Ribavirin exposure

TraumaSurfer · Dec 19, 2013

We only have 2 negative pressure rooms, so we have max 2 Ribavirin patients out of a 30-bed unit. TraumaSurfer, when I was reading up on this it was found that the RNs have much more exposure than the RT's - they generally don't stay in the room while the med is running. If I have to give a slew of IV abx (like I did with this patient, along with IVIG) I am going to be in there longer than the RT while it's going.
Our patients that are getting Ribavirin are usually old lung transplants that have contracted RSV.
GrnTea- you bring up a good point about the hospital's liability. I do wear the gown, gloves, and N100 mask but think it's worth discussing with the employee health department.

RTs also handle the medication and equipment directly which brings them into contact with splashes. They also probably see many more patients on Ribavirin than you at one time. If they have 5 patients on Ribavirin and do all the required checks, assembly and clean up, that is significant exposure. Even with one it can be significant especially if the SPAG is acting up and they have to risk spray or splash while trouble shooting. Don't try to minimalize their job or life if you don't know what all they do. They also have to set up and run Pentamidine (transplant pts), a lot of different antibiotics, steroids, prostacyclin, nitric oxide (PHN diagnostics), hypertonic saline sputum inductions with TB patients and many bronchodilator treatments. Just calibrating a nitric oxide delivery system not in use exposes them and some do this regularly. For many of these treatments they are required to stay at the bedside so they spent much of their 12 hours being exposed. They don't have time to stick around for long exposures to Ribavirin when there are so many other things they have to rush off to so they can get more exposure. RTs and nurses who work in certain units do have the data to show occupational exposure. Some have developed diseases which could be directly related to their long term exposure but at this point for them the damage is done. Some RNs and RTs have been in the profession before gloves were a necessity.

Also, if you do come into contact with some of the exposures in health care such as TB, meningitis and HIV, you might have to take medication directly as a result of that exposure. There were also risks when taking care of H1N1 patients or any other airborne infectious disease. Some who have had Chicken Pox as kids might even be surprised to learn they no longer have positive titers. The same for those who don't get their hepatitis titers checked every few years. Those of us who went through the agony of Smallpox vaccination as kids are also no longer immune.

Know the risks and take precautions. Learn from what others have experienced and adhere to the policies.

Side Question: What do you tell visitors who are at the bedside or do you forbid visitors while the patient is receiving Ribavirin?

This was a big issue in Pediatrics since the parents wanted or sometimes needed to stay at bedside. These parents were often young and still could have more children. They were exposed almost 24 hours every day for several days and often without all the same protective gear. Some health care providers didn't really concern themselves about the parents as long as they has a babysitter to keep the child in the Ribavirin.

sugarmagnoliaRN · Dec 20, 2013

I see what you're saying about the RT's - I guess I was just thinking of it from my perspective and not theirs. As far as visitors go, none are allowed in during the Ribavirin (they can go in 10-15 mins after it's been shut off). Since they haven't had the fit testing for N100 masks, the hospital will not allow them in the room.

TraumaSurfer · Dec 20, 2013

I see what you're saying about the RT's - I guess I was just thinking of it from my perspective and not theirs. As far as visitors go, none are allowed in during the Ribavirin (they can go in 10-15 mins after it's been shut off). Since they haven't had the fit testing for N100 masks, the hospital will not allow them in the room.

That is great the hospital has that policy for visitors. Unfortunately that is not always true in peds.

Good luck to you and I hear where you are coming from. I also started another topic so I don't sidetrack yours about all the stuff we get exposed to on the job.

wooh, BSN, RN · Dec 21, 2013

In the past, our charge nurses assigned these patients only to men or women who are past child-bearing age (or are just done having kids). ...I'm being put in the awkward position to 1) discuss my reproductive plans with my employer which isn't any of their business, and 2) let them know that I'm sexually active and accidents happen (again, none of their business).

So it's awkward for you to discuss those things with your employer, but other nurses on the unit need to make clear when they're done having children, whether they've gone through menopause, if they're completely through menopause (because if they're sexually active, sometimes accidents happen when you think you're in menopause), etc. I guess that's not awkward though...

OCNRN63, RN · Dec 21, 2013

So it's awkward for you to discuss those things with your employer, but other nurses on the unit need to make clear when they're done having children, whether they've gone through menopause, if they're completely through menopause (because if they're sexually active, sometimes accidents happen when you think you're in menopause), etc. I guess that's not awkward though...

Any wonder that there's frustration among nurses who aren't childbearing?

uRNmyway, ASN, RN · Dec 22, 2013

Eh, this might have something to do with my slightly Asperger-esque behavior and thinking, but if I expect others to have these discussions with management, it's only fair that I do the same. To me, sex is kinda like pooping. Normal body function, and most everybody does it.

I don't get all the anger towards childbearing out rearing women. When I've had colleagues who were pregnant I went out of my way, volunteering to take isolation patients not to expose their unborn child, or taking their aggressive/confused patients. Was it my fault they were pregnant? Of course not. Did I have to do that for them? No. I did it because it's the decent thing to do, because I care about the safety of innocent children. And I did it without complaining, even if it was inconvenient to do it.

What is it with people now? Is it a cultural thing? Because I don't remember hearing this kind of b****hing about this back home, but hear it so often coming from American nurses. I don't know, just seems so crazy to me.

BrandonLPN, LPN · Dec 22, 2013

Re: pregnant nurses not recieving isolation patients:

If a pregnant nurse follows policy and procedure for dealing with dangerous medications and/or patients in isolation they, in theory, have nothing to worry about.

Yes, these patients should ideally be assigned to a male nurse or a female nurse post-hysterectomy or whatever. And usually they are. Any prudent charge nurse with a shred of common sense will make the assignments accordingly.

But stuff happens. Sometimes making the assignments this way isn't possible or places an undue burden on the rest of the staff. I think it's completely unreasonable for any nurse, pregnant or not, to expect to never get an isolation patient.

nurseprnRN, BSN, RN · Dec 22, 2013

Re: pregnant nurses not recieving isolation patients:
If a pregnant nurse follows policy and procedure for dealing with dangerous medications and/or patients in isolation they, in theory, have nothing to worry about.
Yes, these patients should ideally be assigned to a male nurse or a female nurse post-hysterectomy or whatever. And usually they are. Any prudent charge nurse with a shred of common sense will make the assignments accordingly.
But stuff happens. Sometimes making the assignments this way isn't possible or places an undue burden on the rest of the staff. I think it's completely unreasonable for any nurse, pregnant or not, to expect to never get an isolation patient.

Speaks the person without a uterus. :)

I agree with you generally but there's a reason that practice guidelines for oncology and other specialties include excluding pregnant women from certain tasks and patient situations.

sistrmoon, BSN, RN · Dec 22, 2013

Re: pregnant nurses not recieving isolation patients: If a pregnant nurse follows policy and procedure for dealing with dangerous medications and/or patients in isolation they in theory, have nothing to worry about. Yes, these patients should ideally be assigned to a male nurse or a female nurse post-hysterectomy or whatever. And usually they are. Any prudent charge nurse with a shred of common sense will make the assignments accordingly. But stuff happens. Sometimes making the assignments this way isn't possible or places an undue burden on the rest of the staff. I think it's completely unreasonable for any nurse, pregnant or not, to expect to never get an isolation patient.[/quote'] I took plenty of isolation patients while pregnant. C diff, MRSA, VRE, bring it on! The only patients we are allowed to refuse are sickle cell crisis as they may carry parvovirus. I work on an Onc floor and we can also refuse chemo. PPE is not failproof, and after 5 miscarriages, you bet your ass I'm not handling a Category X drug while pregnant.

OCNRN63, RN · Dec 22, 2013

Eh, this might have something to do with my slightly Asperger-esque behavior and thinking, but if I expect others to have these discussions with management, it's only fair that I do the same. To me, sex is kinda like pooping. Normal body function, and most everybody does it.
I don't get all the anger towards childbearing out rearing women. When I've had colleagues who were pregnant I went out of my way, volunteering to take isolation patients not to expose their unborn child, or taking their aggressive/confused patients. Was it my fault they were pregnant? Of course not. Did I have to do that for them? No. I did it because it's the decent thing to do, because I care about the safety of innocent children. And I did it without complaining, even if it was inconvenient to do it.
What is it with people now? Is it a cultural thing? Because I don't remember hearing this kind of b****hing about this back home, but hear it so often coming from American nurses. I don't know, just seems so crazy to me.

I don't mind helping, but some people abuse it. I also expect that if I do this for someone who is pregnant (or whatever), then when I need to be accommodated there shouldn't be footdragging. Unfortunately, in my experience I was taken advantage of by many of the co-workers who had kids. My last job was really good about everyone working together, but I had a few jobs that were just ridiculous.

OCNRN63, RN · Dec 22, 2013

Speaks the person without a uterus. :)

I agree with you generally but there's a reason that practice guidelines for oncology and other specialties include excluding pregnant women from certain tasks and patient situations.

Fine, but then help out your co-workers who are picking up the work you can't do. It's unreasonable to expect staff to take on extra work while the staff who can't do those tasks sit back and relax.

NicuGal, MSN, RN · Dec 22, 2013

We had an issue several years back on our peds floors when we were using This med. They had had a huge turnover up there and the older nurses worked days and the off shifts pretty much had newer younger girls, no guys. They just had to be honest about things and take the patients.

We have guidelines on what a pregnant person can take, all other isolation and etc are given out because you should be using PPE and universal precautions.