What info should nurses let a PCT/CNA be aware of?

PinkRocksLikeMe · Nov 17, 2011

I guess it is what the nurse feels comfortable telling you. I am a ER Tech and I have had some nurses tell me, and then I have found out after the fact, after I have started an IV or put a foley in but it doesn't matter because I treat each patient as if they have HEP/HIV whatever cause you know what the PATIENT may not even be aware if they have something, Use universal precautions all the time and the take special care (like inspecting the skin for the BP cuff when taking vitals, you should do this with every patient by the way) all the time and you will be fine.

Pink

OCNRN63, RN · Nov 17, 2011

I am a nursing student and work as a MBT Mother Baby Technician in a hospital dealing with post partum mothers and babies. Amoung other things my duties are helping with breast feeding, peri care for c- section mothers, blood sugars, removing foleys and IV and taking care of the babies. My question is whenever we have patients with certain disease that can be transmitted by body fluid are the nurse suppose to let us know. I do know we are all suppose to follow HIPPA and Universal Protocols but at least they get that info in their reports from their peers. I don't get it why can't they just let us know to be a little more cautious. There was a incident recently where one of my collegaues had to do blood sugar on a patient every 2 hrs during a 12 hrs shift and the nurse NEVER mention to here this patient had HIV. I am concerned and just need to know what you guys think, should I ask for this info if it is not being pass on. HELP.

Make sure you follow universal precautions with every patient. Then you won't have to worry.

OCNRN63, RN · Nov 17, 2011

Say I am entering a room to do vitals. According to universal precautions, gloves are not required. If I know that the patient I am about to take vitals on has HIV or AIDS, I am going to take an EXTRA look at the arm that I will be applying the blood pressure cuff to to make sure there are no open cuts or wounds that could potentially come in contact with a cut on my hand, and maybe put on a pair of gloves to take vitals. When emptying a drain, dealing with bloody stool, sputem, doing a bgm, etc...I would be EXTRA careful...
that is what I would do differently.
Technically, gloves aren't required to give a bath ()...although I wear gloves every time...but maybe someone who practices this would put on a pair of gloves to protect themselves just in case. I am aware that patients can have a disease that they are not aware of or that it might not be listed in the chart...but if the disease is known then why keep that information from the healthcare personel that are dealing hands on with the patient's body fluids??

You should already be doing that, regardless of whether or not you know the patient has a blood-borne illness. If you're not, it's on you if you come in contact with blood/body fluids.

annietart · Nov 17, 2011

I'm just amazed at how HIV and aids are still so stigmatized. Standard and universal precautions are made for exactly this reason. Unless you get stuck by a needle or a boldly fluid of your choice gets into an open area of you, you aren't going to be infected.

Now if a nurse didn't tell me a patient of mine had active cdiff then I would get mad just because it's second nature for me just to go to the hand sanitizer and move on. We don't have sinks in every room.

Esme12, ASN, BSN, RN · Nov 17, 2011

Yes, I don't hardly ever tell my techs about things to do with my patients that they don't need to know. If I ask a nurse to start an IV for me, I don't tell her anything except the veins roll, or she has a big vein in her AC that I was trying to avoid, etc. Patient history in that aspect is not relevant.

Ok, I have to step in before I read all the responses. What are you thinking that you don't have to tell the nurse starting your IV if the patient has a blood borne pathogen? We ALL know, even though some won't admit it, that we are MORE careful when we know a patient has a blood borne pathogen. I may not need to know what pathogen but as I am going to be involved in the patients care buy starting their IV.....I think the prudent thing would be to let me know that there is an active blood borne pathogen. If I found out I later that information was with held (caution sarcastic comment coming) start your own IV. It's no different than telling someone that the patient in on strict droplet precautions and to wear the "special" mask.

Those techs are a part of the TEAM and are involved in the patients care. I think they deserve the respect to know if there is a pathogen that is active. I also think that since they are the ones giving the personal hygiene and skin care a working knowledge of the patients disease process is important to the rendering of that care. They are held to the same HIPAA rules the same as the licensed personnel....and if they are rendering care they are within the circle of "need to know" personnel. How do you expect then to care for your patient to the best of their ability and what is best for the patient if you keep them in the dark about what they are doing and why. I have always depended on the CNA's to report and signs of breakdown or activity intolerance as well as orientation and participation and the patients possible needs for home care, family issues or other aspects of the patient themselves that may affect their recovery......God knows I don't always have time for the details.

Universal precautions is the precaution necessary to prevent and protect the health care provider. I don't think anyone will treat the HIV patient with any less respect and if they do that's another issue that needs to be addressed. I admit that although I use universal precautions when exposed to blood or body fluids I am acutely aware if there is an active pathogen and exercise a little more caution. But if the status of the patient is so insignificant then why test the patient after a stick has occurred when the actual incidence of transmission is so small and just take the drugs and don't test the patient. Why is it OK not to tell someone that a patient has an active blood borne pathogen but then it's OK to tell them the patient has C-diff or TB.

I think anyone on the patient care team should be aware of what affect the patient. They may not need to know what pathogen but they should be made aware that there is one present.....this is a need to know example. wow...why Keep it to yourself? Control? I don't get it, I really don't.

Flame on!

kool-aide, RN · Nov 17, 2011

Thank you, Esme! Reading the reply I posted earlier today, I wish I had "spoken" more eloquently, but I stand by what I said. Not only is this a lack of knowledge for assistive personnel but I also feel like it's a lack of trust and by association a lack of respect by the nursing staff.

On a side note, I would like to say that this type of situation has never come up in my workplace (to my knowledge) and thank God for that! I respect the nurses I work with even more, now.

FloridaGatorRN · Nov 17, 2011

As a Tech I expect to be told, and as I nurse I will tell my aides. Mutual respect. We both have a need to know to provide the best care possible, period.

anotherone, BSN, RN · Nov 17, 2011

just thought i would add that I am sure you have had patients who were HIV positive and neither the patient nor any of her/his healtcare providers knew.......

annietart · Nov 17, 2011

I don't feel like editing my post to add what I was going to say earlier regarding stigmatization of HIV.

I'm working casually as a tech while I go through nursing school, and the last day I worked I had a new admission from a nursing home. Youngish but with cerebral palsy. I had the admitting nurse practically run me down to tell me she was HIV+. After that she just kind of avoided the patient. Now what, pray tell, was the rush? I really appreciate her telling me because I did take a closer look at her skin when I was changing her brief and taking vitals because she was at such a high risk for skin breakdown that she could be bleeding or oozing anywhere. My point is that the nurse was acting like I was going catch HIV just by changing the patient's brief. Good grief, I wasn't going to lick the lancet after I took her blood sugar. It really could've waited until I was out of another patient's room rather then handing me an alcohol wipe with it written on it.

This is just such a sticking point with me. People aren't chided for catching C-Diff, MRSA, VRE, or any other drug resistant communicable disease. Why should HIV or Hepatitis be treated any differently? It is because they are viewed as having done something wrong to catch it? Is HIV it still viewed as the 'gay cancer' and hepatitis something only heroin users get? Why are any diseases viewed as having a moral value? Is it the connotations with sex and drug use? Do these make people bad?

Gah! I'm rambling and it's really late. I'll get off my AIDS activist soapbox for now.

DeliveryRN2007 · Nov 17, 2011

Personally, if I am dealing with someone's blood (finger stick) I would like to know if they have a bloodborne illness. I would wear gloves either way and would not (and never have) treated the patient any different. I have however double gloved just to make myself feel better. I am also even more cautious than I usually am about splashes or other types of exposure issues

EDIT: I feel the same about MRSA, VRE, etc... I know in labor and delivery the external monitors are often put on the mother's adbomen WITHOUT (typo! corrected to without) gloves. I'm not saying it is right or wrong, it just happens that way. It is nice to know if they have any contagious skin issues (although usually you can tell by looking but regardless).

Do-over, ASN, RN · Nov 17, 2011

I get that many of you want to know, or feel that you have a right to know. If you were HIV + - would you tell your patients?

I maintain that it is not your business, and that it is my duty to protect the patient's privacy. This knowledge does not affect your duties, and making you "feel better" is not a reason to disclose this info.

As another has already stated - I suspect that MANY times no one even knows, so the point is moot.

allnurses Guide · Nov 17, 2011

Now if a nurse didn't tell me a patient of mine had active cdiff then I would get mad just because it's second nature for me just to go to the hand sanitizer and move on. We don't have sinks in every room.

Yes, I think c-diff could be possibly different. With the over-reliance on hand sanitizers, one would might need to know if a pt has c-diff, just to ensure a good hand scrubbing, but...

How about just stopping to really wash your hands after each pt anyway?

If a pt was on iso, I wouldn't be relying on just hand sanitizer, though I see this happen. I'd just use it until I could get my hands under a faucet asap.

But then, I'm no big fan of hand sanitizer as a "stand alone" hand hygiene technique... blah.

BTW... I don't think anyone actually needs to be told when someone has c-diff anyway... I mean, nothing smells quite like it, right? :eek:

As to whether the UAP are told, I think it depends on the nurse and the UAP.

But is it necessary?

Nope.

However, thinking about it, I find no one has a problem letting the UAP know if a pt has other conditions that do not necessarily affect the UAP's care of the pt.

Bah.