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

[JMed18]

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

[CloverPark, BSN, RN]

When I was a CNA at a small, not so great (bad actually) hospital that was ready to shut down, I was assigned as a sitter for a patient once who I was made aware had Hep-C. Made no difference to me. I didn't know her full diagnosis since I was a CNA, but she was not alert/very sleepy most of the time, and was having mental/behavioral issues, thrashing out at times (she had restraints on). Anyways, the nurse- who was on the "older" side- said to me at one point when she came in the room: "I'd be wearing gloves if I were you, and I'd keep them on the whole time I was in here. She has Hep-C... There's probably Hep-C all over this room," with this disgusted look on her face. This was all said right in front of the patient. I wanted to slap her. At that same hospital, they put another Hep-C patient on isolation... This was all just 5 years ago. So I have definitely met nurses who are biased and in serious need of education.

[That Guy, BSN, RN, EMT-B]

As long as you don't eat the alphabet soup you should be fine.

[LightMyFire]

I'm reminded of a time when I had a student and we had the opportunity to start an IV. I mentioned the patient's HIV status and she got really nervous. I asked why, since we're following universal precautions. I'll never know if she didn't get the IV because she was nervous or inexperienced. Sometimes I think I shouldn't have mentioned it but wouldn't it have been unethical not to? I trust that she will protect herself but what if something had happened? On the other hand, it doesn't affect my care and I hope it doesn't affect hers either.

[metamedicine]

I wouldn't, you have to treat all the patients with precaution, i.e. gloves, wash in wash out, etc. CNA's can check the signs at the door for contact precautions, but they are also trained to glove when dealing with bodily fluids.

[Dranger]

As an addendum, HIV really doesn't bother me. Transmission rates are extremely low with healthcare workers (0.3% needle stick transmission rate last time I checked) and the virus is very weak outside of the body.

I mention Hepatitis C and to a lesser extant B (even though B is way more infectious) because most nurses have little to know knowledge of how persistent and hardy the virus is and how many different serotypes exist. In some patient populations (IVDU/prison areas) the prevalence rate is very very high. Folks with liver failure secondary to hepatitis also tend to bleed a lot and I have many a situation during codes where blood was everywhere.

It's just good to be informed, that doesn't mean you treat the person any different.

[Tenebrae, BSN, RN]

It doesnt change the level of care I provide, I endeavour to provide a high standard of nursing care to every patient I work with.

We are all supposed to use universal precautions, however sometimes people take short cuts. I would advise my health care assistants that patient X has a pathogen in their blood so ensure all appropriate precautions are used

[Ruby Vee, BSN]

You should wear gloves when changing any pillowcase, not just for your protection, but for your patients. .

Wearing gloves to change a pillow case is overkill -- unless your patient is in isolation. Even then, gloves protect the nurse, not the patient. Because, you know, you should be WASHING your hands . . . .

[Nonyvole, BSN, RN]

Short answer: no.

Long answer: why should it? People who have Hepatitis/HIV/the plague don't ask to get it. The people who need to know, know, and the people who don't, don't.

[blackvans1234]

I had a Nursing aide get mad that I didn't tel her the patient had HIV.

"Use precautions as though every patient has HIV"

I don't see the big deal.

[canigraduate]

I had a Nursing aide get mad that I didn't tel her the patient had HIV.

"Use precautions as though every patient has HIV"

I don't see the big deal.

Because aides come into contact with more bodily fluids than anyone else on the floors. It is courteous to let them know when to be extra vigilant about accidental exposures.

[iluvivt, BSN, RN]

Not sure if anyone has pointed this out yet since I have not read all the post yet but it is, Standard Precautions not Universal Precautions. The name was changed in 1996.

[iluvivt, BSN, RN]

I do share this information with the nurses aids! It can be transmitted via Blood, semen, lady partsl secretions, vomitus, breast milk or pus.

Standard precautions are meant to reduce transmission of bloodborne pathogens and they do no eliminate it. The source may be recognized or not. Sure, if used correctly they are highly effective but not foolproof. Many workers may also be a bit reluctant to report occupational exposure or injuries and if they know upfront I am certain they will speak up should exposure occur!