contact with AIDS patient

[LadyWolverine]

I did trauma surgery in a hospital surrounded by a fairly high-risk population, and I don't think we had anyone with HIV. I only had one HIV+ patient when I did EM at the same hospital, and one Hep C patient. It's not quite as common as you make it sound. You wouldn't be "standing around waiting for a low-risk patient."

Ummm...come to Baltimore. More HIV and HepC than you can shake a stick at. With plenty of syphilis, to boot.

I had my first stick a couple of weeks ago on my trauma rotation. It was just a suture needle and everything turned out OK, but my life came to a screeching halt for a couple of hours that evening. All the statistics in the world being quoted to me over the phone/by my resident/etc. weren't enough to alleviate that feeling of terror.

---

Members don't see this ad.

 

[atomi]

There are plenty of frightening transmittable "stuff" in medicine besides just HIV, by the way. Tuberculosis, Hep C, lice, scabies, MRSA, C. difficile...the list goes on.

Did you just compare HIV to lice in terms of fright?

 

[atomi]

Ummm...come to Baltimore. More HIV and HepC than you can shake a stick at. With plenty of syphilis, to boot.

I had my first stick a couple of weeks ago on my trauma rotation. It was just a suture needle and everything turned out OK, but my life came to a screeching halt for a couple of hours that evening. All the statistics in the world being quoted to me over the phone/by my resident/etc. weren't enough to alleviate that feeling of terror.

Quite a few people in this thread have been stuck by needles - I am going to start a poll in a new thread out of curiosity.

 

[smq123]

Did you just compare HIV to lice in terms of fright?

Umm...yes.

I am significantly less afraid of getting a needle stick, even from a possibly HIV+ patient, than I am of lice. Lice are an incredible pain to get rid of, because they also require you to get rid of the nits. Spreading it to your roommates and family is also quite easy.

Compare that to HIV where a) transmission is very, very, very difficult, and b) prophylaxis is good and readily available.

I'm much more worried about Hep C than I am of HIV. And lice would be a bigger inconvenience than HIV would be.

If you are really that afraid of HIV, though, I would suggest that maybe medicine is not the best career for you, though.

 

[howelljolly]

That's what I thought, but we're talking about needlesticks here. Unless med students are no longer handling needles, I assume fumbles are going to happen occasionally.

And I don't know about L2D's assertion that surgeons will incur hundreds of exposures in their career. Nobody would go into the field if that were true. Aren't there gloves that can protect against sticks and cuts?

There are companies that make needle resistant gloves. They are used almost exclusively by law enforcement officers during searches. If you try and use those gloves on the wards.... besides having no dexterity, you'll look like a tool. Gimbel makes a glove that gives you fairly good dexterity... and actually, it was designed by a physician. In ten years, Ive seen one paramedic who uses them, and he is a tool.

Seriously. If this is a concern for you at this point. You arent afraid of lice (or scabies), because you dont know anything about it. But youve heard of HIV. Once you learn something, what are you going to do with your patients who have TB, HBV...scabies... menningitis. Well who knows, you might die of Pertussis on your Peds rotation.

 

[smq123]

There are companies that make needle resistant gloves. They are used almost exclusively by law enforcement officers during searches. If you try and use those gloves on the wards.... besides having no dexterity, you'll look like a tool. Gimbel makes a glove that gives you fairly good dexterity... and actually, it was designed by a physician. In ten years, Ive seen one paramedic who uses them, and he is a tool.

Can you imagine the response if an MS3 were to hand a pair of these custom-made, needle resistant gloves to the scrub tech?

But you make a good point. Atomi (and the OP) - there is ALWAYS something to "fear" when taking care of patients. I have heard stories of psychiatric nurses who had their spines fractured after being tackled by psychotic patients. HIV is a terrifying thing to you because you've heard of it...but there are a lot of other things that are more dangerous to worry about.

While I don't think that you should be cocky and brazen, just being aware of the risks and what you can do to avoid them is enough. No need to be paranoid about HIV, or worry as much about it as you seem to. If you truly are THAT scared about needle sticks and HIV, I would recommend finding another career. There are far scarier things than HIV, and if even HIV worries you, you're in trouble.

 

[SouthernSurgeon]

It was just a suture needle and everything turned out OK, but my life came to a screeching halt for a couple of hours that evening. All the statistics in the world being quoted to me over the phone/by my resident/etc. weren't enough to alleviate that feeling of terror.

For real. When it happened to me, I couldn't believe. I just kept rubbing my glove, wondering if that hole was real...

Sucked. It was actually really comforting that pretty much every person I talked to (residents, attendings) had had a stick of some sort, and they all remembered feeling traumatized the first time.

 

[Law2Doc]

Did you just compare HIV to lice in terms of fright?

I think the point is that there are things you are much much much more likely to contract from patients, and those are the things that should be first and foremost in your mind. Everybody in med school has heard of somebody who caught scabies, lice, or maybe c diff. from a patient. And everyone in med school knows that TB is contagious enough that the schools feel the need to do a PPD on you every year, like they are expecting somebody to contract it. And there are a whole host of things they make you gown up for before seeing a patient (AIDS not being one of them BTW).

HIV, by contrast, is fortunately hard to catch, even if you inadvertently introduce it right into your hand with a needle. So you be as careful as you can, and abide by all precautions and needle stick prophylaxis, but you don't live in fear of that (unless/until you actually stick yourself, which understandably will be stressful for a few months). But this is medicine. Your patients are sick. Sick people can make other people sick. You are on the front line in a battle against disease, and being on the front line is not without risks. There are plenty of non-medical fields where you never have to deal with patients/clients/customers face to face. If you don't want to deal with sick people, one of those fields sounds better suited to you (OP).

 

[Blesbok]

For real. When it happened to me, I couldn't believe. I just kept rubbing my glove, wondering if that hole was real...

Sucked. It was actually really comforting that pretty much every person I talked to (residents, attendings) had had a stick of some sort, and they all remembered feeling traumatized the first time.

http://content.nejm.org/cgi/content/full/356/26/2693

99% of final year residents had a needle stick with most of them having multiples.

 

[indo]

i don't even talk to people with aids. that is how contagious this gay cancer is.

 

[lazycat]

HIV, by contrast, is fortunately hard to catch, even if you inadvertently introduce it right into your hand with a needle. So you be as careful as you can, and abide by all precautions and needle stick prophylaxis, but you don't live in fear of that (unless/until you actually stick yourself, which understandably will be stressful for a few months). But this is medicine. Your patients are sick. Sick people can make other people sick. You are on the front line in a battle against disease, and being on the front line is not without risks. There are plenty of non-medical fields where you never have to deal with patients/clients/customers face to face. If you don't want to deal with sick people, one of those fields sounds better suited to you (OP).

the main reason why i learn med is i want to be useful to some lives... of course iam or we are not saint.. we are not only becoming doctor but also living as man...a man with ambition to prolong our lifetime!! we like these solders in front line as you described ! when we chose med, it means we chose dangers without insurances. the best thing which can protect us from dangers is our knowledge and experience. most of med student have basic knowledge about infectious disease and precaution.
despite of these, despite of precaution and low risk of contraction in HIV, Hep C...we still get it, we could be 1 in 3/100. i dont complain the high risk we will have with our job !
i know we have to face it... although i myself some moments feel scare... i have to tell that i was really scare, i posted this entry on the first day i had to check AIDS patients! although i have learned about HIV ,AIDS carefully but i still was afraid in that morning.. someone called my scare phobia...
i really want to know what will you do in case you have HIV positive ( just imagine!!), you will quit or continue your career? im not afraid about lice or scabies because its easy to deal with effective drugs.. but with HIV , hepatitis virus.. all what we have is time ..and time..
im not afraid now when contact with my patients... i know what i should do and keep on my mind the main purpose i chose med! but i dont forgive myself to forget the fear i have had , not only to remind how much carefulness i must have ,but also not to laugh to someone who have the same scare!

 

[howelljolly]

the main reason why i learn med is i want to rescue some lives... of couse iam or we are not saint.. we are not only becoming doctor but also living as man...a man with ambition to prolong our lifetime!! we like these soilders in front line as you described ! when we chose med, it means we chose dangers without insurrances. the best thing which can protect us from dangers is our knowlegde and experience. most of med student have basic knowledge about infectious disease and precaution.
despite of these, despite of precaution and low risk of contraction in HIV, Hep C...we still get it, we could be 1 in 3/100. i dont complain the high risk we will have with our job !
i know we have to face it... although i myself some momens feel scare... i have to tell that i was really scare, i posted this entry on the first day i had to check AIDS patients! although i have learned about HIV ,AIDS carefully but i still was afraid in that morning.. someone called my scare phobia...
i really want to know what will you do incase you have HIVpositive ( just imagine!!), you will quit or continue your career? im not afraid about lice or scabies because its easy to deal with effective drugs.. but with HIV , hepatitis virus.. all what we have is time ..and time..
im not afraid now when contact with my patients... i know what i should do and keep on my mind the main purpose i chose med! but i dont forgive myself to forget the fear i have had , not only to remind how much carefulness i must have ,but also not to laugh to someone who have the same scare!

Whatever man, a hero is just a sandwich.

 

[mjl1717]

Whatever man, a hero is just a sandwich.

Agree, its not about being, a hero just do it!!

 

[lazycat]

Whatever man, a hero is just a sandwich.

 

[lazycat]

Agree, its not about being, a hero just do it!!

 

[Rocket3004]

SUNY school here, we are told not to participate in patient care that would provide high risk exposure to Hepatitis or HIV, mainly for the reason above (risk/benefit of injury vs. learning). That said, it's all out the window in the floors/OR, but adhered to for OB.

Wow you guys are lucky!

I am seriously very scared of catching anything from patients. I had to take a history from a pt with pneumonia and I was like trying to cover my face with my notebook and washed my hands 10x after the physical. I know it's not very rational, but maybe just borderline OCD kicking in

 

[howelljolly]

Wow you guys are lucky!

I am seriously very scared of catching anything from patients. I had to take a history from a pt with pneumonia and I was like trying to cover my face with my notebook and washed my hands 10x after the physical. I know it's not very rational, but maybe just borderline OCD kicking in

Or borderline MR. Besides being an exercise in futility, covering your face with a notebook while you are taking the history from a patient is pretty unprofessional. If youre worried about catching a pneumonia...

 

[Rocket3004]

Or borderline MR. Besides being an exercise in futility, covering your face with a notebook while you are taking the history from a patient is pretty unprofessional. If youre worried about catching a pneumonia...

Haha, well it wasn't that bad, I really wasn't covering my face as much as I was just adding distance between us.... and in my defense he was coughing up lots of sputum and wasn't covering his face

 

[howelljolly]

Haha, well it wasn't that bad, I really wasn't covering my face as much as I was just adding distance between us.... and in my defense he was coughing up lots of sputum and wasn't covering his face

What you could do is wear a mask... and if somebody asks, you could say its to keep your own germs in....

 

[Habeed]

Are you allowed to require an HIV/HepC test on a patient before you do a surgery on them? If there's time, that is.

Realistically speaking, while there are a lot of rare bloodborne disease, HepC and HIV are probably more than 90% of the possible risk. If you know to be super-cautious on the ones that actually have it, you would be reducing your risk as a surgeon.

 

[Mr hawkings]

Are you allowed to require an HIV/HepC test on a patient before you do a surgery on them? If there's time, that is.

Realistically speaking, while there are a lot of rare bloodborne disease, HepC and HIV are probably more than 90% of the possible risk. If you know to be super-cautious on the ones that actually have it, you would be reducing your risk as a surgeon.

I dont know about Hep C but i dont think you can request an HIV test without the Pt consent unless if theres already been a needle stick. Someone please correct me if this is innacurate.

 

[cpants]

I dont know about Hep C but i dont think you can request an HIV test without the Pt consent unless if theres already been a needle stick. Someone please correct me if this is innacurate.

Actually you can never order an HIV test without the patient's consent, at least not in my state. If they haven't recently had one, and you get stuck, you need to get in there and get the patient's permission to do the test. They can say no.

 

[Habeed]

Actually you can never order an HIV test without the patient's consent, at least not in my state. If they haven't recently had one, and you get stuck, you need to get in there and get the patient's permission to do the test. They can say no.

That's ******ed. The prophylactic HIV meds have some nasty side effects, and can make you sick enough to miss work or even cause permanent damage in rare cases. While it's possible for someone to have the virus and test negative, if that is the case their viral load is probably very low, and transmission is probably not possible. So it's a huge deal if you are allowed to test or not.

Since you had access to the patient's blood, do you guys see it as a breach of ethics to quietly collect a sample on something and order a test yourself? I mean, if I did this, I'd send the blood sample in anonymously to one of those companies that does mail order HIV tests. I would not contact the patient with the news one way or another, and would not make any written records about where the blood came from. This might be a breach of the rules, but from an ethical perspective, my need to avoid contracting HIV or become horrifically sick from a prolonged regimine of HIV meds appears to greatly outweigh violating a rule that protects noone.

No, this is not a hypothetical : it appears that on average a surgical resident would be in this dilemna about twice a year. While I would be as careful as humanly possible, if 99% of surgical residents get stuck at least once, I seriously doubt that I would be the 1%. Even if I were, it's flat out impossible to keep a streak like that going for an entire career.

 

[SouthernSurgeon]

Actually you can never order an HIV test without the patient's consent, at least not in my state. If they haven't recently had one, and you get stuck, you need to get in there and get the patient's permission to do the test. They can say no.

Definitely not the case in states I am aware of. You sure about that?

When another person's health is at stake, the patient's permission is NOT needed. They can be forced to submit a sample if need be.

 

[SouthernSurgeon]

Since you had access to the patient's blood, do you guys see it as a breach of ethics to quietly collect a sample on something and order a test yourself? I mean, if I did this, I'd send the blood sample in anonymously to one of those companies that does mail order HIV tests.

At my hopsital, if you get a stick, the approved protocol is to go to the ED (who has a plan in place through employee health/risk management). They will initiate testing of the source patient with a rapid HIV (results in an hour or two) - the whole point of the prophylactic drugs is that you need to start taking them immediately so you do that, then d/c them if the source is negative.

You are discouraged from drawing the labs yourself, b/c then you can get into some med/legal issues for not going through the appropriate channels.

 

[Habeed]

You are discouraged from drawing the labs yourself, b/c then you can get into some med/legal issues for not going through the appropriate channels.

Well, of course. And a rapid HIV test is a lot better than a delayed one. I'm talking about a situation where some poorly thought out rule, obviously written by people who are not healthcare workers, shackled you from protecting your own health via some misguided attempt to protect the 'privacy' of the infected.

Honestly, this sounds like the sort of law that California would have...

 

[LadyWolverine]

When I was stuck, I had to obtain the pt's consent before testing their blood for HIV. Luckily for me, they consented. In Maryland, if an HIV tests comes up positive, your name is immediately reported to the State Health Dept and your name is filed away in a state-wide database. Thus, by consenting to an HIV test, you are waiving your right to remain anonymous should it come back positive.

Scary stuff. No wonder some people won't consent.

 

[Habeed]

So, you cannot make an anonymous test even if you wanted to? Say it was just "some blood" on a needle you got stuck with, and not who it came from?

That's exactly the kind of thing I don't see any real ethical issues with disobeying. After all, the point of the law is to protect patient privacy, and by getting a test done anonymously or under your own name (say that it's "your" blood being tested) you're still protecting it

 

[Mr hawkings]

Well, of course. And a rapid HIV test is a lot better than a delayed one. I'm talking about a situation where some poorly thought out rule, obviously written by people who are not healthcare workers, shackled you from protecting your own health via some misguided attempt to protect the 'privacy' of the infected.

Honestly, this sounds like the sort of law that California would have...

HEY, watch it. Jk

On a serious note, i work in an ID dept and we occaisionally get abandoned babies with all sorts of nasty infections needing a consult. The specialists are not allowed to order HIV testing on these babies. I think thats crazy considering that we dont know where they came from or why they were abandoned.

 

[Mr hawkings]

So, you cannot make an anonymous test even if you wanted to? Say it was just "some blood" on a needle you got stuck with, and not who it came from?

That's exactly the kind of thing I don't see any real ethical issues with disobeying. After all, the point of the law is to protect patient privacy, and by getting a test done anonymously or under your own name (say that it's "your" blood being tested) you're still protecting it

So what would you do if it did come back positive. Would you keep it from the Pt? How would you fulfill your duty to let the Pt know his/her status without getting fired. It would really suck to get fired and be HIV positive the same week.

 

[Habeed]

I'd rather be fired, than dead or gravely ill. And, not knowing could cause either of those things to happen. Either I decide to skip the prophylactic drugs due to the side effects and possible contract HIV (something I would not do if I KNEW the blood was HIV+) or I take the prophylactic drugs, get horribly sick from side effects, and fired from residency...

Hmm...

Either way, if the patient didn't consent, I would not tell them nor write it down anywhere.

I don't see how the patient's rights as a patient exceed my rights as a potential patient, and I'm not going to ever do residency in a state that thinks otherwise. Or sue the sh-- out of the state if they tried to penalize me for this.

 

[cpants]

Stay out of NY, NJ, CT, PA, and CA then. To be honest I think most states require consent for HIV testing. You do have a right to look at any existing lab results in the patient's chart, of course.

The scenario you described above is exactly why you must get consent. If the test comes back negative, no big deal. If the test comes out positive, you cannot hide that information from the patient. They need to be evaluated and make decisions about their treatment. More importantly, hiding a positive test puts every sexual partner of that patient at risk of HIV. Do you really want that on your conscience?

Your rights as a patient are exactly equal to your patient's rights. You have a right to make decisions only about your own body, fluids, etc. While it may suck not to know the patient's status, you don't have a right to know. It's not the patient's fault you stuck yourself. If a patient refuses the test, you need to do prophylaxis as if you knew his status was positive.

 

[Mr hawkings]

I'd rather be fired, than dead or gravely ill. And, not knowing could cause either of those things to happen. Either I decide to skip the prophylactic drugs due to the side effects and possible contract HIV (something I would not do if I KNEW the blood was HIV+) or I take the prophylactic drugs, get horribly sick from side effects, and fired from residency...

Hmm...

Either way, if the patient didn't consent, I would not tell them nor write it down anywhere.

I don't see how the patient's rights as a patient exceed my rights as a potential patient, and I'm not going to ever do residency in a state that thinks otherwise. Or sue the sh-- out of the state if they tried to penalize me for this.

You have along hard road ahead of you, my friend.

 

[AeroRNstudent]

I work in EMS, (working towards ER physician) I've had some pretty sticky situations. The fun calls where you are working a pt. whos been tore up by either car accident, violence, etc and thiers no way you can find out thier infection status at the time, you really can't worry about it, PPEs on and go. So when your arms are coverd , your uniforms ruined and all is said and done, then the thought maybe would cross your mind. Or if you accidentally got stuck. The chances are so extremely slim...like really slim. And if you do get exposed hit up the PEP. Sure it sucks and you'll feel like death, but if you got exposed for sure ( A REAL EXPOSURE infected fluids entering you somehow) just cowboy up and get it done. Better safe than sorry.

 

[AeroRNstudent]

and P.S, Habeed, highly disagree with you. Seriously. If your a surgeon, and your constantly worried about this so much that you pull a big no no and abtain your own blood sample? come on now. With all do respect and to represent ER docs, Nurses, Paramedics, all the way down, if they were as concerned as you seem they sure as hell wouldn't be in the buisness they're in. Needle pokes happen a little more frequently in a bumpy ambulance going 65, or buzzing around in a bird than in the controlled quiet atmosphere of OR, Surgeons are magicians they amaze me, but they operate in a different world. I've been in the OR more times than i can remember to intubate pts. I've never seen a stick. I've been on the ambulance more times than i can remember and i can count at least 6 witnessed, No infections. And 1 of those pts. did come back HIV + Don't worry so much my friend!

 

[howelljolly]

and P.S, Habeed, highly disagree with you. Seriously. If your a surgeon, and your constantly worried about this so much that you pull a big no no and abtain your own blood sample? come on now. With all do respect and to represent ER docs, Nurses, Paramedics, all the way down, if they were as concerned as you seem they sure as hell wouldn't be in the buisness they're in. Needle pokes happen a little more frequently in a bumpy ambulance going 65, or buzzing around in a bird than in the controlled quiet atmosphere of OR, Surgeons are magicians they amaze me, but they operate in a different world. I've been in the OR more times than i can remember to intubate pts. I've never seen a stick. I've been on the ambulance more times than i can remember and i can count at least 6 witnessed, No infections. And 1 of those pts. did come back HIV + Don't worry so much my friend!

its with all DUE respect.

I think Habeed is a paramedic.

The only needle stick I ever got was on an ambulance. I had just delivered a baby and was setting up the Pitocin drip. I was injecting the Pitocin into the medication port in the IV bag, and accidentally went all the way through the other side of the bag, and injected 20 units of Pit into my finger.

No big deal. It was a clean stick, and so I just breast fed the neonate on the way to the hospital, myself.

 

[Habeed]

I'm interested in surgery. (and I have the grades for it). A linked study says that on average, a needle stick happens to a surgery resident 1.7 times a year, and that 99% of surgical residents are stuck at least once before the end of residency. While I'd like to think that if I were a surgeon, I would be 'above average', I know that against odds like these I'd probably get stuck once or twice a year.

Odds like these make it pretty clear that getting stuck is not always avoidable nor your fault. (even if it is technically your fault, it appears that very few people alive are perfect enough to never get stuck)

Hence, it seems very important to be able to always get an HIV test on the blood you are stuck with. And the patient's rights don't trump mine.

 

[smq123]

the main reason why i learn med is i want to be useful to some lives... of course iam or we are not saint.. we are not only becoming doctor but also living as man...a man with ambition to prolong our lifetime!! we like these solders in front line as you described ! when we chose med, it means we chose dangers without insurances. the best thing which can protect us from dangers is our knowledge and experience. most of med student have basic knowledge about infectious disease and precaution.
despite of these, despite of precaution and low risk of contraction in HIV, Hep C...we still get it, we could be 1 in 3/100. i dont complain the high risk we will have with our job !
i know we have to face it... although i myself some moments feel scare... i have to tell that i was really scare, i posted this entry on the first day i had to check AIDS patients! although i have learned about HIV ,AIDS carefully but i still was afraid in that morning.. someone called my scare phobia...
i really want to know what will you do in case you have HIV positive ( just imagine!!), you will quit or continue your career? im not afraid about lice or scabies because its easy to deal with effective drugs.. but with HIV , hepatitis virus.. all what we have is time ..and time..
im not afraid now when contact with my patients... i know what i should do and keep on my mind the main purpose i chose med! but i dont forgive myself to forget the fear i have had , not only to remind how much carefulness i must have ,but also not to laugh to someone who have the same scare!

You're being kind of silly.

As you progress through med school, you'll learn how different viruses are spread, how dangerous they actually are, and how to protect yourself.

If you know to be super-cautious on the ones that actually have it, you would be reducing your risk as a surgeon.

No, you're increasing your risk. While I understand your logic, that's a dumb idea.

If you change your routine, based on the patient you have in front of you, you will make mistakes. Assume that ALL patients have Hep C until proven otherwise, and create your routine accordingly. If you do things differently for Patient X than you do for Patient Y, you're liable to make mistakes.

Since you had access to the patient's blood, do you guys see it as a breach of ethics to quietly collect a sample on something and order a test yourself? I mean, if I did this, I'd send the blood sample in anonymously to one of those companies that does mail order HIV tests.

Either way, if the patient didn't consent, I would not tell them nor write it down anywhere.

I don't see how the patient's rights as a patient exceed my rights as a potential patient, and I'm not going to ever do residency in a state that thinks otherwise. Or sue the sh-- out of the state if they tried to penalize me for this.

I can't believe that you're even suggesting this. YES it is HIGHLY unethical! I don't care how scared you are, you DO NOT VIOLATE the patient's fundamental rights, just for YOUR peace of mind!

While I understand that sounds harsh, those are the ethics that bind us. You can take them or leave them. You can't sue the state if they penalize you for this - by agreeing to be a practicing physician, you have tacitly agreed to follow certain ethics and morals. YOU would be the one in violation of your contract, not the state.

 

[smq123]

Hence, it seems very important to be able to always get an HIV test on the blood you are stuck with. And the patient's rights don't trump mine.

- If you're stuck, there are generally protocols that are followed, and will involve testing the patient's blood.

- But your "rights" (and peace of mind is not a right) don't trump the patient's right to privacy.

 

[Law2Doc]

I'm interested in surgery. (and I have the grades for it). A linked study says that on average, a needle stick happens to a surgery resident 1.7 times a year, and that 99% of surgical residents are stuck at least once before the end of residency. While I'd like to think that if I were a surgeon, I would be 'above average', I know that against odds like these I'd probably get stuck once or twice a year.

Odds like these make it pretty clear that getting stuck is not always avoidable nor your fault. (even if it is technically your fault, it appears that very few people alive are perfect enough to never get stuck)

Hence, it seems very important to be able to always get an HIV test on the blood you are stuck with. And the patient's rights don't trump mine.

Bear in mind that all these figures are even likely to be underreported. In many cases the surgeon already knows the patients HIV/Hep status and doesn't bother to report, in some cases the nick is not noticed, etc. From what I hear from surgeons, they nick themselves periodically, have to change gloves due to tears/punctures pretty regularly. It happens. Very very few suffer ill consequences due to it, fortunately. But I wouldn't question the notion that 99% of surgical residents get stuck, and that's but a small percentage of ones surgical career -- surgeons will do many times the number of operations in their career that they did in residency, so their odds of getting stuck are well over 100%.

 

[cpants]

Bear in mind that all these figures are even likely to be underreported. In many cases the surgeon already knows the patients HIV/Hep status and doesn't bother to report, in some cases the nick is not noticed, etc. From what I hear from surgeons, they nick themselves periodically, have to change gloves due to tears/punctures pretty regularly. It happens. Very very few suffer ill consequences due to it, fortunately. But I wouldn't question the notion that 99% of surgical residents get stuck, and that's but a small percentage of ones surgical career -- surgeons will do many times the number of operations in their career that they did in residency, so their odds of getting stuck are well over 100%.

I don't think the odds can be more than 100%...

 

[njbmd]

Vascular surgeon here who completed a residency where I spent more than a minimum amount of time on Trauma surgery and operating (something I do on a regular basis). My practice has been to double glove at all times and to use universal precautions. I ended residency and fellowship with zero needle sticks and no glove nicks that penetrated both pairs of my gloves.

Universal precautions and common sense (no needle capping, no sticking needles in bed mattresses and careful handling of sharps) will take one a long way in terms of protection. Certainly, there are more things to worry about than HIV/AIDS such as Hepatitis. I am not even CMV positive (as most of the population is CMV positive). Use common sense and use universal precautions.

You are far more dangerous to the HIV/AIDS patient than they are to you. There are patients who will be HIV negative today and HIV positive tomorrow because of risky behavior. You can't know the HIV status of every patient so every one of my patients get universal precautions and good handwashing on my part. (Cuts down on infection transmission too).

 

[Law2Doc]

I don't think the odds can be more than 100%...

Sure they can -- if you are likely to get stuck more than once.

 

[atomi]

But I wouldn't question the notion that 99% of surgical residents get stuck, and that's but a small percentage of ones surgical career -- surgeons will do many times the number of operations in their career that they did in residency, so their odds of getting stuck are well over 100%.

I would be willing to guess that >50% of these sticks are clean sticks given the amount of prep that happens and the propensity to be less careful when working with clean tools.

 

[atomi]

My practice has been to double glove at all times and to use universal precautions. I ended residency and fellowship with zero needle sticks and no glove nicks that penetrated both pairs of my gloves.

I don't think it's unreasonable to expect zero sticks. What are your feelings on the stick-proof gloves?

 

[AeroRNstudent]

I recognize your concern Habeed, however, there are literally hundreds of variables that have to be exactly right for you to contract. The main varibles being:
1. You have to first and most importantly have a source (actual infected patient)
2. You have to be actually exposed ( infected fluids entering your mucous membranes, blood stream etc.
3. You have to have ENOUGH of the virus enter your body, despite popular belief, your immune system can easily destroy the virus in small numbers.
4. also you have to keep in mind that this virus is extremely fragile, it works by reverse transcript and it can only work in the right enviornment, it "dies" or becomes damaged in fractions of a second in open air.
In no way am I saying don't be concerned with the possibility of infection from a needle stick in a clinical inviornment, but you really have to look at your odds. Are your odds poor enough that you violate your patients rights? No.
Another fun fact comes from a different infection setting. Studies have shown that even if you were to be exposed, your chances of contracting are under 1% (ofcourse this varies with method of exposure) People forget how much good quick management of a stick can eliminate exposure risk, pull it, wash the area with good' ol soap and water and take it from there. PEP side affects can also be lessoned with proper vitamin, mineral and amino acid complex. ( selenium, various aminos, liquid Multi) so, PEP is not the end of the world.

 

[howelljolly]

I don't think it's unreasonable to expect zero sticks. What are your feelings on the stick-proof gloves?

You can't autoclave them. And you cant wear them after youve scrubbed up. And you cant scrub up with them on. So... you can't use them in the OR.

On the wards, you can look like a tool if you want.

But

The gloves are not stick-PROOF. They are stick-resistant. And, you'll need to wear the regular exam gloves as well, because they do not isolate blood and body fluids.

 

[Law2Doc]

I don't think it's unreasonable to expect zero sticks. What are your feelings on the stick-proof gloves?

I'd agree that zero sticks as a surgeon is beating the odds, precautions or not.
I also agree that the stick proof gloves can't be used in the OR, making them useless -- I expect in a couple of decades someone will come out with a disposable version, but until then you can forget it. More likely someone will develop a gel you put on your hands under the glove that makes transmission of live viruses through the gloves and into your skin less likely.

 

[Habeed]

So what's the problem? People are jumping on me for saying that I'd like to more effectively protect myself by having any blood I get stuck with tested for HIV. If the patient didn't consent, then the HIV test should be anonymous, sent out of state via overnight mail to a lab in a state that doesn't have mandatory reporting requirements. I don't see any ethical issues : if the patient didn't consent to testing, I'm not testing the patient...I'm testing blood I just got stuck with that might have come from anywhere... It's a fiction, but from a moral perspective I don't see anything wrong with it. Whatever I find out, from the patients view it's like the test never happened, as they wanted. And the results of such a test could easily save my life. (because if I get stuck twice a year, like the average surgical resident, after a while I'm probably going to stop bothering with prophylaxis drugs)

And, testing a patient before surgery for AIDs probably means it would be easier to make sure you don't get stuck THIS time. As in : only one set of hands in the surgical field at at time, double glove or wear those sharps resistant gloves under sterile outer gloves (maybe they could tolerate sterilization via electron beam), ALWAYS use the more expensive needles that have guards on them, ect. ALWAYS use the full face shield rather than just splash goggles. Change your scrubs immediately after you get even a tiny drop of blood from the HIV+ patient on them. Don't make a n
urse or doctor who has recently had, say, mouth surgery do certain procedures. Ect, ect...'universal' precautions are not going to be the absolute final word in what can be done. I mean, for a patient that had the drug immune strain of TB, you'd want to wear a full isolation suit, right?

I've anechdotally heard second hand of surgeons who do, somewhat illegally, order HIV tests on every patient prior to surgery. The results of the test don't go in the patients file, and the surgeon does the procedure either way, but knowing which patients to treat like they are a biohazard is rather valuable information.

The entire reason this is even an issue is because :
1. People who don't have to follow them believe in the fiction of perfect 'universal precautions' that aren't going to be a hermetic defense anytime, all of the time. Or, MRSA wouldn't be such a huge problem.
2. Whoever cooked the rules up thinks that needlesticks are always the fault of the healthcare provider. That may technically be true...but it appears that very few human beings alive are both smart enough to make it into med school and coordinated and lucky enough to never get stuck, even when it's been 30 hours of call and the patient is seizing.
3. Whoever cooked the rules up thinks that always doing prophylaxis when the patient won't consent is a practical idea.

 

[cpants]

So what's the problem? People are jumping on me for saying that I'd like to more effectively protect myself by having any blood I get stuck with tested for HIV. If the patient didn't consent, then the HIV test should be anonymous, sent out of state via overnight mail to a lab in a state that doesn't have mandatory reporting requirements. I don't see any ethical issues : if the patient didn't consent to testing, I'm not testing the patient...I'm testing blood I just got stuck with that might have come from anywhere... It's a fiction, but from a moral perspective I don't see anything wrong with it. Whatever I find out, from the patients view it's like the test never happened, as they wanted. And the results of such a test could easily save my life. (because if I get stuck twice a year, like the average surgical resident, after a while I'm probably going to stop bothering with prophylaxis drugs)

And, testing a patient before surgery for AIDs probably means it would be easier to make sure you don't get stuck THIS time. As in : only one set of hands in the surgical field at at time, double glove or wear those sharps resistant gloves under sterile outer gloves (maybe they could tolerate sterilization via electron beam), ALWAYS use the more expensive needles that have guards on them, ect. ALWAYS use the full face shield rather than just splash goggles. Change your scrubs immediately after you get even a tiny drop of blood from the HIV+ patient on them. Don't make a n
urse or doctor who has recently had, say, mouth surgery do certain procedures. Ect, ect...'universal' precautions are not going to be the absolute final word in what can be done. I mean, for a patient that had the drug immune strain of TB, you'd want to wear a full isolation suit, right?

I've anechdotally heard second hand of surgeons who do, somewhat illegally, order HIV tests on every patient prior to surgery. The results of the test don't go in the patients file, and the surgeon does the procedure either way, but knowing which patients to treat like they are a biohazard is rather valuable information.

The entire reason this is even an issue is because :
1. People who don't have to follow them believe in the fiction of perfect 'universal precautions' that aren't going to be a hermetic defense anytime, all of the time. Or, MRSA wouldn't be such a huge problem.
2. Whoever cooked the rules up thinks that needlesticks are always the fault of the healthcare provider. That may technically be true...but it appears that very few human beings alive are both smart enough to make it into med school and coordinated and lucky enough to never get stuck, even when it's been 30 hours of call and the patient is seizing.
3. Whoever cooked the rules up thinks that always doing prophylaxis when the patient won't consent is a practical idea.

Testing patients for HIV (you don't test people for AIDS, unless you already know they are HIV positive and you are checking their CD4+ levels), is always a good idea prior to surgery. In most urban hospitals testing every patient is a good idea. At my hospital anyone who comes in the ER gets a rapid HIV test, provided that they consent. As a result, we know the HIV status of almost every patient on the wards. This is more for the health of the patient and control of the HIV epidemic, than for the healthcare workers' health. As I and others have already told you, HIV patients do not need to be treated differently than other patients, unless they are in full blown AIDS or have active TB. In fact, it would probably be better for your patients if you don't know their status, since you want to unneccesarily treat them like "biohazards".

Needlestick injuries are an occupational hazard for physicians. There's no getting around it. The good news is that your risk of contracting HIV is extremely low. Even when stuck with a wide-bore needle, well under 1% of patients will seroconvert. Furthermore, there has never been a reported case of someone who seroconverted after undergoing post-exposure prophylaxis. So there is really no reason to mandate patients to get tested. Most of the time if you get stuck, the patient's status will be known or you will be able to easily convince her to get tested. If the patient refuses, that is your problem and no one else's. You can decide to risk it and 99.5%+ of the time you will be fine. That means that even in a 40 year career where you are stuck 2x/year by HIV POSITIVE patients, you probably wouldn't seroconvert. Or you can take prophylaxis and reduce that risk to basically nothing. Sorry, but this minimal risk does not warrant violating the rights of patients.