Can someone please appease my paranoia?

gigglymo · Apr 25, 2011

So as a follow-up, in case any OTHER paranoid nurses out there search a similar situation. From the CDC: "The CDC does not list human breast milk as a body fluid for which most healthcare personnel should use special handling precautions. Occupational exposure to human breast milk has not been shown to lead to transmission of HIV or HBV infection. However, because human breast milk has been implicated in transmitting HIV from mother to infant, gloves may be worn as a precaution by health care workers who are frequently exposed to breast milk (e.g., persons working in human milk banks)."

I also called the AIDS Post-Exposure Hotline (judge me if you must) and the physician I spoke with said that this was an extremely...extremely....extremely...low risk situation. Apparently moms are tested during pregnancy...and if they're not, then the babies are tested at birth. An HIV+ mom wouldn't be breastfeeding, and even if she were, the risk of passing on HIV in milk comes from the fact that babies are consuming it in vast quantities as their only source of nourishment for several months...and even then, it's not a guarantee that it will be passed on. At one point, I told the Dr. that I had the distinct impression that he thought I was being paranoid and somewhat ridiculous. He said that he couldn't tell me there was NO risk, but repeated that this was not a situation where he would recommend prophylaxis, there are no documented cases of HIV being passed to an HCP this way, and repeated that this was an extremely...extremely...extremely low risk situation.

Considering the above information, and the fact that the infectious disease portion of the chart said, "Nothing notable," I'm going to chalk this up to (rather massive) paranoia and a lesson learned.

Akeos · Apr 25, 2011

"Apparently moms are tested during pregnancy...and if they're not, then the babies are tested at birth. An HIV+ mom wouldn't be breastfeeding, and even if she were, the risk of passing on HIV in milk comes from the fact that babies are consuming it in vast quantities as their only source of nourishment for several months...and even then, it's not a guarantee that it will be passed on. "

How can you have be a nurse and not already know this?!?!?!?!?!

gigglymo · Apr 25, 2011

I've worked with this patient population for approximately three days. I don't have kids.

Personally, I don't think comments like "How can you have be a nurse and not already know this?!?!?!?!?!" are helpful. You have peds experience. I have cardiac experience. Two totally different worlds - and while I'm clearly perfectly capable of doing the research on my own, sometimes it's helpful to hear from someone who's been there. That's why I asked.

allnurses Guide · Apr 25, 2011

I've been a nurse more than 30 years and didn't necessarily know that. Not to mention there are a fair number of women with no prenatal care. OB is not my specialty either. There is a great deal of specialized knowledge in different areas of nursing, and we don't all get the same level or type of education.

OP: glad you followed up for your own peace of mind, so now you have "official" and "peer" reassurance. I wondered how the human race survived anything after studying microbiology! lol

Akeos · Apr 26, 2011

I'm just saying, Since the way HIV is transfered is common knowledge, and especially as a healthcare professional you should know them, as a nurse and bsn, you should be able to critically think through the situation. it shouldn't matter what specialty you're in. You should be able to realize that HIV is transfered through breast milk..hence you should NEVER feed a baby breast milk if the mother is infected.. that information is in the chart! and if you were afraid that you would get infected with the milk you were feeding the baby, I think the bigger issue is that you even thought you were feeding a baby infected milk.. if that's the case I would be 100 times more worried about that baby than you. And someone should be getting in major trouble. Use your common sense and critical thinking skills.

gigglymo · Apr 26, 2011

Actually, exclusive breast-feeding for the first six months is recommended by both the CDC and the WHO, if the mother is unable to formula-feed exclusively or if she lives in an area with unclean water, as proteins in breast milk as well as those in saliva and the GI tract work to denature the virus.

Of course I know that upon thinking through this situation, it's in no way logical. Do YOU, in every situation, always come to the most correct and logical conclusion? I'd rather ask those who are more knowledgeable than me and who have more experience than assume that my common sense, whopping one year of nursing, critical thinking skills, and/or BSN are going to be the answer in every situation.

I very much appreciate everyone who was able to look past my paranoia and realize I was being irrational, and provide words of encouragement anyway. Sometimes we all need that.

Akeos · Apr 26, 2011

Absolutely I look to my peers and more experienced people for help in a lot of situations, however I did go to school for 4 years and realize that i should be able to think through a lot of situations on my own, and come to the correct conclusion. And you couldn't possibly be more wrong when it comes to HIV infected women..seriously the information your claiming to be correct is just scary! Once again lets logically think here, how could one of the few ways HIV is transmitted denature the virus... that makes no sense at all any way you look at it. Here's the ACTUAL CDC recommendations, not just ones that you made up. WOW it's seriously like you've never learned anything about HIV, educate yourself! http://www.cdc.gov/breastfeeding/disease/hiv.htm

TinyHineyRN · Apr 26, 2011

I have to think that CDC/WHO recommendation refers more to mothers and babies living in underdeveloped 3rd world conditions where the only choices are exposure to HIV or death related to dysentery from unclean water. Those women are between a rock and a hard place. They want to keep their child from starving, but the only choices they have will eventually kill the baby.

hiddencatRN, BSN, RN · Apr 26, 2011

Absolutely I look to my peers and more experienced people for help in a lot of situations, however I did go to school for 4 years and realize that i should be able to think through a lot of situations on my own, and come to the correct conclusion. And you couldn't possibly be more wrong when it comes to HIV infected women..seriously the information your claiming to be correct is just scary! Once again lets logically think here, how could one of the few ways HIV is transmitted denature the virus... that makes no sense at all any way you look at it. Here's the ACTUAL CDC recommendations, not just ones that you made up. WOW it's seriously like you've never learned anything about HIV, educate yourself! http://www.cdc.gov/breastfeeding/disease/hiv.htm

You might want to educate yourself as well. In areas where access to clean water isn't possible or reliable, the WHO does in fact recommend breastfeeding regardless of the HIV status of the mother.

"Exclusive breastfeeding is recommended for HIV infected women for the first six months of life unless replacement feeding meets five criteria -

that it is acceptable, feasible, affordable, sustainable and safe - before that time. When these conditions are met avoidance of all breastfeeding

by HIV-infected women is recommended (WHO 2006)." http://whqlibdoc.who.int/publications/2008/9789241596596_eng.pdf

linearthinker, DNP, RN · Apr 26, 2011

OFFS. Is this for real? Did you take any science classes in your nursing school?

hiddencatRN, BSN, RN · Apr 26, 2011

I have to think that CDC/WHO recommendation refers more to mothers and babies living in underdeveloped 3rd world conditions where the only choices are exposure to HIV or death related to dysentery from unclean water. Those women are between a rock and a hard place. They want to keep their child from starving, but the only choices they have will eventually kill the baby.

Yes, it does refer to third world countries- stats I've read show 60% of infants at risk of death due to malnutrition and diseases related to lack of access to clean water and breastmilk replacement....versus a high of 20% at risk of HIV transmission (and WHO data gives a much lower risk than that) from breastfeeding. In the US, with access to clean water and formula and government programs that provide formula, it's a no-brainer not to breastfeed. But without that same access to clean water and affordable formula, it's a much different decision.

gigglymo · Apr 27, 2011

Did I think I was feeding a baby "infected" milk? No. Did this somehow turn into a "who can outgoogle who" competition? Yes. Will I post an admittedly paranoid and highly unlikely scenario when all I'm really looking for is for someone to say, "Hey! I spilled boob juice all over the place too once! No biggie!" again? Unlikely. Do I understand that the CDC and WHO rec's refer only to moms in extreme situations? Absolutely - but I was disputing the statement that moms with HIV should "never" breastfeed. That's just not true, nor is it a guarantee that HIV will be passed on to the baby.

Sheesh. Once again, thanks to everyone who understood where I was coming from on this one.