While we always inform each other of a pt's positive HIV status in report I don't do anything special beyond that. HIV is not that easy to catch, nothing near hepatitis and, honestly, I take more precautions when I encounter conjunctivitis, scabies or bedbugs.
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.
Gosh..In my haste I didn't realize that I typed PCP, and meant PPE instead.
Before the HIPPA law, in NYC, when I would visit an AIDES patient, their neighbors would follow me and pepper me with question like"Does he have AIDES?" Is it dangerous to have his garbage near me" I would not answer their questions, but a lot of other people did! After HIPPA I could just say I'm not allowed to discuss anyone that I visit as a nurse. Case closed. Also, people would come up to you in the hospital cafeteria ask "concerned" questions." And health care workers would discuss patients on the subway and use their names!
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.
Actually in California, we can legally test for HIV in case of a needle stick...without patient consent.
why aren't all patients given the swab test for hiv upon entrance to a hospital so nurses can take extra precautions?
what "extra" precautions. i already don't have sex with any of my patients, or share needles with them - and i try as hard as i can to not stick myself with anyone's needle.
My friend who is a dentist said that she takes every precaution when working on every patient but that she definitely has a heightened awareness while working on her HIV patients.
Nothing wrong with a heightened awareness, nothing discriminatory about that.
I have a heightened sense of awareness regarding the lack of insight, knowledge, judgement, and professionalism of your dentist.
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.
I was watching one of those "Life in the ER" type docudramas the other day. An MD was inserting a chest tube in a patient with a tension pneumothorax and when he cut into the chest, blood exploded out, covering his face, in his eyes, his mouth.
The patient then told him he was HIV+. The doc was angy that the patient had not told anyone. (He ended up not getting infected.)
I remember thinking, "Why in the hell would you not wear PPE when slicing into any pressure and blood filled cavity, HIV or not?"
Specializes in Spinal Cord injuries, Emergency+EMS.
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.
doing a HIV test is much much more than just drawing the bloods there are requirements for pre and post test counselling ... who is going to do that for every inpatient ... what about people who can't consent...
Universal precautions are universal for a reason ... if you follow them there is a much reduced chance of a needlestick / other body fluid exposure and if you do get an exposure when following Universal precautions and safe systems of work the chances of infection are much reduced ... HIV is the least of your worries as a relatively fragile virus that requires significant exposure - and often blood to tissue in a penetrating injury with the innoculation of a volume of infected fluids vs Hep C which is much more robust and requires less exposure to contract.
In general the over-reaction to needle sticks and expsoure to MRSA seems to come from Posters based in the USA , perhaps there is a cultural factor at play ditto for the 'Narcotic Panic' that seems to pervade when Opiates or Benzos are discussed
In Oklahoma the Disease Intervention Specialists are the ones to inform people of their status almost all of the time. That's one of the job requirements we have as well as partner notification and rapid testing. We do all the counseling and referral to the IDI clinics and case managers. Here, the state govt knows before most doctors offices, so very few places actually perform rapid HIV testing...
You think a hospital setting is bad? Some of my coworkers have had to draw blood in the field at a crack house/prostitute's house/and the back seat of cars. We've had IV drug users threaten us if we blow their last good veins. If we don't have a high infection rate, I wouldn't be too worried about being in a hospital environment. I can't remember the last time we had a nurse test positive for HIV because of work exposure, normally they were having unprotected sex or using drugs themselves.
There are some states that are now trying to make it adequate to diagnose someone as HIV+ after TWO rapid tests. We are not happy about that.... There is also a push to make it where you have to actually opt OUT of HIV testing.
It's not the HIV pts I know about that worry me. Heck, it's not really even the HIV+ folks I don't know about that scare me. I'd almost have to be trying to catch HIV from them, and sometimes even that wouldn't work.
It's prions like Creutzfeldt-Jakob that scare the bejeebers out of me. And viruses like HepC for which there is no cure, no vaccine, and that can live for a week on fomites. That's what worries me.
The only reason we test pregnant women during pregnancy, usually around the 28-week mark in my state, is so that we can treat her during labor (or do a section) and treat the infant with AZT after birth. This reduces the likelihood of vertical transmission. It's not for protection of the healthcare workers caring for them.
Testing everyone is WAY too expensive and is opening a great big can of worms IMO.
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Floyd Nightingale
8 Posts
While we always inform each other of a pt's positive HIV status in report I don't do anything special beyond that. HIV is not that easy to catch, nothing near hepatitis and, honestly, I take more precautions when I encounter conjunctivitis, scabies or bedbugs.