I'm working in the lab of a large hospital while waiting to start the nursing program at my local community college this fall.
I was on phlebotomy tonight and before one of my draws the patient's RN pulled me aside outside the room (in the hall) and told me to "be careful because she's HIV positive." Another phlebotomist related that the RN had also advised him of the patient's HIV status before he drew the patient earlier in the evening.
As a phlebotomist, you'd have to be point-blank stupid not to approach every draw as if the patient had a blood-borne pathogen. That's why we have things called personal protective equipment and universal precautions. A patient's HIV status is and should be irrelevant when it comes to drawing blood since you should be taking the same degree of precaution with every draw that you do.
I believe that the RN needlessly compromised the patient's right to confidentiality, especially with such a highly confidential diagnosis. In addition to what seems to be to be a serious breach of ethics on the part of the RN, it also sounds like a big, glaring HIPPA violation.
I'm not even in RN school yet and it's setting off alarms with me. Am I off base in my assessment of the situation? I'm seriously considering reporting it to our compliance officer, my motivation not being to "nail" the RN, but rather to take advantage of the situation as a teaching opportunity for the RN, and also advocate for the patient who probably has no idea that her confidentiality was breached.
Any thoughts from you seasoned professionals would be most appreciated!
Specializes in LTC/SNF, Psychiatric, Pharmaceutical.
I believe that there is an allowance in the privacy law specifically for this situation, where if an HIV+ person is making credible threats, then the safety of others trumps their right to privacy.
Intentionally infecting others with HIV is a serious felony.
Intentionally infecting others with HIV is a serious felony.
Yes, but that wasn't my point. My point was that if the person is making threats that are credible, then their HIV status can be disclosed, for the protection of others, prior to them actually infecting others intentionally.
NancyNurse, I agree with you. People with HIV need to be protected from discrimination.
People that are not infected also need to be protected from infection. What about the SOs of infected pts that don't know their SOs are infected and the SOs refuse to tell them? I know that happens - I have seen it.
Specializes in LTC/SNF, Psychiatric, Pharmaceutical.
Need to factor in :
By the way, isn't it time we treated HIV status the same as we do HCV or HBV?
HCV and HBV are spread much more easily than HIV. They transmit readily through urine and feces as well as blood and can even be spread by contaminated food. Also, like HIV, a person can carry HCV and HBV for a long time with no symptoms. There also isn't the same social stigma. I've known plenty of people who have lived with viral hepatitis for years, and nobody makes a big deal about it. Could you say the same thing, right or wrong, about someone with HIV? The simple acronyms "HIV" and "AIDS" cause the same reaction for many in our modern society that the word "plague" caused in medieval Europe. So you would be making life very difficult for someone who may yet still have years to be productive members of society and help their own quality of life.
HCV and HBV are spread much more easily than HIV. They transmit readily through urine and feces as well as blood and can even be spread by contaminated food. Also, like HIV, a person can carry HCV and HBV for a long time with no symptoms. There also isn't the same social stigma. I've known plenty of people who have lived with viral hepatitis for years, and nobody makes a big deal about it. Could you say the same thing, right or wrong, about someone with HIV? The simple acronyms "HIV" and "AIDS" cause the same reaction for many in our modern society that the word "plague" caused in medieval Europe. So you would be making life very difficult for someone who may yet still have years to be productive members of society and help their own quality of life.
Let's get the facts straight.
HAV is transmitted via the fecal oral route.
HBV is transmitted via blood and body fluids (and is five times as infectious as HIV).
HCV is transmitted through blood to blood contact.
HCV does carry a social stigma from what I have experienced. People assume that the person got it from IV drug use, but many people with HCV contracted it through blood transfusions prior to 1989.
My SO is HCV+. He got it from getting a tattoo while in the armed forces in the seventies. I have no doubts that if he were hospitalized, people would look at him like an IV drug abuser if they knew his status. I've seen it too many times to think otherwise.
NancyNurse, I agree with you. People with HIV need to be protected from discrimination.
People that are not infected also need to be protected from infection. What about the SOs of infected pts that don't know their SOs are infected and the SOs refuse to tell them? I know that happens - I have seen it.
That's a whole nother ball of wax. What we're talking about here is health care providers being privy to that information. We're not having unprotected sex with our patients, and we use universal precautions.
I agree with you that people who are HIV+ do have an ethical responsibility to disclose that information to their intimate partners.
i am all for confidentiality and universal precauations. but sometimes that does not work. patient gets irate at the thought of a being admitted, and spits on me. in my eyeball. now i am not an RN or LPN. did i still need to know that this young woman was HIV positive?
So in this case you knew her status and it didn't affect the precautions you took - not really an argument for disclosure to all and sundry.
In this case it might be appropriate to disclose her status following an incident that put you at risk of transmission because it could affect the treatment you received, if the treating doctor considered starting prophylactic therapy and wouldn't have in a pateint in every way similar but with an unknown HIV status.
Well, what if said aide went into a room and the patient asked for help with a procedure? This could be throwing away tissues that could have blood or other body fluids on them, helping them to the bathroom, where they could be exposed to body fluids, etc. These aides maight not be as stringent about gloves or handwashing as nurses or CNAs. Another thing, goggles are not typically a part of universal precautions, nor are masks with a splash guard. What if a CNA went to empty a bedside commode and it fell? It could splash in her eyes. (Been there, done that). I
Then this is an issue for education about universal precautions. I know it's been said before, but the reason they're applied universally is that you never know what undiagnosed transmissable conditions a patient may have. The number of times we discover a patient is VRE positive part way through an admission... and I haven't heard anyone I work with saying "If only I'd known I'd have worn gloves!"
And goggles are considered to be part of universal precaution equipment, depending on the task being performed. That many people don't wear them when emptying pans or catheters is a combination of poor role modelling, choice and inadequate knowledge.
And I don't think that anyone has the right to tell me that I should not have access to information that I feel is crucial. That's just how I feel, and not everyone will agree.
And that's why the law isn't determined by motion but by rationality and dispassionate judgement, taking into account what's in the best interests of all the stakeholders and weighing their competing interests equally. Is it perfect? No. Is it the most equitable method. Yes.
Our phlebotomists aren't told about blood-borne diseases, only those infectious conditions that universal precautions don't cover - air-borne, droplet infections and contact transmission.
Frankly I feel more concerned about hepatitis, which is far more contagious than HIV and has fewer treatment options. And I don't think Hep B/C status is something that should be disclosed, either.
AIDS is going to continue to be a serious public health problem as long as we protect the infected more than we protect the un-infected.
And/or change intervention strategies - promote condom use and safer sex, improve sex education, provide needle exchange programs, legalise prostitution, fund research and include stakeholders in strategy planning. Look at that! You get to reduce the spread of a number of diseases, reduce unplanned pregnancies and manage not to marginalise anyone.Win, win, win.
And/or change intervention strategies - promote condom use and safer sex, improve sex education, provide needle exchange programs, legalise prostitution, fund research and include stakeholders in strategy planning. Look at that! You get to reduce the spread of a number of diseases, reduce unplanned pregnancies and manage not to marginalise anyone.Win, win, win.
...why would anyone choose to use condoms if they don't have a legal right to know if their partner is infected?
sure, i can see taking these precautions that are consistent w/any type of informed consent.
but since hiv+ people are under no obligation to inform others of their status, there looms tremendous opportunity to spread this virus.
...why would anyone choose to use condoms if they don't have a legal right to know if their partner is infected?
Leslie, I don't understand that question.
That being said, in today's world, anyone choosing not to use condoms is responsible for the outcome of that decision. I have a responsibility to take care of my own body, and just as I choose whether or not to smoke tobacco, eat fast food, or sit in front of the TV rather than go for a walk, I choose whether to use protection when having sex, and I am the one accountable for the results of those decisions, whether they be COPD, CAD, or HIV.
I disagree....drawing blood where there is always the possibility of contaminating yourself with HIV falls under a need-to-know basis.
If you were observing, then it would be a privacy breech, but since you were working directly, you need that information so you can be "extra" careful.
That is all they were trying to communicate to you.
Anyone can have a needle accident, but I would bet my bottom dollar that you were MORE cautious with that patient because of the info.
I disagree....drawing blood where there is always the possibility of contaminating yourself with HIV falls under a need-to-know basis.
If you were observing, then it would be a privacy breech, but since you were working directly, you need that information so you can be "extra" careful.
That is all they were trying to communicate to you.
Anyone can have a needle accident, but I would bet my bottom dollar that you were MORE cautious with that patient because of the info.
Anyone would have.
That's what folks here are not getting. "Need to know" is not a matter of your personal opinion. The rights of HIV+ persons to keep that information private are dictated by LAW. By violating that right, you are breaking the law.
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Intentionally infecting others with HIV is a serious felony.