Question on risk of HIV exposure/infection

[LUV ALZ]

I just recently started home health as a second job. The client I have been assigned to is HIV positive. Client is trached and does not tolerate deep suctioning. Client has a very productive cough. PC asks that nurse grab inner cannula at the height of the cough and pull it out, thereby catching the bulk of the secretions in the cannula. The only PPE's I have been provided with by the agency is gloves (we get one box a month of which I used 20 the first night alone as client coughs up moderate amounts of phlegm frequently). What are the risks of HIV transmission through phlegm, droplet exposure? I know when a person coughs droplets can land as far as 15 feet away. Am I at risk if it lands in my eyes or if I inhale freshly expelled microscopic droplet via mouth or nose? I don't want to go in there in a bio suit, but this is my first HIV pt and i do want to take appropriate precautions. Client is taking HIV meds at this time. Thanks for any info or links in advance guys!

[linearthinker, DNP, RN]

PPE beyond standard precautions is unnecessary. It offends me that so many nurses don't know better.

[DA314]

PPE beyond standard precautions is unnecessary. It offends me that so many nurses don't know better.

I don't think gown, gloves, goggles, and mask would be conisdered beyond standard precautions with any pt that has flying goobers, no matter what their hiv status is. I don't know about you, but I'm not going to a big wet cough to the face if I can prevent it. And I was taught to always wear face protection anytime bodily fluids were at high risk of splashing into my face (like during trach care).

[xtxrn, ASN, RN]

I don't think gown, gloves, goggles, and mask would be conisdered beyond standard precautions with any pt that has flying goobers, no matter what their hiv status is. I don't know about you, but I'm not going to a big wet cough to the face if I can prevent it. And I was taught to always wear face protection anytime bodily fluids were at high risk of splashing into my face (like during trach care).

And I can guarantee that if I had to chisel one loogie out of my hair, I'd be asking for OR caps as well

[wooh, BSN, RN]

I think what bothers me is people freaking out and wanting extra precautions for known HIV when any of your patients could have it without you knowing. If standard is good enough for all your patients, standard is good enough for HIV.

[KentechRN]

I would want the extra PPE just for the flying bodily fluids. It has nothing to do with the patient having HIV or not. There is no need to expose yourself to these things regardless of what the patient has. It's not like this patient is HIV+ with no other issues. There is a risk of exposure to bodily fluids that I would want to decrease in this case.

[xtxrn, ASN, RN]

Yeah, anybody with a blowhole for snot gets the full banana-suit in my book

[mrr5745]

The truth is, health care professionals really do not receive nearly enough education about HIV or really any other blood-borne pathogens. Most only learn about HIV during orientation at their jobs (unless you count the five minutes it is discussed in school.) This education often uses scare tactics to help ensure the staff will use PPE to reduce potential liability for the health care organization. It is completely understandable given this background that HCP are concerned about HIV exposure.

Personally, I find it refreshing to know that HCP caring for HIV positive patients are on this board seeking further information rather than just assuming he or she can get HIV from respiratory secretions. Chastising people for their lack of knowledge or misunderstanding is no way to promote further education about HIV. IMO, the people posting in this particular thread are leaps and bounds ahead of many other HCP because they are taking the initiative to educate themselves. There is no need to chastise them for their efforts.

[RNChristy]

Anytime that I did trach care with a patient with a productive cough, I always at least wore gloves, goggles and a mask. This did not matter whether the patient had HIV or not. I feel that this is the proper PPE needed.

Christy

[Rob72, ASN, RN]

Suctioning is inherently traumatic. In conjunction with increased vascular pressure r/valsalva (coughing), *assume* that there is blood/serum in the sputum.

HIV? Possible, but not really likely. TB, pseudomonas, strep, hep. Sure. Obviously the greater concern is the fact that you have a respiring culture medium respiring on you. Seriously, folks, anyone want a direct culture of any of that in their eyes or nose?

[LUV ALZ]

For all of you who felt the need for chastising someone who is honestly seeking information on something they do not know, "Shame on you"! It is that kind of reception to questions that keeps people from learning the right way to do things. I am with Rob, how many of you Really want a face full of respiratory secretions or any bodily fluid regardless of the the donors health status?

[heron, ASN, RN]

For all of you who felt the need for chastising someone who is honestly seeking information on something they do not know, "Shame on you"! It is that kind of reception to questions that keeps people from learning the right way to do things. I am with Rob, how many of you Really want a face full of respiratory secretions or any bodily fluid regardless of the the donors health status?

Your concern about being splattered with sputum is legitimate and smart ... but not because the pt has HIV. We are 40+ years into the epidemic and still seeing the panic and ostracization of people with HIV that doesn't exist for any other infection.

A good source for information about infection risk and prevention is the CDC website: http://www.cdc.gov/

Meanwhile, I didn't see any "chastising" going on. I did read some concern that HIV seems to scare you more than, say, MRSA or hepB. HIV is just about the hardest to catch of any infection in the health care setting. Piling on PPE just because a patient has HIV can be emotionally devastating to a patient and some of us are a bit oversensitive to that. We remember the days of moon suits and meals left outside the door because people refused to even enter the room.

Pointing out a prejudice is NOT the same as chastising the OP for asking a question. Respect for, and the emotional care of, the patient is as important as helping him clear his secretions. The shame belongs with the your trainers and agency for failing to address this.

Now, if the patient had multi-drug-resistant Tb ...