Ethics: Does knowledge of a patient's blood borne pathogen change your care?

Nurses General Nursing

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I'm sure we have all had patients with various blood borne pathogens... HIV, AIDS, Hep B, etc.

If the patient is under your care for an unrelated issue, do you find that they may generally be treated any differently? Do you aware the CNA/PCA who also may be working with the patient?

Just looking for different view points from a bed-side nursing perspective.

Thanks

Specializes in ICU.
I don't treat them different. I treat me different. And I'm sorry to have to admit that. I should know better, but I can't help it. For example, an individual without any of these bloodborne diseases may not warrant me using gloves to change their pillowcase...someone with HIV, I may put gloves on to change their pillowcase. I know, it's overkill. I can't help it. And to be completely opposite than most of you, I'm not one to just follow crowds and post what everyone else likes to agree with, I would not hug an HIV positive pt. Nope. Sorry. Bash me if you please.

You should wear gloves when changing any pillowcase, not just for your protection, but for your patients. How do any of your patients know what is on your hands, if you deem some not needing gloves for what you think are trivial things? I don't get that. If your patients are in the hospital, most likely their immune system is compromised. Maybe not like someone with HIV, but nonetheless, when you are sick, your immune system is compromised at for something, even if they are just getting routine antibiotics.

And you would not hug someone with HIV? That is crazy to me. There are so many other things you can get from hugging somebody but you won't from the HIV person, where you cannot even remotely get it. That boggles my mind. Maybe some remediation in pathology and microbiology is needed for you.

Heron, I stand corrected. I falsely assumed that in the year 2015 people were educated on these things. I can remember being in high school in the early 90's and it was drilled into our heads about how HIV was transmitted. I grew up in the Magic Johnson era and I think when he got it, it really became real. I loved watching him on the Lakers and loved watching him and Larry Bird go at it. Then, when it was discovered he had HIV, I remember the controversy over him playing and being on the Olympic team. Fortunately for him, he had the money to pay for what has essentially been a cure for him. From what I understand, it's not even detectable in his blood anymore.

I just thought as a country, we were over those kinds of thoughts that a hazmat suit should be worn around a HIV positive patient. Especially, in the medical community. Guess, I was wrong. Every patient should be treated with precautions for their protection and yours. You should be careful of every needle, because of a stick. With hospitals not having universal charting, you have no idea what that person's real medical history is. A person may not tell the ER doc what they have or the orthopedic doctor. And if they are being treated by a physician in another hospital network for HIV or any other bloodborne disease, you at that hospital may not know. That's why when you go in for any procedure or are admitted, they ask you upon admittance if there a healthcare worker comes into contact with your blood, can they test it for certain diseases.

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Specializes in Dialysis.

As sad as it sounds, with all of the safety gear, precautions, info, etc. out there, I'm more afraid of contacting cdiff. I've seen CNAs handle bedpans and other items without PPE, except gloves. They, along with some nurses, don't seem to believe that this is a horrible illness to come down with!

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OP didn't come in complicated and worried. OP came in as if he as just doing some research.

I don't think my hospital's IRB committee would approve of doing "research" (?) on what is essentially an anonymous discussion board with no consenting procedures.

I did not come in here looking to offend anyone, and if choice wording led to that I apologize.

Please trust me when I say I wish I was still at the point in my life where I had homework!

I'm happy to have facilitated discussions and it is interesting to see the different view points this thread has brought up. Thanks for the contributions.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
You don't think that there is an inherent bias created when disclosing PHI that isn't relevant? Given universal precautions, why should it matter?

Is this homework?

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
For every patient dx'ed with HIV, Hep B/C, there are several who have not yet been diagnosed. So, are you advocating that staff should be warned about patients with these diagnoses and practice "extra special, super-duper universal precautions," while the other patients are to be presumed safe enough to do a hemi-gluteal job protecting themselves from the rest of the patients?

My vote is for following proper PPE procedure for universal precautions. There's no such thing as sorta-kinda adhering to universal precautions.

Edit: stupid autocorrect!

Hemi-gluteal! That's a new one for me. Love it!

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Specializes in ICU.
As sad as it sounds, with all of the safety gear, precautions, info, etc. out there, I'm more afraid of contacting cdiff. I've seen CNAs handle bedpans and other items without PPE, except gloves. They, along with some nurses, don't seem to believe that this is a horrible illness to come down with!

It is horrible. My mom has had it 3 times. It almost killed her. It's horribly painful and just the amount of fluid loss was crazy. It's more than just some foul-smelling diarrhea. She gets it when she has to take any kind of antibiotic whatsoever. Her immune system is not very strong and if she gets something like strep which requires and antibiotic, she ends up in the hospital in isolation. It usually comes from a public restroom or something like that. People don't think about how nasty even the faucets to turn the water on and off are. They are touched before people wash their hands so it gets all over them. Then you wash your hands, turn them off again and bam, you can get c-diff if your immune system is not up to par for whatever reason. After my microbiology class two years ago, I don't look at anything in our world the same again!! :nailbiting:

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Specializes in Hospice.

@heathermaizey: yours is the rational approach, but since when is fear rational? Whether from misinformation or social prejudice, it exists and healthcare workers are not immune. As a supervising nurse, it behooves me to keep an eye out and make sure the issue doesn't manifest at the bedside.

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No, I don't treat them any different. Why would I? A little more caution when doing things that may involve blood, yes, but that's about it. And yes, I alert my CNAs when I give them report.

Without reading this whole thing again I can't tell if I already answered this, but this attitude is not good for two reasons:

1) You are completely unable to be certain of ANYONE's status regards blood-borne illness of any kind. Period.

2) Therefore, if you are "a little more careful" with only the ones who are diagnosed, and not exercising the same level of practice regarding universal precautions with the others, you

2a) put yourself at increased risk of infection and

2b) by telling your CNAs that, you decrease their commitment to UP and therefore increase their risk of infection

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Specializes in School Nursing, Hospice,Med-Surg.
And to be completely opposite than most of you, I'm not one to just follow crowds and post what everyone else likes to agree with, I would not hug an HIV positive pt. Nope. Sorry. Bash me if you please.

I'm not bashing you, I guess. But I am saying this:

This makes me very, very sad. Like, a lot. Withholding affection or compassion that you would give to any other patient simply because of a disease that you absolutely CANNOT catch through a simple hug is sad and ignorant.

I hope someone would give me a hug when I needed it, HIV or not.

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Specializes in critical care.
I'm not bashing you, I guess. But I am saying this:

This makes me very, very sad. Like, a lot. Withholding affection or compassion that you would give to any other patient simply because of a disease that you absolutely CANNOT catch through a simple hug is sad and ignorant.

I hope someone would give me a hug when I needed it, HIV or not.

I wanted to say exactly this but gave up because I couldn't find the words. I recently had an HIV patient and he was downright nasty to most of the staff. We got along great, though. I had him for 3 straight, all nights so I had time to spend with him. He was a hilarious person, and we got some great laughs in while I got to help him get better. I provided for his comfort, and treated him like any other person.

Turns out..... A lot of people around here, nurses included, are afraid of HIV. He knows it. When a person can't even put their hand on his shoulder without first grabbing gloves, he's put off by it. I admit - he was overly sensitive to this, but some of his frustration was legit. When I conducted the initial part of my assessment of him without gloves, his guard went down. It was like this instant sigh of relief filled the air.

People crave comfort, affection. Not everyone is the comforting type, and I wouldn't expect them to be. I am, though, and I'm not afraid of the bugs we know about. I'm more afraid of the ones we don't. Heck, every single person that sneezes in your direction could have TB. If you're my patient, I'm going to hold your hand whether you have HIV or not.

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Specializes in ORTHO, PCU, ED.

To add to how appalled some of you are that I would not hug an HIV+ pt, I don't generally hug my pt's period. What do yall do? Just go around loving on strangers with diseases? I don't hug patients hardly ever unless they reach out to hug me then certainly I hug them back and show a caring shoulder.

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Specializes in ORTHO, PCU, ED.
You should wear gloves when changing any pillowcase, not just for your protection, but for your patients. How do any of your patients know what is on your hands, if you deem some not needing gloves for what you think are trivial things? I don't get that. If your patients are in the hospital, most likely their immune system is compromised. Maybe not like someone with HIV, but nonetheless, when you are sick, your immune system is compromised at for something, even if they are just getting routine antibiotics.

Are you a nursing student or an RN? I completely disagree. It is not always necessary to wear gloves when changing a pillowcase. If they are THAT immunocompromised then we should wear gloves when handing them a glass of water. That's ridiculous.

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