HIV Risks in Pathology: Safety Measures and Disinfection Protocols

Q: HIV Risks in Pathology: Safety Measures and Disinfection Protocols

Dear readers：<br>Regarding the transmission routes of HIV, as stated on the Taiwan CDC website： <br>A： There are three main transmission routes for the HIV virus： <br>1. <br>Sexual transmission： Engaging in sexual activities, including oral, anal, or vaginal intercourse, or any e

Laboratory HIV Risk

Hello, I am a pathology technician.
Our small tissue specimens are immersed in 4% formalin for an indefinite amount of time, at least 30 minutes.
When we take the specimens out of the container, some formalin droplets may splash out, and they might even get on our faces.
Each time I get splashed, I feel very anxious.
The next day, if I hear that a particular specimen is from an HIV-infected individual, I become even more fearful, worrying that I might have splashed some into my eyes without noticing.
My supervisor mentioned that extracellular HIV requires 30 minutes in formalin for disinfection, but I am unsure how long HIV on cells needs.

1.
For tissue specimens sized 3mm to 5mm (such as stomach, intestine, esophagus, etc.), how long should they be immersed in 4% formalin to ensure they are no longer infectious for HIV?
2.
Is there a possibility that formalin solution could carry viral-containing bodily fluids (such as blood, gastrointestinal fluids, or tissue fluids) and pose an infection risk?
3.
Could formalin solution carry viruses that have not yet been inactivated from the cells, thereby posing an infection risk?
4.
Is there a risk of infection if such fluids splash into the eyes?
5.
Should splashes of such fluids into the eyes be reported?
Thank you.

Li, 30~39 year old female. Ask Date: 2015/09/14

Dr. Liao Zhongxin reply Internal Medicine

Dear readers:
Regarding the transmission routes of HIV, as stated on the Taiwan CDC website:
A: There are three main transmission routes for the HIV virus:
1.
Sexual transmission: Engaging in sexual activities, including oral, anal, or vaginal intercourse, or any exchange of bodily fluids with an HIV-infected individual carries a risk of infection.

2.
Blood transmission:
(1) Receiving or coming into contact with blood or blood products contaminated with HIV.

(2) Sharing needles, syringes, or diluents with intravenous drug users who are HIV-positive.

(3) Receiving an organ transplant from an HIV-infected donor.

3.
Vertical transmission from mother to child: Infants can acquire HIV from their infected mothers during pregnancy, childbirth, or breastfeeding.
HIV generally exists in human blood and bodily fluids at approximately 37°C.
It dies within 15 minutes outside the human body, especially when exposed to formalin.
However, the odor of formalin and its corrosive effects on tissues can be uncomfortable; it is advisable to rinse thoroughly with plenty of water and follow up at an ophthalmology clinic as recommended by Dr.
Liao.

Reply Date: 2015/09/14

More Info

When it comes to handling specimens in a pathology lab, especially those that may be contaminated with HIV, it is crucial to understand the risks involved and the appropriate safety measures to mitigate those risks. Here’s a detailed response to your questions regarding HIV infection risks in the context of handling specimens preserved in formalin.

1. Duration of Exposure to Formalin for HIV Inactivation: The Centers for Disease Control and Prevention (CDC) states that HIV is relatively fragile outside the human body and can be inactivated by exposure to disinfectants. Formalin, which is a 37% solution of formaldehyde in water, is effective in inactivating HIV. For HIV to be effectively inactivated, it is generally recommended that specimens be immersed in 4% formalin for at least 30 minutes. However, the exact duration may depend on the concentration of the virus in the specimen and the type of tissue. It is advisable to follow institutional protocols and guidelines for handling potentially infectious materials.

2. Risk of Infection from Formalin-Containing Fluids: Formalin itself is not a carrier of HIV; however, it can be mixed with bodily fluids that may contain the virus. If the specimen is from an HIV-positive individual, there is a potential risk if the formalin solution is contaminated with blood, gastrointestinal fluids, or other body fluids. Therefore, it is essential to handle all specimens with caution, assuming they may be infectious.

3. Presence of Active Virus in Formalin: When tissues are placed in formalin, the fixation process begins immediately, which helps in denaturing proteins and inactivating viruses. However, if the specimen has not been adequately fixed or if there is a delay in processing, there may be a risk of exposure to viable virus particles. It is crucial to ensure that specimens are processed promptly and according to safety protocols to minimize this risk.

4. Risk of Eye Exposure: If formalin or any fluid containing HIV-positive material splashes into your eyes, there is a potential risk of infection. The mucous membranes of the eyes can serve as entry points for viruses. In such cases, immediate washing of the eyes with copious amounts of water or saline is recommended to reduce the risk of infection.

5. Reporting Exposure Incidents: If you experience a splash of potentially infectious material into your eyes, it is essential to report the incident to your supervisor or the designated safety officer in your institution. Most healthcare facilities have protocols for managing exposure incidents, including post-exposure prophylaxis (PEP) for HIV, which may be initiated depending on the circumstances of the exposure.

In summary, while the risk of HIV transmission in a laboratory setting can be minimized through proper handling and disinfection protocols, it is essential to remain vigilant and adhere to safety guidelines. Always assume that specimens may be infectious, and take appropriate precautions, including the use of personal protective equipment (PPE) such as gloves, goggles, and lab coats. Regular training on biosafety practices and emergency response protocols is also vital for all laboratory personnel to ensure a safe working environment.

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