ANNEX 1).
6. Universal
Precaution
Universal
precautions assume that blood, blood products and other body fluids of all
patients are potential sources of infection independent of diagnosis or
perceived risk. It is, therefore, mandatory for all hospital personnel to
practice precautionary measures (see ANNEX 2) to prevent transfer of HIV and
other infectious agents.
7. Post–mortem
care
All
dead bodies shall be considered potentially infected with HIV. Procedures that
would entail physical contact with blood and other body fluids shall be carried
out with precautions. Cadavers should be properly placed inside a non–permeable
material such as plastic bag before burial or cremation. Physical barriers to
prevent exposure of skin and mucous membranes to potentially infected body
fluids during post–mortem procedures shall be utilized. Patients who die of
AIDS shall be buried un–embalmed within 24 hours or cremated.
IX. PENALTY
CLAUSE
Any
individual who does an act in violation of the foregoing provisions or fails to
do an act provided hereof, shall be subject to appropriate action by proper
authorities after due notice and process.
X. EFFECTIVITY
This
order supersedes Administrative Order No. 27, s. 1994 (Guidelines on OPD
Consultation and/or Hospitalization of HIV/AIDS Patients) and shall take
effect immediately.
HILARION J. RAMIRO,
JR., MD, MHA
Secretary of Health
******
ANNEX 1
US Center for Disease
Control (CDC), AIDS Defining Conditions
Opportunistic
Infections
Candidiasis of bronchi, trachea or lungs
Candidiasis, esophageal
Coccidioidomycosis, disseminated or extrapulmonary
Cryptosporodiosis,
chronic intestinal (>1 month’s duration)
Cytomegalovirus
disease (other than liver, spleen or nodes)
Cytomegalovirus
retinitis (with loss of vision)
Herpes
simplex: chronic ulcers (>1 month duration), or bronchitis, pneumonitis or
esophagitis
Histoplasmosis,
disseminated or extrapulmonary
Mycobacterium
avium complex or M. kansasii,
disseminated or extrapulmonary
Mycobacterium
tuberculosis, any site (pulmonary or
extra–pulmonary)
Mycobacterium,
other species or unidentified species, disseminated or
extrapulmonary
Pneumocystic
carinii pneumonia
Pneumonia,
recurrent
Progressive
multifocal leukoencephalopathy
Salmonella
septicemia, recurrent
Toxoplasmosis
of brain
Malignancies
Kaposi’s
sarcoma
Lymphoma,
Burkitt’s (or equivalent term)
Lymphoma,
immunoblastic (or equivalent term)
Lymphoma,
primary of brain
Cervical
cancer, invasive
Encephalopathy, HIV–related
Wasting syndrome due to
HIV
Advanced immune deficiency
(CD4 cell count <200/ul)
ANNEX 2
Universal
Precautions
a. Standard hygienic procedures, especially handwashing,
should be followed at all times.
b. Hospital or medical center guidelines for disinfection
and sterilization should be consulted and followed faithfully.
c. Any skin disease or injury should be adequately
protected with gloves or impermeable dressing to avoid contamination with a
patient’s body fluids.
d. Any spills of blood or other potentially contaminated
material should be liberally covered with household bleach (dilution 1 to 10),
left over 30 minutes then carefully wiped off by personnel wearing gloves.
e. Needles and sharp object should be discarded in
puncture–proof containers. Do not bend or break needles by hand. Do not recap
used disposable needles.
f. Reusable needles and syringes should be handled with
extreme care and safety stored prior to cleaning and sterilization or
disinfection.
g. Linen soiled with blood or other body fluids should be
handled as little as possible. Gloves and a protective apron should be worn
while handling soiled linen.
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