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

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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.

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 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...

Originally Posted by skinMD

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

No it isn't. HIV screening is appropriate for most patients in a routine H&P. Without consent it is illegal in some states, but as long as you ask the patient if it's ok and/or get the form signed, you are golden.

Originally Posted by cpants

No it isn't. HIV screening is appropriate for most patients in a routine H&P. Without consent it is illegal in some states, but as long as you ask the patient if it's ok and/or get the form signed, you are golden.

"because she felt like it" ....doesn't really sound like she got consent beforehand

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 skinMD

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

naw. she just had a really good "clinical eye". she did a lot of things that are super random but she always turned out right. pretty impressive actually.

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

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

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 skinMD

"because she felt like it" ....doesn't really sound like she got consent beforehand

Some states including my own are including consent for HIV screening in the paperwork you fill out as a new pt at a pcp office. So technically you could if you felt like it...

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 myhandsarecold

naw. she just had a really good "clinical eye". she did a lot of things that are super random but she always turned out right. pretty impressive actually.

That doesn't change the fact that it's generally illegal to test people without their consent.

Originally Posted by b-real

That doesn't change the fact that it's generally illegal to test people without their consent.

What makes you assume that she didn't? The med student has no basis on which to tell if she did or didn't get consent.

Although I really wish HIV laws would be changed in every single state to match other tests. It's not the 1980's anymore, we should treat it like any other disease and assume consent when general consent forms for blood tests are signed.

Originally Posted by b-real

That doesn't change the fact that it's generally illegal to test people without their consent.

It's illegal to do a lot of things without consent. That's why such broad forms are made to be filled out.

Originally Posted by Rendar5

What makes you assume that she didn't? The med student has no basis on which to tell if she did or didn't get consent.

Although I really wish HIV laws would be changed in every single state to match other tests. It's not the 1980's anymore, we should treat it like any other disease and assume consent when general consent forms for blood tests are signed.

You're right, the poster may not have a basis for knowing. However, when the poster states the resident tested the blood "because she felt like it," it sounds like there wasn't consent. By the same token, why do you assume there's consent? Also, just because we're in a more enlightened time and we should treat HIV like any other disease, the law must still be followed as it pertains to getting consent, no?

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.

Originally Posted by b-real

You're right, the poster may not have a basis for knowing. However, when the poster states the resident tested the blood "because she felt like it," it sounds like there wasn't consent. By the same token, why do you assume there's consent? Also, just because we're in a more enlightened time and we should treat HIV like any other disease, the law must still be followed as it pertains to getting consent, no?

1) I didn't say to ignore the law, I said the law needs to change, and they actually are starting to thankfully. If the law says to get a separate consent form, you do.
2) You're harping on the "she didn't get consent point" for some strange reason. All blood tests and all blood draws require consent regardless of the test. HIV simply gets a separate one. Otherwise drawing blood and testing it is actually assault. Do you normally assume that someone didn't consent for a blood draw if someone talks about a surprise test result.
"she tested my TSH for some reason and it was low"
"that's illegal, you need consent to draw blood"

At the hospital I am at right now, buccal swabs for HIV are routine on errybody in the ER, which corresponds with the latest national recommendations in terms of testing errybody. iirc.

Originally Posted by QuizzicalApe

At the hospital I am at right now, buccal swabs for HIV are routine on errybody in the ER, which corresponds with the latest national recommendations in terms of testing errybody. iirc.

depends on the state statutes how it is implemented, but they usually involve getting a separate consent. Separate consent can be as simple as "do you want to be screened for HIV" in some places. But it's still only done after getting basic consent, if pt's refuse they refuse. It's done in ED's because it's currently the best place for such a screening test, at least until PMD's get active in screening for it and until

My hospital doesn't routinely test. I was in a case where a resident did get a stick and he ordered blood drawn to test for HCV and HIV, then got new gloves and went back to work.

Originally Posted by QuizzicalApe

It's illegal to do a lot of things without consent. That's why such broad forms are made to be filled out.

"broad forms" don't hold up in court. You can't stick something like this into the fine print. The patient has to know and understand what they are consenting to or it's not "informed consent" and is a meaningless piece of paper. so unless the person is highlighting what they are agreeing to in some way it's a very precarious legal position.

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 Law2Doc

"broad forms" don't hold up in court. You can't stick something like this into the fine print. The patient has to know and understand what they are consenting to or it's not "informed consent" and is a meaningless piece of paper. so unless the person is highlighting what they are agreeing to in some way it's a very precarious legal position.

eh, it's also standard practice where I am. They have the opportunity to opt out, but it is basically a routine ER test at this point.

.

Originally Posted by QuizzicalApe

eh, it's also standard practice where I am. They have the opportunity to opt out, but it is basically a routine ER test at this point.

Most states don't have such rules, and they are legally problematic if someone chooses to challenge it.