Patients should ALL be swabbed tested for HIV

Tait, MSN, RN · Jul 8, 2011

Because we stopped alienating, segregating, and isolating HIV+/AIDS patients a long time ago.

We have standard precautions for a reason, to protect ourselves, and to protect the privacy of our patients. I have had new grads flat out refuse to walk into an HIV+ patient room because of old school fears. Some of those patients have been my best, most compliant patients.

I assume everyone has HIV/Hep C and protect myself accordingly. My fear can be contained in procedure and does not require me to label them for it to work.

Babies are a different case because they need to be aware of all possible infections and suppression on their systems. I don't have more research on this at the moment, but am sure some of the following posters could provide more succinct evidence to this.

Orange Tree · Jul 8, 2011

The most recent needle stick post I've seen mentions that the patient was confirmed to be HIV and hep C + before the stick....and it sounds like the nurse was very cautious- it was just a weird, freak thing

**NickiLaughs, ADN, BSN, RN** · Jul 8, 2011

I don't think that would make a significant difference, other than ostracize patients even further.

Here's two things I assume of every patient:

they may have a blood borne disease (Hep C, etc)

they are unpredictable and may attack me at any time (I worked in a prison, but I've had little old ladys in various units do the same thing).

I think it's a good belief for anyone.

I also think that regardless of how good our precautions are, it is a risk we take as nurses. I hope the best for all needle sticks.

Picklefreak · Jul 8, 2011

What "extra precautions" should a nurse take when treating an HIV + patient?

heron, ASN, RN · Jul 8, 2011

To answer the OP, cost effectiveness. With standard precautions, transmission of HIV is pretty much impossible unless there's an accident.

Hard to see that there's still such fear when the epidemiology has been well-known for 40+ years.

RNTOBE_1970 · Jul 8, 2011

Universal Precautions work with all patients. Another tip, if you think you need to use PCP, then you probably do. I am so flipping tired of hearing from exposed employees "I always am extremely careful when caring for an HIV patient". Yet they present with an eyesplash from bloody sputum while suctioning-never protected their eyes/mouth. Or, "I am always so careful with Hep C patients" and there they sit with a hollow bore needle stick injury after RECAPPING a dirty needle, OR failing to activate the safety mechanism...or, starting an IV and leaving the needle in the linen. Just my 2 cents.

RoyalPrince · Jul 8, 2011

Will u take a pay cut so each and every patient gets HIV swabbed - the collecting, the recording, the test itself?

How about Hep C?

Standard Precautions protect the nurse, each and every needlestick has one loophole - "Ohh It just moved all of a sudden" or the bed wasnt high enough and RN had to maneuver etc etc..

ChristineN, BSN, RN · Jul 8, 2011

In some states, testing all pts for HIV without their consent would be an invasion of privacy. I know when I worked in PA you could not do an HIV test on a pt without their consent, even in a needlestick situation. While some states will let you test without consent, it's too much of a legal nightmare to routinely test pts for no reason.

BabyLady, BSN, RN · Jul 8, 2011

needle stick postings break my heart!
why aren't all patients given the swab test for hiv upon entrance to a hospital so nurses can take extra precautions?
i realize that the test is not difinitive but it would alert nurses for those that test positive.
i also realize that nurses take precautions with every patient but surely they would be more aware and more cautious with an hiv patient.
patients in labor are tested prior to birth, why not everyone?

because if you are practicing universal precautions there is no need to know anything any differently.

i have seen nurses start iv's with no gloves, get blood all over their hands, etc.

they shouldn't be crying later if they find out the patient is positive.

i would never, ever advocate for hiv testing of all patients.

BabyLady, BSN, RN · Jul 8, 2011

In some states, testing all pts for HIV without their consent would be an invasion of privacy. I know when I worked in PA you could not do an HIV test on a pt without their consent, even in a needlestick situation. While some states will let you test without consent, it's too much of a legal nightmare to routinely test pts for no reason.

No testing is done in any facility in any state without your consent.

Kinda falls under that "right to refuse" aspect of healthcare.

I had a nurse in the OR after I had major surgery to stick herself with a sharp and they came back into my room to do a blood draw for HIV testing. My veins were not good after the surgery and after they stuck me 3 times I refused to allow them to stick me any more. I told them that I would allow them to draw in a couple of days but right now, I was in so much pain I didn't need anymore...so they stopped.

So I allowed them to do the blood draw two days later. So yes, you have the right to refuse.

heron, ASN, RN · Jul 8, 2011

As we've seen, the stigma persists. HIPAA notwithstanding, test results get out and can create endless problems for pt, family, friends and facility. I've seen it happen.

My involvement with HIV/AIDS goes back to the 80's before testing was available at all, so I'm perhaps a little oversensitive to the stigmatization and avoidance that still occurs.

The only rationalization for blanket testing that I can think of is to uncover previously unknown infections ... but you'd have to also provide the counseling and education for new positives, as well. Runs to a lot of time, money and aggravation for all concerned for very little to no return.