Routine testing of HCV, HIV in healthcare professionals

boomertx · Jun 25, 2012

Would this be for the benefit of the healthcare professionals or the patents? And if the test came out positive, what do you suggest be done different than it is now (i.e. protocols, limits in scope of duties?) Could employment be denied or healthcare benefits withheld? How would privacy be maintained?

Double-Helix, BSN, RN · Jun 25, 2012

If a nurse is concerned about his or her exposure to blood borne pathogens, then it's perfectly acceptable for that nurse to seek testing from his or her primary physician.

However, requiring that this test be done annually isn't feasible for a hospital. In many hospitals, if something is required as a condition of employment, the hospital must provide that service for the employees. I doubt many hospitals would like to take on the added expense of performing blood draws and running HIV and HCV tests on all of their employees. For larger hospitals, that could easily be 500-1000 blood draws and tests per year. Plus, they would have to test phlebotomy staff, the IV team, doctors, residents, interns, anyone that might be drawing blood or using needles. That's a lot of money and time.

The reality is that the risk of transmission of HIV or Hepatitis from a needle stick is very small to begin with. If the stick does not draw blood, and the nurse doesn't feel it (two circumstances that would have to take place for the stick to go unnoticed) the risk of transmission is much lower again. Investing the time and resources to run annual blood tests on all employees who may have gotten a needle stick without knowing it (a very low percentage) to make sure that they did not contract an blood borne illness (an even smaller percentage) just doesn't make sense.

Again, if the nurse feels there is a reason that he or she needs to be screened (so if you're concerned about your HIV, HCV status or exposure) then the nurse can very easily contact her primary physician and get the testing done.

Meriwhen, ASN, BSN, MSN, RN · Jun 25, 2012

Everything Ashley said...plus that fact that despite HIPAA, word may still get out about a positive result. That could result in the nurse/healthcare professional being stigmatized and/or having that information used against them...yes, I know it's illegal to do that. But that doesn't mean it doesn't happen.

IMO, let healthcare professionals worry about their own monitoring...and if they are wise, they won't have the tests drawn at the same place that they work at.

msjellybean · Jun 25, 2012

When I accidentally stuck myself with an insulin syringe, I sure as heck felt it. It was after I drew up the insulin & was re-capping to go dose the patient... I was being uber careful, as I was still kinda tremor-ey from some sudafed that morning, but not careful enough.

docomo · Jun 25, 2012

In 20 years, I was stuck by needles 4 times, all before needles came with safety devices built in, and all of them due to someone else being careless. 1. needle someone left in a chucks pad. 2. someone reaching across the patient with a needle and poked me in the arm. 3. a needle sticking out the side of a sharps container (fortunately, it had already been through the autoclave.) 4. during CBR training, someone dropped a Mark I auto injector, when it hit the floor the spring activated and it shot across the room like a missile into my leg and loaded me up with atropine and 2-pam. ouch!

I felt all of them for sure and I can't imagine being stuck with a needle and not knowing it. But one thing I have learned, it's the other person that you've got to watch out for when it comes to needle sticks.

boomertx · Jun 25, 2012

Everything Ashley said...plus that fact that despite HIPAA, word may still get out about a positive result. That could result in the nurse/healthcare professional being stigmatized and/or having that information used against them...yes, I know it's illegal to do that. But that doesn't mean it doesn't happen.
IMO, let healthcare professionals worry about their own monitoring...and if they are wise, they won't have the tests drawn at the same place that they work at.

My thoughts exactly. The stigma and job discrimination is real. You can tell people they can't catch it from casual contact but most people would rather play it safe and label you "leper". One of my friends recently died from complications of HCV and except for a couple of very close friends and family members no one knew she had it until after she died. She saw how people treated people she knew with HCV and didn't want to experience it herself.

minnymi · Jun 25, 2012

i can't imagine being stuck with a needle and not feeling it, but assuming that it's possible....yearly testing would only confirm or deny that you had HCV or HIV. It wouldn't hold the facility you work for accountable. How are they to know you didn't contract it from sex?

that's why it's so important to file a report as soon as it happens so if/when the test comes back positive then it can be considered an on the job hazard. i get that it would be impossible if you didn't feel it...i just can't see that happening. if sticks that you can't feel were common (or even possible) then every nurse who ever got HIV/HCV could blame it on the facility.

sauconyrunner · Jun 25, 2012

In addition, if you were to require annual testing, how would the hospital determine if this was acquired while at work, or not.

It would be very rare to get stuck and not know it, especially with a dirty needle.

KelRN215, BSN, RN · Jun 26, 2012

It would hardly be worth it, as Ashley said and with routine annual screenings how would they know that it was contracted via needle stick if the person didn't even remember being stuck in the first place?

Working in pediatrics, I can count on one hand the number of HIV+ patients I have come into contact with over the years. When I worked in the hospital, they were talking about getting rid of the annual TB screenings and I highly doubt that hospitals want to take on a huge expense to identify a handful of people.

BlueDevil,DNP, DNP, RN · Jun 26, 2012

The cost-benefit outcomes would not justify it.