Colleague bitten by pt--what should be done for the bitee?

elkpark · May 28, 2005

I had a similar situation in the past (it was me that was bitten, and it was a pretty serious bite). The hospital IC nurse, when contacted promptly, asked me if I "had had (my) shots" (literally, a direct quote -- I felt like someone's dog), and felt that was the end of it. I went to the local ER on my own to get treatment (the supervisors at the psych hospital where I worked didn't think it was any big deal that I had a hole in my thigh (the client bit right through my pants!)) and blood running down my leg.

The ER doc who saw me put me on a course of prophylactic antibiotics, which I understand is pretty standard because the human mouth is so filthy. Shortly after that, when I happened to be at a conference on universal precautions, I asked one of the presenters about my situation and whether the IC nurse should have taken more of an interest or done anything more. Interestingly, the presenter's explanation was that, in situations like that, the concern is for the biter, because, technically the biter is at greater risk from being exposed to my blood than I am from being exposed to the biter's saliva. In IC circles, apparently, it is the biter who is considered the "victim" in terms of exposure (to the sorts of things that can't be handled by ABx, that is ...)

Katnip, RN · May 28, 2005

I think it varies by state law. You cannot draw blood in a situation like that without pt consent in most states.

I know in Maryland, very soon that will change and we can take blood without telling the pt that we're testing for hep or HIV. About time.

ValerieB · May 28, 2005

I think it varies by state law. You cannot draw blood in a situation like that without pt consent in most states.
I know in Maryland, very soon that will change and we can take blood without telling the pt that we're testing for hep or HIV. About time.

I agree, it's about time. :uhoh21:

chris_at_lucas_RN, RN · May 28, 2005

Thank you so much. This makes a lot of sense. I do think they should be able to draw and test the biter's blood, since he was well aware of his situation and knew right from wrong at the time. No dx of psychosis, just a depressed conduct disorder involved in an exciting melee at the time.

Still, at least I can quote (even if it is second hand) substantive reasoning for how he has been treated. He's taking Augmentin. The least they could have said was, take it with food. He was nauseated from it until I told him to eat.

What a world.

Thanks, all....

I had a similar situation in the past (it was me that was bitten, and it was a pretty serious bite). The hospital IC nurse, when contacted promptly, asked me if I "had had (my) shots" (literally, a direct quote -- I felt like someone's dog), and felt that was the end of it. I went to the local ER on my own to get treatment (the supervisors at the psych hospital where I worked didn't think it was any big deal that I had a hole in my thigh (the client bit right through my pants!)) and blood running down my leg.
The ER doc who saw me put me on a course of prophylactic antibiotics, which I understand is pretty standard because the human mouth is so filthy. Shortly after that, when I happened to be at a conference on universal precautions, I asked one of the presenters about my situation and whether the IC nurse should have taken more of an interest or done anything more. Interestingly, the presenter's explanation was that, in situations like that, the concern is for the biter, because, technically the biter is at greater risk from being exposed to my blood than I am from being exposed to the biter's saliva. In IC circles, apparently, it is the biter who is considered the "victim" in terms of exposure (to the sorts of things that can't be handled by ABx, that is ...)

rjflyn, ASN, RN · May 28, 2005

I dont know much as far as any thing out side the acute hospital setting. Contrary to what one poster stated most states actually have laws that allow for testing of a patient of an exposure to body substances occur. Specificly I know IA, FL AND MI, have such laws. Also by not attempting to test the person who caused the injury a facility may be opening themselves up to liability. Most hospitals as well when a patient consents for treatment they consent for this type of testing as well.

Also make sure as a healhcare worker a report of the assault to the police is in order, I know in my current state that such assault is most likely going to be a felony. FL law is written as such that any assault on a healthcare worker gets upgraded one level in severity ie mistameaner becomes serious mistameaner becomes felony ect.

Rj

Daytonite, BSN, RN · May 28, 2005

No, there is no mandatory blood draw of the biter. He can be asked if he would submit to the testing. He would have to be counseled and sign a consent like any other patient being tested for HIV. However, he has the right to refuse. Sorry, I know that is not the answer you were looking for.

sbic56, BSN, RN · May 28, 2005

One of the techs on my inpatient psych unit was bitten by an adolescent patient. The skin was broken, and a small flap of skin on the back of his hand was hanging by a small piece of skin. At my insistence, the tech reported it immediately, was sent next door to the "real" hospital, and was treated.
Our infection control nurse offered to have blood drawn on the tech but not on the patient.
Am I missing something here? Drawing blood on the tech might protect the hospital in case the tech later develops something and they can prove he probably already had it, I guess.
I thought there was a mandatory blood draw on the biter to discover if he was carrying any goodies (HIV and hep for starters), so that a prophylactic protocol could be started until there was an all-clear.
But just in case I am missing something obvious, I thought I'd run it by you guys first.

In Maine, even if the source person refuses, the courts can order a blood draw for testing. The only stipulation is that the person receiving the exposure agree to have their blood tested first so their own HIV status is determined.

Demonsthenes · May 29, 2005

It is imperative to report this bite to Texas Workmen's Compensation and the Texas Workforce Commission immediately such that ,if this tech develops AID's from the bite, he will receive compenasation from the same. Employers are known to have terminated employees under false pretexts, if they think that the employee was exposed to the AID's virus on the job, especially if the employer did not take appropriate precautions to protect employees from known AID's patients and/or potentially violent patients.Also, Workmen's Compensation will pay for AID's testing under the circumstances. He should take the AID's test immediately to prove that he currently doesn't have it such that, if he subsequently develops it, it was the result of the bite.

The incident should be reported to the police as this case involves assault and battery. Also, the tech should seek the advice of an attorney with regard to all of the aforementioned such as to obtain any actual and/or potential damages because of any intentional and/or negligent criminal acts that caused him damages.

I am not an attoreny. :uhoh21:

PicklesRN, RN · May 29, 2005

One of the techs on my inpatient psych unit was bitten by an adolescent patient. The skin was broken, and a small flap of skin on the back of his hand was hanging by a small piece of skin. At my insistence, the tech reported it immediately, was sent next door to the "real" hospital, and was treated.
Our infection control nurse offered to have blood drawn on the tech but not on the patient.
Am I missing something here? Drawing blood on the tech might protect the hospital in case the tech later develops something and they can prove he probably already had it, I guess.
I thought there was a mandatory blood draw on the biter to discover if he was carrying any goodies (HIV and hep for starters), so that a prophylactic protocol could be started until there was an all-clear.
But just in case I am missing something obvious, I thought I'd run it by you guys first.

The obvious is that the laws need to be changed. In many states (all???) you must obtain permission from the patient, or in this case the patient's parents/guardians.

If nobody attempted to obtain consent from the guardian, the bitee should be pushing to attempt this.

It's the same as when my sis was raped. This was when we didn't have a lot of info about HIV, clearly she wanted him tested for all the usual dx's but ... he refused. He had the right.

The upside is that the judge did was pubic hair samples, as well as other samples. My sis was dating a police officer at the time. It was his buddies that helped to obtain the samples. Sometimes what we put out in this world comes back to bite us... in the pubic hair region.

johnjrb · May 29, 2005

I am a nursing student in Texas. I know when we had the infection control nurse at our hospital talk to us, she that they would first voluntarily try and get the patients consent. If they patient did not agree she said that they could force the patient to be tested.

JessicaInOr · May 29, 2005

I am a nursing student in Texas. I know when we had the infection control nurse at our hospital talk to us, she that they would first voluntarily try and get the patients consent. If they patient did not agree she said that they could force the patient to be tested.

How can you force anyone to cooperate? How could you force them anymore than you can force treatment when the patient refuses? Force how? Via the courts? Or sitting on the patient until they give up a blood sample? At what point is it assault?