With regards to the HIV screening, it would depend primarily on what the patient says. Maybe it would be a lot more easier if we could train those in the frontline to ask the patient regarding this syndrome in a manner that it would be answered truthfully. We have to also emphasize the gravity of giving a complete history, if they know what it is for, they would answer the best way they can. the problem is the stigma, reason why they would not answer questions. maybe we could ask the patients regarding "STDs", eg. Have you been exposed or had a history of any Venereal Disease? If they say yes, then ask what it was that they were exposed to.
Another case would be of course, if there is a needlestick injury involving the patient, the source person, if the attending physician agrees, that the patient be screened for blood borne pathogens (Hep B, Hep C and HIV). HIV testing should also be done after the patient consents (thus, a need for HIV Consent Form).
For MRSA and VRE? It would also be consented by the patient especially if it is a rectal examination. Although through my surveillance so far, i have seen that there is increased probablity that a patient who comes in with either cellulitis, lumps, abscesses are commonly the patients who will turn out to be MRSA(+). Here in our country though, i have not heard of VRE (+) patient yet. Hopefully it never comes
For the signages, we are in the process of producing a general precaution signage to the patient's door, well to think it is for their relatives' protection and so will be the protection to all healthcare workers. for now, wemake use of signagnes that says "PLEASE WEAR MASK before ENTERING the ROOM" for droplet and airborne precautions (Airborne says please wear n95 mask...) and PLEASE WEAR GLOVES" for contact precautions. We are near to finishing another precaution signage with the general requirements and meanings of the different precaution with color coding. With that a letter to the patient informing him why we need to put up a signage.
Hope this would help.