Pt Bites Nurse

[Pepper The Cat, BSN, RN]

Hi all

I'm just curious about other hospitals reactions to this.

Between Xmas and New Years, a confused/combative pt bit one of our nurses on her finger. It was bad enough to draw blood.

Our wonderful, fabulous infection control department stated that there was NOTHING to be worried about and she did not need to get blood work done, and there was no need to draw blood work on the pt! She had to fight, FIGHT,to get bloodwork done on the pt and herself. Apparently, ( I was not present, all info is 2nd hand) she had to call multiple managers, directors etc until someone would support her.

Is this normal in other hospitals?? According to infection control, they would be concerned if it were a needle stick, but not a bite that was bad enough to draw blood.

Everyone I have spoken with agrees that 1) the mouth is one of the dirtiest, germiest part of the body and 2)if blood if drawn, you should be concerned.

One doctor (who is well known for supporting nurses) has said that she would have ordered Hepatitits and HIV blood tests right away. Unfortunatetly she was not the doctor on call when this occured. The doctor on call only ordered blood work after infection control told him too, and infection control only agreed to it after the nurse involved made multiple calls to managers, directors etc pleading her case.

My question: Are we just out of line here? Or are we justified in our concerns? By the way - the pt passed away less then 24 hours later, so time really mattered.

I just really want to know how other institutions would have reacted to this. The nurse in question is currently on anti-biotics, and her family MD will be doing blood work check ups for the next 6 months at least. She hasn't been back to work since because she was off for New Years, and then had to call in sick because the anti-biotics are playing havoc with her intestines.

[PAERRN20]

I absolutely think blood work should have been drawn. The chance of contracting anything is probably pretty small but better safe than sorry. You never know and it is always a good idea to have a paper trail in case something does happen. Thoughts and prayers to your friend.

[RNKPCE]

Blood work should be done to protect both the nurse and the patient.

[Propranolol]

when i accidentally stuck myself with a needle, they sent me to the ER IMMEDIATELY to get blood work done. They took blood from the patient also. I have follow ups and blood drawn 1 month, 6 months and 1 year after. They get consent from the patient for HIV/AIDS rapid screen. Everyone was supportive. This is from a 250 bed community hospital. Shame on your management. sorry to hear that. hope all is well with your co-worker.

[zacarias, ASN, RN]

When I think of a bite, I'm worried about tetorifice and staph infection as potential sequelae. I think the risk of other bloodborne diseases is so little that they don't often draw blood in these cases. That makes sense to me, although I'm wondering if somewhere on the CDC webside there is a definitive answer...

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[mochamonster]

I have 9 years of past experience in the dental field and I would say that you must assume the patient's saliva had blood in it. Especially if they were combative, it would be too easy for them to have bitten their cheek or tongue. Saliva by itself is not cause for concern, but given the circumstances she did the right thing by insisting she get the care she needed. It is ultimately her body and her health at risk if the patient were infectious.

I had a similar incident where I stuck myself with an instrument that was probably contaminated with just saliva. The problem was it was mixed in with instruments that were contaminated with blood and the patient had received a blood transfusion in the past that was Hep C positive and didn't know her status. While the doc made it seem like no big deal, it wasn't his body, so he really wouldn't be that careful. I went and got the immunoglobulin and blood testing just to be sure. As a provider and as a patient you must be proactive with your healthcare.

[RN1982]

She should have told the doc she was going to make a call to a lawyer if they didn't do the necessary bloodwork to make sure she and the patient were HIV and Hepatitis free.

[mcpkin]

I think blood work should have been drawn also. I am not sure why injuries seem to be downplayed. I work on a med/surg floor and we have a room with 4 beds, for confused/combative pt's. and one night I heard yelling coming from the room, and a nurse was standing next to a pt, that was trying to hit her. She was holding his hands down by his side. I told her to let him go and back up away from him, and she did. Well no one told me that along the back side of his leg he had a cane. Long story short, he started using it, and a very good aide, made a very bad decision and went between the bed and the wall to pick up a pillow. He went after her, I could not let him hit her, she is 65, I called a code grey for manpower, but he had the cane above his head swinging at her. I got his attention and got hit 3 times with the cane before help arrived. When I told the supervisor, I already had a lump, red/bruised area on my forearm, and his only comment was "if you report it you have to take a drug test" I told him I dont care what I have to do, I want it reported and I have to go to er, just to be on the safe side. It also hurt really bad. I was made to wait until morning to er, at least 2-3 hrs. I also told the manager that we should not have any one with canes in that room, as they are all confused thus the reason for being there, and alot of them combative. since then we have had another code grey, same thing I just turned around and walked out of the room. I let the others take care of this one........

[GadgetRN71, ASN, RN]

My dad got bit by a patient once..badly too. Took a chunk out of his arm bigger than a half dollar. He also had to fight to get stuff done but they finally did it. There are ways to draw labs even if the patient doesn't consent and a lot of places do this. The patient in my dad's case was an admitted IV drug user and admitted to promiscuous behavior. They started him on the drug protocol for HIV exposure and he had to get tested. He's OK, thank God, and he ended up suing and won $5000. Still has a nasty scar though.

If a patient is mentally ill or has dementia, that's one thing. But, these people who hit/bite/ assault nurses because they're ticked off? Call the cops, I say.

[rngolfer53]

In thinking about this, I think it helps to ask what would be done if the circumstances were reveresed: Nurse bites Pt, draws blood.

Would blood work be promptly ordered?

I suspect the answer to that is "not only 'yes' but 'he11, yes.'"

Why shouldn't the nurse get the same consideration?