Are patients scheduled for surgery routinely screened for HIV, HCV, etc...

prior to the procedure?

no. there's not point unless they have major complications from them (coagulopathy, cancer, malnutrition, bone marrow issues...)

if pregnant, then yes, because you need suppression meds.

http://emedicine.medscape.com/articl...1-overview#a30

Nope. Don't get stuck. You never know what someone might have.

Originally Posted by TheProwler

Nope. Don't get stuck. You never know what someone might have.

Until you take a vial of their blood from their central line and run the test anyway, with or without their consent. "hey, i need blood" said the nurse.

i did have one resident who screened a bunch of guys for HIV as part of their normal physical exam because she felt like it, a bunch turned out positive. props for her

i had to make those awkward result phone calls.

we still scrub in on HIV+ people, but the attendings usually tell us to double glove using the thick orthopedic ones.

Originally Posted by myhandsarecold

i did have one resident who screened a bunch of guys for HIV as part of their normal physical exam because she felt like it, a bunch turned out positive. props for her

i had to make those awkward result phone calls.

did she get reprimanded or lose her license? because that's SUPER illegal in most if not all states

Originally Posted by myhandsarecold

i did have one resident who screened a bunch of guys for HIV as part of their normal physical exam because she felt like it, a bunch turned out positive. props for her

i had to make those awkward result phone calls.

we still scrub in on HIV+ people, but the attendings usually tell us to double glove using the thick orthopedic ones.

I triple-gloved on my last Hep C case...

They aren't screened. I can't comment on other schools, but if there was a known high-risk patient our residents asked us not to scrub.

Originally Posted by CuriousGeorge2

prior to the procedure?

What would be the point?

What would you do with the information? Would you cancel the case? Would you take precautions you wouldn't otherwise (hint - you should be taking those precautions with EVERY patient, known disease status or not)?

Originally Posted by southernIM

What would be the point?

What would you do with the information? Would you cancel the case? Would you take precautions you wouldn't otherwise (hint - you should be taking those precautions with EVERY patient, known disease status or not)?

Just wondering if you accidentally relax and let down your guard at times? Even when I'm doing CNA scut work at a clinic, I'm too focused on other stuff to be thinking about HIV/AIDS etc. I can't imagine what it's like for you guys, having to worry about contracting a life-changing disease in addition to everything else.

Originally Posted by southernIM

What would be the point?

What would you do with the information? Would you cancel the case? Would you take precautions you wouldn't otherwise (hint - you should be taking those precautions with EVERY patient, known disease status or not)?

I think a physician should have the right to cancel the case.

Originally Posted by FutureCTDoc

I think a physician should have the right to cancel the case.

Oh boy.

Originally Posted by Bacchus

Oh boy.

Why? If it's an elective why not? The culture of self-sacrifice in medicine is obscene, if someone feels that they can't treat the patient or would be uncomfortable doing so, it is better that they appropriately refer it.

Originally Posted by FutureCTDoc

Why? If it's an elective why not? The culture of self-sacrifice in medicine is obscene, if someone feels that they can't treat the patient or would be uncomfortable doing so, it is better that they appropriately refer it.

it's not as much of a "self-sacrifice" as you imagine to operate on an HIV positive patient. as other posters have alluded to, you should be wearing PPE barriers at all times with all patients. if you do get a needlestick, the number I always hear is that you have 0.3% chance of seroconverting IF it's a hollow core needle (ie not a suture needle) and IF the patient is viremic (usually not the case if someone is on appropriate HAART). the number is much much lower if those two conditions are not met. there's also standard protocols for starting anti-HIV therapy as prophylaxis if you get a stick.

Originally Posted by FutureCTDoc

Why? If it's an elective why not? The culture of self-sacrifice in medicine is obscene, if someone feels that they can't treat the patient or would be uncomfortable doing so, it is better that they appropriately refer it.

if you're gonna go that far, may as well refuse to do an incision and drainage procedures. Hell, that needle stick would worry me more, getting a purulent needle stick.

Originally Posted by FutureCTDoc

I think a physician should have the right to cancel the case.

lol.

A bunch of high end hospitals with good, privately insured or cash payors do go ahead and do a complete, unnecessary preop work up including EKG, CMP, CBC and all that but not HIV or HCV because no one will reimburse you for that and the hospital will end up eating the cost. A bunch of these patients also undergo autologous blood transfusions complete with preop epo treatments and have their blood stored for later use.

it all depends. yes, physicians do have the right to cancel, but not very many would, if any.

Originally Posted by FutureCTDoc

I think a physician should have the right to cancel the case.

In a lot if cities and specialties you would have no patients if you refused to do procedures on folks with blood borne illnesses. A lot of people are only sick enough to need a procedure precisely because they have such a disease. Try getting a job in Miami (or wherever your "sunny Florida" locale is) and expect to screen your patients this way.

It's silliness. You don't need to know if the patient is HIV HepC positive unless you get stuck. Before that simply assume they are HIV Hep C positive and act accordingly. Just as you should be doing whether you know IR not. Double glove. Switch out nicked gloves. Watch the needles.

Originally Posted by southernIM

What would be the point?

What would you do with the information? Would you cancel the case? Would you take precautions you wouldn't otherwise (hint - you should be taking those precautions with EVERY patient, known disease status or not)?

Yeah, you never know what new diseases will be discovered. Before the 70's people didnt even know about HIV. I'm sure there will be a new diseases discovered in the future. As doctors we'll be exposed to those patients for years before they are discovered.

Originally Posted by marksimmons457

My grandfather had knee-joint surgery a month back.Sadly he developed infection in the region where surgery was done.My point is precaution against infection must be taken before any surgery.In such a scenario critical tests such as HIV or any other must be done before surgery.

HIV test results wouldn't impact this in anyway. Infection is a standard risk to surgery and the risk is reduced by certain standard measures that wouldn't change at all.