alternatives in admitting dx: hiv

[SNB1014, RN]

originally this was break room discussion, but it was confirmed by a veteran RN on our unit that we have HIV?/AIDS patients who are admitted inpatient with a admitting dx: on the change of shift report as "communicable/community acquired pneumonia/communicable illness" etc.

at the same time, I see patients who have their admitting dx is HIV exacerbation r/t complicated UTI (or vice versa).

does your unit/facility have any other "confidential pseudonyms" that could help be target my care best and someone could be kind enough to "tip me off to"???

I am now told that a patient may chose to keep their HIV status private to medical professionals. Wow, i feel uneducated, naive and flabbergasted. I would think you would want the best and appropriate care to be given to you as well as wanting your RN and various other to take protection measures to ensure they don't become ill or spread the disease.

Is this because "oh well its contact precautions anyways, etc we don't have to treat them different? (and i don't believe i do, i treat this population as a human who deserves privacy, respect, dignity and quality care, just like the guy next door over!

as an employee who provides direct contact care, isn't that my right to know for my safety?if i have a pt i *believe* needs to be screened for HIV, must I tell him this is what I am getting this culture for? Because I have seen people come in and swab for cultures and leave, wham Bam,

i suppose i feel uneasy because i KNOW i have used excellent hand hygiene after KNOW contact w hiv/aids, but now i'm like "omg crap, wha about.....?"

thanks for all the replies, helpful and those not so much

[hiddencatRN, BSN, RN]

We call it "special immunology" but we all have been told this is code for HIV+. We do this to protect the patient's privacy from nonmedical folks who might be listening in- visitors, other patients, etc.

[Asystole RN]

There was (and in reality still is) such a stigma attached to someone with HIV that caregivers would refuse care or at best deliver sub-par care to someone identified with HIV. I thought I came across a law once that gave special protection to the identification of patients infected with HIV, might have been a local state law, I'll check.

Side note:

I once had a CNA who was from Africa who absolutely refused to care for a patient with HIV and walked off the job then and there, this was about a year ago.

[Altra, BSN, RN]

A few points:

HIV+ status does not require contact precautions, only standard precautions. What concerns do you have about "spreading the disease" as an RN caring for the patient?

What "cultures" are you obtaining for HIV? HIV testing is a serum blood draw. You are correct, it does require a specific signed consent from the patient.

Realize that patients who present to a new hospital system for the first time sometimes provide incomplete histories for a number of reasons other than intentional withholding of information.

[jadelpn, LPN, EMT-B]

The initial assessment discsusses PMH. Should the patient not want to reveal their HIV status, then wellll they are not going to reveal their status. Standard precautions, if pneumonia then droplet precautions. It is highly unlikely that one is going to get HIV from general caring for a patient who is positive. The spread of HIV is through the sharing of needles and unprotected sex. So unless any of that is happening, or you stick yourself with a needle from an infected patient (

Any sputum cultures obtained would be cultured for the bacteria to ensure proper antibiotics are used, not whether the patient is HIV+. HIV virus dies when hitting the air. So in other words, sputum in a cup is not going to give you HIV. A patient coughing on you, although gross if ANY patient does, is not going to give you HIV. The stigma attatched to the disease still is why most people don't like to reveal their status.

And it is illegal in most states to obtain a blood sample from anyone and test it for HIV without their consent--which is a seperate consent form.

[jadelpn, LPN, EMT-B]

BTW the best thing you could do for yourself and your patients is to get educated on today's HIV. It is thankfully, no longer a death sentence for most. A relative of mine has been living with HIV for well over 20 years. So the likelyhood of a nurse caring for a patient with HIV related illness is high, as with the new drugs that are available it is chronic condition rather than a terminal one. Make use of your infection control nurse. She has lots of reading material on HIV I am sure.

[all517]

I was aways taught standard precaution with the notion to carry yourself like anyone has any infection (washing hands, wearing gloves, safety with sharps...). That is the standard of care in order for you to keep your patient and yourself healthy. As for "spreading the disease"... HIV+ or not, following general safety is meant to ensure preventable needle sticks. Many of these patients feel treated differently immediately after making their "diagnosis" public, thus possibly withholding this info. Because of their weakened immune system, the RN should be protecting the PT from any further infection, not the other way around. I was always taught any further contact/ special precautions for a pt who happens to be HIV+ (barring another dx), is for the patients safety.