Protocols for dealing with patient's blood/bodily fl. or who are known to be HIV+etc?

Sun0408, ASN, RN · Jul 4, 2013

HIV is universal protocol, meaning gloves when dealing with blood or bodily fluids. I have cared for my fair share of HIV/AIDS pts with several of them in for GI bleeds, nothing more than gloves, gown if you are dealing with big messes that might mess up your scrubs:) Every day things, just gloves. As long as your skin is intact, no worries..MRSA and things like C. Diff are the similar except gowns are used at all times with gloves. Isolation pts for TB etc we wear a special mask..Hospitals have guidelines to follow.. I have no real fear dealing with any of them. Safety of myself and the pt is top priority. For labs or IV's, I treat all pts as if they "have something" meaning gloves each and every time.

Keep in mind, pts are more likely to catch something from us then us catching something from them. They are sick, meaning their immune system is down. We also travel room to room. Washing our hands is a must..

TiffyRN, BSN, PhD · Jul 4, 2013

Per CDC guidelines, only standard precautions are needed with HIV+ patients. In reality, you will probably see healthcare workers being very rigorous with gloves. Some people double glove based on studies showing a measurable percentage of gloves that have pinholes. I no longer regularly work with HIV+ very often but back in the early 90s when every patient died from it and died quickly, most nurses would wear full barrier precautions including masks with eyeshields any time they entered the patient's room.

Different kinds of isolation precautions including Standard (for every patient)

http://www.cdc.gov/hicpac/2007IP/2007ip_appendA.html

Guidelines from CDC on what kinds of precautions to use for selected infections.

http://www.cdc.gov/hicpac/2007IP/2007ip_appendA.html

BlueDevil,DNP, DNP, RN · Jul 5, 2013

Standard precautions. 'nuff said.

I don't worry about HIV, MRSA, Hepatitis, etc anymore than I worry about rhinovirus. I just assume everyone potentially has something I don't want. The thing I "worry" about most is probably influenza. I really, really do not want it, and statistically, it is the thing I am most likely to come down with based on simple exposure. I stay fit, eat well, practice standard precautions, get my flu vaccine annually and hope for the best. I don't freak out every time a febrile person with body aches coughs in my presence. :dead:

TiffyRN, BSN, PhD · Jul 5, 2013

Yea, I would say my biggest infectious transmission, well, in my field, not really afraid of anything these babies have once we wash them off. They have no resistance to anything that would scare me.

When I practiced on adults, I would say once HIV had treatment and most patients I was in contact with had low to undetectable viral loads, my biggest fear went to Hep C (would have been Hep B if not for inoculations) or SARS. I would be fearful of TB as in this geographic area, there are many immigrants from areas where it is prevalent, but I had BCG and I believe it would be protective to some degree.

I will have to kind of agree with BlueDevil DNP. I'm kind of paranoid about colds/flus. They are so rampant during the winter. My husband and I went a little nuts this last flu season disinfecting everything we touched in public places and carrying hand gel (I've now heard it's not very effective against flu virus).

CharleeFoxtrot, BSN, RN · Jul 5, 2013

...my biggest fear went to Hep C (would have been Hep B if not for inoculations)

Totally agree here, HIV doesn't scare me-Hep however is a more more sturdy virus. My worry is an accidental needle stick. Just be very aware and assume every patient has "something you don't want" when you are working with needles, and wear protective gear PRN :up:

nurseprnRN, BSN, RN · Jul 5, 2013

I was working in the hospital (Harborview in Seattle) when and where universal (now called standard) precautions were invented and first described in the literature more than 30 years ago. The 80s and early 90s were a very sad and sometimes scary time in the AIDS-care world. We had a thriving gay community in the city and people were all fluffed up about that at the time, but fortunately cooler heads (with a better grasp of microbiology) prevailed.

Briefly, OP, the concept to hold in mind that many organisms are considered infectious in blood and body fluids, not just HIV and not just blood. Furthermore, at any given time, many people who have undiagnosed or subclinical infections and are not in care for anything remotely related to their infectious diagnoses; think: someone with a head injury who has undiagnosed hepatitis, for example, or that apple-cheeked little granny in for an MI who got a contaminated blood transfusion with her total hip last year. Therefore, the only rational thing to do is to treat all patients-- everybody, all of them-- as if they do carry something to be avoided.

This protects staff, doesn't stigmatize anyone, and has been standard of practice for decades. Your nursing school buddy who says that HIV warrants any kind of special isolation is wrong. This may be related to whatever reason she didn't graduate. :)

That said, there are special precautions for other routes of transmission, such as airborne. HIV and hepatitis are not known to be communicable via the air droplet route, but others are. Persons with those diagnosed diseases are managed with masks or other airborne/droplet management gadgetry. TiffyRN has helpfully given you the CDC link that describes these.

Jory, MSN, APRN, CNM · Jul 12, 2013

Hey everyone :) I've been stalking the forums for a while now and decided to make an account because I want to be involved too! I'm not in nursing school but I will start next year; I am currently undergoing Pharmacy Tech training so I can start somewhere and make decent money. I have been thinking long and hard about Nursing since high school and I decided I really want to do it. I love helping others along with other reasons,that being the main. I began to form a lot of questions but one of them is ,what are the protection protocols that are set into place when a nurse is going to be dealing with someone who has HIV, etc. (or even if the patient ,as far as they know, has nothing at all because I know you would have to view every patient as infectious for your own protection and you have to be cautious) if you have to do things such as bathing,cleaning, dealing with their blood etc. ?A friend of mine who is older went to nursing school but didn't finish and she told me that there are "special" precautions with people who are known to be infectious with HIV and other things? What is worn in dealing with patients with highly infectious diseases if you are dealing with their bodily fluids, what protocols are set into place when dealing with blood/bodily fluids in general for nurses?

Universal precautions means you assume everyone is HIV positive.

Therefore, all of your patients, with regards to how you treat them and their body fluids, should be treated equally.

nurseprnRN, BSN, RN · Jul 12, 2013

Universal precautions means you assume everyone is HIV positive.
Therefore, all of your patients, with regards to how you treat them and their body fluids, should be treated equally.

Not just HIV-positive, but anything-that-is-blood-or-body-fluids-borne-positive.

KelRN215, BSN, RN · Jul 21, 2013

We practice universal precautions. A doctor friend of mine describes this as "assuming all blood/bodily fluids are infectious even though they are unlikely to be." Basically, you do the same things for a patient with a known HIV infection when dealing with his/her blood, feces, urine, vomitus as you do with a patient who does not have HIV. There are no "special" precautions for HIV. You use the same exact precautions on a 31 year old male with full blown AIDS as you do with an infant with no infectious diseases that you are drawing blood from or changing a diaper on.