Sharon

Ellie, Sorry to hear about your accident. If the worst case does happen and you convert there are some great dual modality therapies (Interferon Alfa 2B and Ribavirin) out there. Unlike most of the population you will be able to start so soon you have a very high rate of converting back to negative after a single course of treatment. You should consult with an infectious disease specialist who specifically works with post exposure patients. I see a significance difference in how they handle patients from the average ID physician. Keep an eye on http://Clinicaltrials.gov to watch for post-exposure prophylaxis studies. Three years ago when I consulted in infectious injectable biopharmaceutical industry many patients with chronic Hepatitis B requested studies on Interferon Alfa 2B and Ribovairin. All these patients did was call the drug companies and ask for the studies. Therefore you should also call the manufactures of Interferon Alfa 2B and ask if they have something in the works not yet listed on the web.

Sorry to hear about your accident. If the worst case does happen and you convert there are some great dual modality therapies (Interferon Alfa 2B and Ribavirin) out there. Unlike most of the population you will be able to start so soon you have a very high rate of converting back to negative after a single course of treatment. You should consult with an infectious disease specialist who specifically works with post exposure patients. I see a significance difference in how they handle patients from the average ID physician. Keep an eye on http://Clinicaltrials.gov to watch for post-exposure prophylaxis studies. Three years ago when I consulted in infectious injectable biopharmaceutical industry many patients with chronic Hepatitis B requested studies on Interferon Alfa 2B and Ribovairin. All these patients did was call the drug companies and ask for the studies. Therefore you should also call the manufactures of Interferon Alfa 2B and ask if they have something in the works not yet listed on the web.

What industry are you in? I would first review both the Nurse Practice Act and the practice act for Paramedics. In the states I practice in Paramedics cannot do Audiograms or PFT's. I don't have time to look this up - anybody who knows jump in- I don't know if PFT and hearing testing by allied health professionals meet OSHA standards. Since they are not independent practitioners they usually must work under a Medical Director who is on duty. Do you have a Medical Director on duty when they are? These people have the same personality as fireman. I found it can be a dominance issue. I would suggest if you can challenge both your states EMT and Paramedic exam which many states allow RN's to challenge the exam. (What you will need to get experience with is the use of the equipment in the field, like back boarding.) If you are also certified as an EMT/Paramedic they will have nothing about skill level to complain about plus you will outrank them in the field with a Paramedic/RN designation. Next ,if they are spending so much time being paid and not working, why don't you document and suggest reductions in force for additional corporate savings. What is your chain of command? Is your company a single site? Are there other sites using the same staffing structure?

I am not aware of tracking vendor reps. Since the reps have no practical risk of transmitting TB or being exposed to TB from patients (they're masked, the rooms are too well ventilated for respiratory transmission, and there is not enough time of exposure) it seems a waste of resources to track. The reps I spoke to today do not routinely get PPD's and they cover Level I hospitals. The only time I might consider tracking reps are if they are exposed to large volumes of body fluids and can contract TB from your patients.

If a water point is a water fountain I agree with the previous poster that there is no risk. But if a water point is communal bucket of water like it is in some communities. He will need to use his own glass and there should be a serving ladle that no one drinks from. Please clarify what do you mean by a water point.

LA Nursing Board is coordinating with the other state boards for volunteers. You are to contact your local Board of Nursing who will verify your license/certification status per the National Disaster plan and forward a list of Volunteers to LA Board of Nursing. Please do not overwhelm LA Board of Nursing with individual calls of offers to volunteer. The LA Board of Nursing does not have the time to do license checks on nurses who call them from out of state.

Katia, Don't worry about your grammar. Your skills are much better than mine would be in any second language I would attempt. My background has been the occupational/environmental health of rescuers, safety, relief, law enforcement personnel and children during all phases of disasters. I have also had experience in radioactive events and emergencies. Some of the industries I have worked in include food manufacturing and retail, transportation, government and non-profits. I have recently started some educational programs to get more experience with how the laws and courts work. Classes actually start fulltime tomorrow night. Good luck with your classes. Sharon

Katia, Welcome to the board. It is great to have a nurse from Brazil participating. I have interacted with Occupational and Environmental Health Physicians from Brazil in the past. Are you working in a specific field or industry or cover a variety? Sharon

Youknowwho Yes you can have antibodies already but if you don't you will have to pay for it again. Since we know second vaccine titers don't last very long, none of the schools where I have taught Nursing would accept a second vaccine titer level. Check with your school before going to the expense. You usually need pot prove the entire series and titer to start clinical.

I see people all the time who continue to work through the pain, ADLs including sports. Decreased ROM is one possible sign of a fracture. Even when I did disaster rescue decreased ROM was rarely a sign of severe fractures even in the field. Step classes are notorious for fractures check with sports medicine. Regardless you do not have confirmation of either illness. I think it was reasonable to be treated for the most likely conditions, an infection and a fracture. BTW I have never seen symptoms such as yours caused by Staph not grow Staph on culture. But then the physicians I have worked with would have cultured your arm either by swab, punch biopsy or some other form of biopsy. Just out of curiosity - Is MRSA so rampant on your unit/facility that the ED physician automatically assumed you have it? If he was concerned that it was MRSA why did he not get an ID consult in the ED? If you are going to be concerned about how your case was handled I would be more concerned about how the initial assessment of what infection was going on and what drugs you where treated with. I have recently seen virus joint and soft tissue infections that sound just like what you have. Guess what? You haven't been covered for that. BTW you are in the right gender and since the two labs you mention are dead on for an acute flare of collagen vascular disease, do you have any other risk factors?

The medical reserve corp. has been around for generations under various names. I had a great aunt who received her LPN as a member back in 1901. Many of these volunteer opportunities have always existed there has just been a lack of interest by health care professionals to participate.

I did have a case like this and it did prove to be only a fracture. The scans supported this. There was no acute or six month uptake to support a systemic infection of any type. We where concerned about an infection seating at the stress fracture site because of the high risk position he was in. The individual was a post transplant recipient who was an industrial hygienist who had multiple sewage exposures. I can't remember why but there was another non-infectious cause found for the elevated WBC and shift. BTW don't forget any swelling ("only swollen") is considered a deformity. It is not uncommon for minor fractures, i.e. stress, not to swell for days, weeks or months; sometimes not until further damage occurs like from immobility. Rarely do stress fractures show up on flat X-rays during the first six months. Actually today I just saw a facial one show up via the third CT scan that we have been looking for for 24 months. We strongly suspected it was there based on deformity (swelling) on the opposite side of the face, discomfort, warmth, temperature, and elevated WBC's. At one point a severe sinus infection occurred and was aggressively treated to prevented osteomylitis at the fracture site. I am glad my patient did not file a complaint between onset of care and the past 24 months!

I just came from my Torts class. I am studying for my Paralegal Degree to be a Nurse Paralegal. I am looking for some references/citations to cases involving defendants who used PTSD as a defense and where still convicted. I am even more interested if the crime or tort occurred against a nurse in the workplace. A couple of classmates, who claim to be healthcare workers, have stated in class that no one with PTSD can be convicted of a tort or crime because: 1.all people with PTSD are incompetent and require hospitalization and, 2.only veterans can have PTSD. I don't need a discussion on these wrong statements I need specific case citations before 7 pm EST tomorrow. I do not have access to either Westlaw or Lexis before then. Thank you for limiting your responses to specific cases.

If you intend to work in the next few months after applying you will also need to possibly apply for a temporary nursing license which will include fees in addition to the 176.00. DC has a notoriously long response time of more than three months via mail. The last three people I know who just got their licenses had their applications lost multiple times by the DC government despite sending it express mail certified return receipt more than twice. They all had to go down in person and prove they had paid the fees multiple times as well. Last I heard they had not gotten their refund for the extra payment. If you have all of the paperwork in hand and are willing to stay and wait, you used to be able to hang out and walk out with your license. Typically waits were four plus hour with no access to bathrooms. This is also true for DC DMV. With your next renewal you will also need to have 30 CEUs. If you get upset with the current lack of service you get to blame your current legislator where you live now because DC does not have representation. Funding for the DC government comes from personal property taxes of 200,000 people and less supplementation than PR and other US territories. DC provides services to a minimum of 1.5 million daily visitors and federal employees and legislators who cannot be taxed but drain the resources and infrastructure daily. In other words DC deals with the equivalent of the Popes Funeral Daily. I think every US citizen should live and work for a time period in DC to see how badly the residents are treated. I moved out when some neighbors lost their home due to a minor Hill fight and funding for fire and rescue was delayed. This resulted in a nearby station being closed and equipment not serviced. The truck from the next closest station broke down in route.

Since this is no longer an infectious disease nursing discussion I am closing this thread. This discussion can be restarted in another area of the board such as General Nursing Discussion.

If the patient is having further deteriorating symptoms, which she must be having since it has resulted in her diagnosis, then she is definitely is still infectious in some form. She will need antibiotic treatment to prevent further deterioration of her condition. If one of the conditions she has developed is neuro syphilis, treatment will not reverse the permanent brain damage that has already occurred. There was a recent very good episode of House about a woman who contracted syphilis 30 years ago and her only presenting symptoms was a change in libido. I have had three large blood and spinal fluid exposures to patients with tertiary syphilis and it is considered very infectious. Syphilis is named the great mimic because it can be misdiagnosis as any disease. One movie I show my students is Mrs. Evers' Boys about the Tuskegee Experiment.

Inform your chain of command that HIPPA does not apply to every health care information situation in the world. It specifically does not apply to the following: Work Place Exposures, Injuries, Hazardous Material Incidents regulated under the community right to know act (SARA, Title II), and those rights covered under the Federal Whistle Blower Rights Acts. I could list a whole page of what HIPPA does not cover and the liability the average nurse has for preventing care by wrongly using HIPPA. I did do a little research on the following statements: "90% of all nurses have colonized MRSA in their noses". "40 percent of the population are carriers of MRSA, no big deal" Because you specifically mentioned the Center's for Disease Control I went to their website and drilled own in their publications and discovered that what they define a community carrier as is: "Community acquisition was associated with recent hospitalization, previous antibiotic therapy, nursing home residence, and intravenous drug use." 1: Infect Control Hosp Epidemiol. 1995 Jan;16(1):12-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7897168&dopt=Abstract Please note this is a ten year old definition. I cannot find any prospective studies of healthy nurses or of general population of MRSA rates. So the first two statements are not supported at this time. So what would I do to cover myself professionally and medically? 1.Throw the HIPPA crap back in your manager's face in a professional manner. 2.Another mechanism to move around the HIPPA and notification issues is to give your employer a written release and instruct the employer to notify my co-workers that I have an infectious disease and I want my co-workers notified in order to seek preventive and/or treatment ASAP. I would ask your co-worker who is sick to do this. This will begin to get both of you off of the HIPPA block. Do not rely on your employer to send out the letters you may want to send your own out to your co-workers. 3.File worker's compensation due to exposure of an occupational infectious disease. The cost of the medical surveillance should be covered by your employer. Medical surveillance should have begun before your placement, during and after. I would be interested in hearing how your employer reacts when you point out this is outside of HIPPA.

Since the original poster has not been on this bulletin board since a week after posting this message, which was 1/29/2004, I am closing the thread.

InfRn, Thank you for your reporting of events as you experience them. Your updates have been more valuable to me than any news reports since the first 24 hours of the disaster. Your words are an invaluable resource to me, other nurses, and to future nurses. I hope over the next few years you are able to continue periodic updates on how this disaster has impacted your country. The historical value as well as the practical value is immeasurable. There has already been much information in your reports that I am able to apply to disaster planning and response here in the U.S. I hope you find the sharing of this experience helpful to your recovery. The feelings you have experienced while off of duty and away from work are normal and common among workers in a disaster. Here in the U.S. we actually assigned a nurse, usually an occupational health nurse, to ensure people are getting time away from the worksite because there is such a pull to stay work. Again thank you for sharing what has happen to you and your country. Sharon

A quick response is SARS mutated from a specific avian flu and there are thousands of avian influenzas.

The nice thing about Disaster Rescue and Relief is that research and resources are not usually divided by professional group. Disaster care is a very blended community, which I believe is its strong point. To find resources you would need to search by disaster type, phase, or function. Two examples on this board that list extensive resources are in the following threads "Major Incidents" https://allnurses.com/forums/showthread.php?p=30862#post30862 and "Hospital Evacuation Planning" https://allnurses.com/forums/showthread.php?t=9137 .

I am working the disability management field. Are you sure the salary is not the issue? My salary is comparable to specialty care positions in the hospital and I have a M-F 8 to 5 schedule. Of course you have to be able to quickly defend your decisions and be very comfortable with challenging all types of providers and doing the legal case prep. Usually dealing with government agencies and attorneys turns off nurses in case management roles faster than anything else. We just had an influx of RN's from the OR and Dialysis.

This form is a standard type of form required by OSHA for respirator fit testing. I have reviewed those forms and done the testing off and on for many years. The information on the form is not covered by HIPPA. Where I have been employed all employees who falsify either through omission or misstatement on the history form when discovered are terminated immediately. We have also terminated for not being qualified for some positions because the individual was unable to pass the fit testing. In others we have sent the employee home unpaid and temp hired a fully qualified individual. The employees sent home have been allowed to use their vacation. No employees have prevailed under ADA to be waived from the fit testing because it is a safety policy.

I work in the mid Atlantic area where it is endemic and has been for about 10 years. I don't know of a day care that does not have a substantial outbreak each year. Five years ago I dealt with a workplace adult outbreak when some employees brought ill children to work when they could not send them to daycare. Out of the adults who contracted coxsacki: two contracted meningitis (including myself) four developed cardiomyopathy (two required interventional cardiology), 20 developed infectious costrochondritis that lasted at least six months. For four years coxsacki had been the third highest cause of medical loss workdays in this corporation of 30,000 employees. This was ten times the number of loss workdays due to influenza for the same time period.

During the early 1990's I taught in a nursing program that did not accept students who were Hep B positive. Many of the hospitals at that time would not hire Hep B nurses nor allow Hep B positive students practice on their patients. Since I no longer live or practice in this geographical region, I do not know if the practice continues. During that time I taught a clinical at a hospital that announced that future urine eye splash exposures would be considered contributory negligence on the part of the staff because there was no excuse for not using appropriate personal protective equipment. Failure to follow appropriate safety procedures that caused significant exposure would result in termination. With the life time cost of worker's compensation cost infectious disease claims in the millions of dollars when cases result in an organ transplant, some hospitals have become aggressive in managing the cost. The issue has begun to migrate into the non-health care industries. The most recent example of this is SARS. Another is a retail grocery case I worked a few years ago. A corporate employee contracted coxsacki due to a co-worker bring 3 year old who had coxsacki to work when they could not leave them at daycare. The 22-year-old employee developed myocarditis, arrhythmias, including afib, requiring ablation, and cardiac management for the next 50 years.