Exposed to HIV, HBV, HCV

fergus51 · Mar 11, 2004

So everytime you enter a room you wear full PPE now including mask and goggles? Any room or just vents? Anticipating they may spew body fluids in your face, etc.? I've always worn gloves and used caution but....wow. I'm starting to wonder if my area of the country is very lax on this issue. I can't even FIND the whole range of PPE many days. Maybe this is something I need to bring up at the next nurse practice committee meeting.

Not every time we enter a room (unless they are on contact or isolation precautions, but that obviously doesn't cover HIV or Hep), but yes every time we can anticipate the possibility of being hit with bodily fluids, like in the case of a patient who is intubated (though gowning is not considered necessary since your uniform provides the same protection and same goes for gloves if your skin is intact, it's the faceshield that really matters). A face shield is preferable to me, cause I HATE the masks (wearing it 12 hours a day every day during SARS has caused some strong dislikes for me) and it's easy to just slip it on if it's sitting at the door. We don't have to do it in the NICU if the kid is in an isolette, because that acts as a barrier, but we do if they are in a crib and vented. And people with glasses still have to wear the goggles or a faceshield because glasses provide no protection from the sides.

I can't really say what it used to be like because SARS hit just after I arrived, but now they are HARDCORE about ppe. Every staff member had to go to a mask fitting session and an infection control session (2 hours and 8 hours long). People are so careful about intubated patients in particular because that is how some health care workers aquired SARS and a few died. In order to intubate adults at the time, I believe they were wearing the whole spacesuit, not just a faceshield. I would STRONGLY encourage you to press for PPE on the floors. Our union was instrumental in this, but as SARS showed us, it is SO important. I mean two nurses here are dead because they didn't use ppe, cause they were told it wasn't necessary. It was really sobering for a lot of us.

caroladybelle, BSN, RN · Mar 11, 2004

I have always treated EVERYONE as though they are positive for bloodbourne illness. But then, I started out in ID.

teeituptom, BSN, RN · Mar 12, 2004

I have always treated EVERYONE as though they are positive for bloodbourne illness. But then, I started out in ID.

Trust me. after me experience, treat them all as guilty untill proven innocent

Trauma Columnist · Mar 12, 2004

Gosh - working in the ER, we do use PPE, but again, people do cough, spit, sneeze, etc. However, we don't (as a rule) run around for a 12 hour shift with goggles and face shield on.

mattsmom81 · Mar 13, 2004

I can't really say what it used to be like because SARS hit just after I arrived, but now they are HARDCORE about ppe. Every staff member had to go to a mask fitting session and an infection control session (2 hours and 8 hours long). People are so careful about intubated patients in particular because that is how some health care workers aquired SARS and a few died. In order to intubate adults at the time, I believe they were wearing the whole spacesuit, not just a faceshield. I would STRONGLY encourage you to press for PPE on the floors. Our union was instrumental in this, but as SARS showed us, it is SO important. I mean two nurses here are dead because they didn't use ppe, cause they were told it wasn't necessary. It was really sobering for a lot of us.

I can understand how the SARS epidemic must have shook up Canadian nurses... I'm glad patients and families understand the precautions ya'll take.. Full precautions on all patients here would definitely catch flack from our families, as we have open visiting (a whole nuther nightmare...LOL) I've ran into problems with families visiting infectious patients...where I worried how to protect THEM....they did not know the dx and the patient did not wish them to. HIPAA again....

It really bothers me when I can't find face shields in my ICU for myself and my docs for procedures, etc. It bothers me to think another nurse would ask me to suction her patient and not alert me to an infectious dx.

Barring full isolation garb on every patient, personal judgment comes into play with PPE, and sadly we will not always be able to fully protect ourselves...in every situation....one of the risks of our job.

My hubby says I'm negative and sensitive about this issue so I'm gonna try and chill...I've been hurt on the job before and not treated well. My patient cultured MRSA sputum too with his other dx...I asked the hospital if they were going to followup with me on that, they said no. One of my coworkers is on disability now due to a MRSA infection that went systemic to osteomylitis, eating up her cervical vertebrae. The hospital is denying any responsibility.

One of my coworkers the other night said 'Don't ever let the EHN culture you (nasal swab)...we will probably ALL grow (colonize) MRSA and probably VRE...then you won't be able to work.' This struck me as a rather strange position to take.

I appreciate hearing from nurses who work directly with infected patients so I can judge whether my unit is lax or not, and try to improve things.

Thanks for everybody's input. :)

fergus51 · Mar 13, 2004

MRSA and VRE seem to be treated very differently in the US than here in Toronto as well. All our patients are screened at the point of entry and isolation procedures are followed. Our rates have decreased and remain low. Our infect doc said it seems like some places in the US have just stopped trying.

I would be really mad that a coworker didn't alert you to their patient's status before asking you to sx and I would be really mad you don't have the proper ppe on the floor (I mean, one simple faceshield would have prevented this, it doesn't take anything fancy). I don't even care if family members ask about my garb, I just give the standard "it's unit protocol" or "universal precautions" or "whenever we might contact fluids we are required to wear them, regardless of patient diagnosis". One of the reasons I won't work non-union anymore is because of bs like this. Too many hospitals put no value on the safety and health of their nurses.

mattsmom81 · Mar 14, 2004

We seems to approach issues and feel similarly in many cases Fergus...perhaps because I was raised in northern Minnesota (nearer Canada) and some of our culture and 'raising' was similar. :)

Thanks for letting me bounce some of these issues off you...it helps. I appreciate your responses greatly. I sure do miss my pro union environment back up home in Minnesota. I do feel sometimes like I'm 'flying alone' a whole lot in this non union, employment-at-will state. After 20 some years I should be adjusted but I guess not...LOL!!

I'm a strange duck...conservative, more or less Republican and pro-union...hehe.

After everybody's good input here, I recognize now I probably trust my coworkers a little too much and need to be more personally cautious. Our charge nurses keep a report sheet with dx and I will make it a habit to preview this; and will not be so quick to enter an unknown patient's room unprotected.

Thanks all and stay safe out there. Even an old nurse has to learn some new tricks.:)

fergus51 · Mar 14, 2004

LOL! Conservative republican and pro-union? You just might make it into a museum display;)

I do hope this kind of thing never happens to you again. Too much stress for no reason.

panda_181 · Mar 14, 2004

I think that's just horrible! Something needs to be done...talk to whoever you have to so that this is fixed and you're looked after.

Amanda :)