VRE, MRSA, and HIV testing question

[william5703]

Hi all,

I am doing a sort of research project for school regarding HIV. We are trying to research the policy regarding reporting of HIV positive patients to healthcare providers. I live in NC and have read over the laws regarding HIV reporting, and it looks like just the primary physician has to report the positive test and name to the health department.

The questions that I have are: Is it standard procedure to screen for VRE and MRSA in patients admitted to hospitals, or is simply for high risk patients, or patients that exhibit s/s of an infection? Also, is informed consent needed for screening of VRE and MRSA? Finally, is it up to the patient to inform nurses that they are HIV positive or can consent be obtained to have this information released and put in a medical record?

The reason that I am asking all of this, is that it seems like so much confidentiality is placed around HIV testing and results, but if someone has VRE or MRSA isolation precautions are taken (signs put on doors, etc.) and it is broadcasted that these patients are infected with either VRE or MRSA. I know the transmission rates are much higher with VRE and MRSA and healthcare providers can become infected simply by contact, but we're trying to figure out what the difference is with HIV (simply the stigma of the disease?).

Although we've all learned that simply using standard precautions can prevent HIV infection many nurses don't follow these precautions. Apart from the stigma of HIV, I don't really see what the difference is in having it in a medical record like VRE, MRSA, or something like Hepatitis.

Thanks in advance!

[grad*student]

about the confidentiality aspect of your post:

VRE/MRSA are generally acute and non-lethal (though not always), while HIV is a chronic lethal condition that historically faces stigma & opens patients to discrimination in many aspects of their lives (ex. employment, residence, memberships, etc...). Remember when HIV used to be thought of as a "gay disease"? As if people w/ lifestyles different than mainstream deserved the disease somehow? These types of discussions were going on in the 80's and 90's!

Also, on a healthcare unit, standard precautions protect all of us from HIV. VRE/MRSA require extra precautions in order to protect staff and the other patients on the floor (ie. these infect via nosocomial transmission, whereas HIV should not). VRE/MRSA can spread on a hospital floor from patient to patient, but this is not the case with HIV.

[grad*student]

I couldn't edit my post, but just wanted to correct what I said about VRE/MRSA normally being non-lethal. For some patients, it obviously can lead to significantly longer hospital stays, disability, and even death. So I think the big thing (the reason we are OK about posting signs) is that these things are typically nosocomial, meaning that staff needs to be ultra-cautious in preventing spread. That's really the difference. We can't afford to use extra precautions with all our patients (& it's cumbersome), so we have to identify those patients who are infected so that staff & visitors follow the extra precautions and prevent illness from spreading to others. Hospitals are breeding grounds for VRE/MRSA/c-diff.

[oMerMero]

Where are you getting your information that many nurses do not use standard precautions?

[william5703]

Thanks for the replies everyone!

We've actually changed our project to focus on home HIV testing and the effects of reporting and no face-to-face counseling. But I appreciate the information regarding VRE/MRSA screening.

As for the question about where I'm getting the information that some nurses aren't compliant in regard to standard precaution...it's simply from observation. Maybe I'm a glove freak, but I'm been taught the correct way to practice these precautions and nurses simply don't. Maybe it's a matter of the time it takes to put on gloves or wash hands, or simply they feel the rate of transmission of a disease is low. If you want real research simply search for it. In searching for peer reviewed journals this is one of the first that I have found:

McCoy, K.D., Beekmann, S.E., Ferguson, K.J., Vaughn, T.E., Torner, J.C., Woolson, R.F., et al. (2001). Monitoring adherence to standard precautions. American Journal of Infection Control. 29(1), 24-31.

Nurses simply don't follow the standard precautions outlined by the CDC

(unless of course the infection control nurse is on the unit). If you have

a different opinion I am open for it.

Again, thanks for the replies!

[faltura, RN]

Hi!

With regards to the HIV screening, it would depend primarily on what the patient says. Maybe it would be a lot more easier if we could train those in the frontline to ask the patient regarding this syndrome in a manner that it would be answered truthfully. We have to also emphasize the gravity of giving a complete history, if they know what it is for, they would answer the best way they can. the problem is the stigma, reason why they would not answer questions. maybe we could ask the patients regarding "STDs", eg. Have you been exposed or had a history of any Venereal Disease? If they say yes, then ask what it was that they were exposed to.

Another case would be of course, if there is a needlestick injury involving the patient, the source person, if the attending physician agrees, that the patient be screened for blood borne pathogens (Hep B, Hep C and HIV). HIV testing should also be done after the patient consents (thus, a need for HIV Consent Form).

For MRSA and VRE? It would also be consented by the patient especially if it is a rectal examination. Although through my surveillance so far, i have seen that there is increased probablity that a patient who comes in with either cellulitis, lumps, abscesses are commonly the patients who will turn out to be MRSA(+). Here in our country though, i have not heard of VRE (+) patient yet. Hopefully it never comes :)

For the signages, we are in the process of producing a general precaution signage to the patient's door, well to think it is for their relatives' protection and so will be the protection to all healthcare workers. for now, wemake use of signagnes that says "PLEASE WEAR MASK before ENTERING the ROOM" for droplet and airborne precautions (Airborne says please wear n95 mask...) and PLEASE WEAR GLOVES" for contact precautions. We are near to finishing another precaution signage with the general requirements and meanings of the different precaution with color coding. With that a letter to the patient informing him why we need to put up a signage.

Hope this would help.