Patients should ALL be swabbed tested for HIV

[Cathylady]

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?

[klone, MSN, RN]

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.

But what does that mean? Are you going to treat the patient differently than you would anyone else?

From a practical standpoint, tell us specifically what you would do differently if you knew the pt was HIV+?

[cherrybreeze, ADN, RN]

As recently as 2007, I was on an EMS program rotation at a large trauma center. I watched as an ER registration clerk at a large trauma center donned gloves before approaching a patient (an HIV-positive patient very familiar to ER staff) to ask him for demographic information. After the patient signed some forms, the clerk held out a trash can so that the patient could throw away the pen without her touching it again.

I'm sure that this clerk was doing what seemed right to her, taking precautions above and beyond what was recommended by any training she might have received. But those extra precautions left me, the other students and surely the patient with bad tastes in our mouths.

Bad taste indeed. Shame on her.

It might have seemed right to her, but it wasn't right (as we know). How must that patient have felt, too? There is no risk from touching the same pen he touched, for crying out loud. The pt must have felt terrible and if anyone else was watching (staff and public alike), that would have made it worse.

People need to educate themselves.

[klone, MSN, RN]

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.

And even then, pregnant women can decline the test as well.

[klone, MSN, RN]

People need to educate themselves.

Perhaps starting with the OP.

[Elvish, BSN, DNP, RN, NP]

And even then, pregnant women can decline the test as well.

True. I've never heard of anyone at my place decline after we tell them why we test, though.

[klone, MSN, RN]

True. I've never heard of anyone at my place decline after we tell them why we test, though.

We have a few women refuse everything, just on general principle. I always wonder why they're choosing to birth in a hospital, rather than at home.

[yankee nurse09]

I may be going a whole diff. direction with this but I just heard about a major hospital not to far from where I work that was starting to test everyone who entered their ER between ages (15-65 ish) ?? for HIV, their reasoning ....didnt really specify that it was for the safety of healthcare workers they were saying that it is no longer a death sentence and the majority of the people that came into the ER that actually had HIV werent even aware....so it was more of an awareness type thing for the patient ....which I think is a great idea! However, would I treat them any different? NO, use your precautions that yoU have been taught...you will be fine. It really makes me sad to see healthcare workers of alllll people treat these patients so badly ....really sad, not touching a pen bc someone has HIV and touched it....seriously?!! shame on you...remember these are PEOPLE for heavens sake...

[Elvish, BSN, DNP, RN, NP]

When I was a brand new nurse I had a HIV+ patient with an abscessed dialysis access that was pressure wrapped and due to be taken out the next AM. He took the pressure dressing off for a few minutes and I walked out of the room for a few minutes. I then hear "Oh my God! Someone get in here fast!" I go in there and there's blood spurting all over the room, as the abscess had ruptured in those few minutes, and arterial blood is everywhere. Without thinking about it I slammed my bare hand down on top of his access to stop the blood. It was him that yelled at me to go wash my hands and get gloves on, which I did, but I had already gotten blood all over my hands.

I think my skin was intact but you never know about microscopic tears etc. I did not contract HIV. Just to make the point that HIV is about the hardest bloodborne pathogen to get. Washing my hands with soap and water effectively rendered the virus dead on my skin. There are way bigger pathogens to worry about.

[Jenni811, RN]

To the OP:

Yes...it is correct that all patients are not tested for HIV because 1) its VERY expensive. and 2) this is what we call STANDARD precautions. Basically....treat every patient as if they were infected with HIV. If my Jane Doe in room 3 is infected with HIV i should treat her no different than my John Doe in room 4 who doesnt have HIV. I should assume that John Doe is affected with HIV as well.

This is taking responsibility for your own actions and to take the same precautions with every patient.

[BabyLady, BSN, RN]

Actually in the District of Columbia where I practice now if I suffer a needlestick we are legally allowed to draw blood for HIV testing without pt consent. D.C. feels that with our higher than average rates of HIV/AIDS medical staff need to know if they are exposed, and pts don't always consent to testing if it is optional.

I have a feeling you need to go back and familiarize yourself with the healthcare laws in your state.

That is what they call assault and you cannot stick a patient for a blood draw if they refuse without a COURT ORDER. What are you going to do if the patient refuses? Hold them down in 4-point restraints and do the blood draw?

What you are probably confusing it with, is many facilities inform all patients that should a sharps stick occur that they have the right to do HIV testing, hwoever, this is usually done in conjuction with drawing for other labwork.

However THEY CAN refuse to allow you to draw the sample.

[BabyLady, BSN, RN]

Actually in California, we can legally test for HIV in case of a needle stick...without patient consent.

..and they still have the right to REFUSE to be tested. In fact, you are required to inform them, they have the right to refuse.

http://www.cdph.ca.gov/programs/aids/documents/ctthivtestinfoforclinicians.pdf

[Penelope_Pitstop, BSN, RN]

I see only one pro to this suggestion: earlier treatment for those who are HIV positive and do not know it.