I work on a unit that often gets patients with RSV and other viruses that require aerosolized Ribavirin treatment. In the past, our charge nurses assigned these patients only to men or women who are past child-bearing age (or are just done having kids). This rule recently changed to exclude only women who are currently pregnant or actively trying to get pregnant. I am young, female, have no children, and am in a serious relationship. I'm being put in the awkward position to 1) discuss my reproductive plans with my employer which isn't any of their business, and 2) let them know that I'm sexually active and accidents happen (again, none of their business). I don't feel like I should be assigned to these patients (but of course I was the very day the rule changed). There are other nurses on my unit who are more appropriate to take these patients, but the charge nurses aren't being very receptive to feedback on this. Does anyone have any articles about the dangers of ribavirin exposure that could be helpful in persuading them? I'm not really sure what to do here.
Dec 19, '13
I hope you are wearing a gown, N95 and gloves when you enter the room.
I can not imagine any other unit still using Ribavirin since it is now just used as a last ditch effort for those in Oncology or HIV. Peds determined it was ineffective at least 15 years ago. Those who advocate for it sometimes run it long enough (like 10 - 20 days) for the RSV or other viral infection to run its course but still claim the drug was responsible for the success.
Talk to the RTs. They probably have lots of resources since they go through this and some RTs don't have a choice about being the care provider even if pregnant due to the small size of their departments and "it being their job".
Last edit by TraumaSurfer on Dec 19, '13
Dec 19, '13
Quote from sugarmagnoliaRN
We only have 2 negative pressure rooms, so we have max 2 Ribavirin patients out of a 30-bed unit. TraumaSurfer, when I was reading up on this it was found that the RNs have much more exposure than the RT's - they generally don't stay in the room while the med is running. If I have to give a slew of IV abx (like I did with this patient, along with IVIG) I am going to be in there longer than the RT while it's going.
Our patients that are getting Ribavirin are usually old lung transplants that have contracted RSV.
GrnTea- you bring up a good point about the hospital's liability. I do wear the gown, gloves, and N100 mask but think it's worth discussing with the employee health department.
RTs also handle the medication and equipment directly which brings them into contact with splashes. They also probably see many more patients on Ribavirin than you at one time. If they have 5 patients on Ribavirin and do all the required checks, assembly and clean up, that is significant exposure. Even with one it can be significant especially if the SPAG is acting up and they have to risk spray or splash while trouble shooting. Don't try to minimalize their job or life if you don't know what all they do. They also have to set up and run Pentamidine (transplant pts), a lot of different antibiotics, steroids, prostacyclin, nitric oxide (PHN diagnostics), hypertonic saline sputum inductions with TB patients and many bronchodilator treatments. Just calibrating a nitric oxide delivery system not in use exposes them and some do this regularly. For many of these treatments they are required
to stay at the bedside so they spent much of their 12 hours being exposed. They don't have time to stick around for long exposures to Ribavirin when there are so many other things they have to rush off to so they can get more exposure. RTs and nurses who work in certain units do have the data to show occupational exposure. Some have developed diseases which could be directly related to their long term exposure but at this point for them the damage is done. Some RNs and RTs have been in the profession before gloves were a necessity.
Also, if you do come into contact with some of the exposures in health care such as TB, meningitis and HIV, you might have to take medication directly as a result of that exposure. There were also risks when taking care of H1N1 patients or any other airborne infectious disease. Some who have had Chicken Pox as kids might even be surprised to learn they no longer have positive titers. The same for those who don't get their hepatitis titers checked every few years. Those of us who went through the agony of Smallpox vaccination as kids are also no longer immune.
Know the risks and take precautions. Learn from what others have experienced and adhere to the policies.
Side Question: What do you tell visitors who are at the bedside or do you forbid visitors while the patient is receiving Ribavirin?
This was a big issue in Pediatrics since the parents wanted or sometimes needed to stay at bedside. These parents were often young and still could have more children. They were exposed almost 24 hours every day for several days and often without all the same protective gear. Some health care providers didn't really concern themselves about the parents as long as they has a babysitter to keep the child in the Ribavirin.
Last edit by TraumaSurfer on Dec 19, '13