contact with AIDS patient

[smq123]

Habeed - Most of your post seems driven by fear and emotion, and not logic. There are a lot of logical flaws in your thinking.

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.

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)

You seem to think that by sending the patient's blood out anonymously to get tested will help you avoid the hassle and pain of taking HIV prophylaxis.

However - Post exposure prophylaxis needs to be started ASAP. We're talking hours, NOT days.

And anonymous HIV testing by mail can take WEEKS to come back. Most labs don't do rapid HIV tests unless it's a documented occupational exposure....in which case they would require a signed patient consent form.

So what are you going to do in the meantime while waiting for your anonymous HIV tests results to come back? Probably take HIV prophylaxis, which is what you were trying to avoid in the first place!!

So, ethical issues aside, I don't think that sending off the patient's blood anonymously makes any practical sense, since it doesn't improve the situation at all.

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.

Ummm...what?!

Without the patient's consent, how do you plan on drawing blood to get it tested? Sneak in and do it while they're asleep? (Most patients tend to hate it when they wake up and see someone coming at them unannounced.) Lie and say it's just for "phlebotomy practice?" (Which leads you to an even worse moral quandary!) How do you plan on getting this blood without being forthcoming with the patient?

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?

WHAT?!

- "one set of hands in the surgical field at a time" is an impossibility. Some maneuvers just require 3 hands or more. You can't get around that. When you do your surgery rotation, you'll see.

- You should always double glove anyway. You should always wear a face shield or goggles anyway. Even those aren't impervious - they don't cover your full head, they can crack, leak, etc.

- If there were sharps resistant gloves, even if they were sterilizable under "electron beam," we'd use them if they were at all cost efficient. It's cheaper just to be careful than try to use an "electron beam" to sterilize gloves, though.

- Suture needles can't have "guards" on them - that pretty much defeats the purpose of a suture needle. I don't know what you're talking about here.

- WHY ON EARTH would I use a "full isolation suit" for a patient with TB??!! TB is not blood borne. I would wear an N95 mask, regardless of the type of TB the patient had.

Dude, I know you're scared. But some of your suggestions (i.e. a full isolation suit for TB patients) are giving away the fact that your thoughts are driven more by fear, and not logic.

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.

Just because you've heard of surgeons being unethical people doesn't mean that YOU should follow suit.

I've heard of transplant surgeons who harvest organs without the donor being fully brain-dead. Does that mean that I can do it too??

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.

What the heck are you talking about?? MRSA is completely different, seeing as it is not a bloodborne disease!

"Universal precautions" are meant to protect against blood borne diseases like HIV, Hep B, Hep C. You can get MRSA just going to your favorite gym and using a public locker room. It's a VERY different story.

2. Whoever cooked the rules up thinks that needlesticks are always the fault of the healthcare provider.

No, whoever cooked up the rules realized that the healthcare provider is not the only person who matters here....and that patients have the right to decline consent to have their blood tested, should they choose to do so.

I understand your fear. Trust me, I've been there, having been stuck once myself (which was completely my fault, by the way.) But some of your reasoning as to why patient consent doesn't need to be obtained seems to be a little....selfish, one-sided, and egocentric.

3. Whoever cooked the rules up thinks that always doing prophylaxis when the patient won't consent is a practical idea.

Maybe, but your suggestion didn't make much sense either.

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[atomi]

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.

Can you cite/link literature on this one?

 

[howelljolly]

Can you cite/link literature on this one?

do a google search on "viral load", and "median infective dose".

 

[yonanz]

Hi dudes, I need some help here!!!

I am shadowing an oral/maxillofacial surgeon and assisting in his surgeries. I am an extremely paranoid person and has some sort of mild phobia with infectious diseases. After 4 weeks of shadowing, I am a little worried about contracting the HIV virus.

I am always wearing mask and gloves when assisting. The problem is, sometimes when he yanks the tooths out or saws the jaw bone etc the blood and all the Godknowswhat fluid splatters all over. The splatter is not great but some of it definitely got onto my face etc.

I have no nicks and cuts and pricks from needles/scalpers whatsoever as I am not qualified to handle them. I'm just worried if those blood/fluid that lands on my face will lead to any infection of any sort. If a HIV infected blood gets splattered into my eye, will I contract HIV?

I'm sorry for sounding dumb and ignorant. I have not been through med school and do not intend to be a dentist or doctor as well. This is just for the money before I enter university, and also the experience.

Please also highlight any risk in this setting if you can foresee any. Basically I am always standing beside the patient, peering into this mouth and using the hi-vac to suck all the blood and fluids in its mouth, and occassionally pour saline water when the doc is drilling the bones to lower the temperature. Definitely plenty of contact with blood, saliva, and other fluids of unknown nature. I'm so worried. Would really appreciate all of your input, pls dont flame me, as I have already qualified, I am no doctor, and no intention of becoming one. I'm just an assistant working for the salary before entering university to study another course. Thnx!!

 

[Habeed]

Well, if you believe what was said in this very thread, yonanz, your risk is minimal. Although, you should be wearing scrubs, a face shield, and mask and gloves, of course. At a very minimum, you do need eye protection.

The question I have is : if you're not going into dentistry or medicine, why are you assisting? Did you spend time or money to get training to act as an assistant? I'm just curious as to what your actual job position is : I wouldn't think a dentist would pay someone to shadow unless they had some level of educational credentials in order to be there.

 

[Law2Doc]

...The problem is, sometimes when he yanks the tooths out or saws the jaw bone etc the blood and all the Godknowswhat fluid splatters all over. The splatter is not great but some of it definitely got onto my face etc.

I have no nicks and cuts and pricks from needles/scalpers whatsoever as I am not qualified to handle them. I'm just worried if those blood/fluid that lands on my face will lead to any infection of any sort. If a HIV infected blood gets splattered into my eye, will I contract HIV?

I'm sorry for sounding dumb and ignorant. I have not been through med school and do not intend to be a dentist or doctor as well. This is just for the money before I enter university, and also the experience.

Please also highlight any risk in this setting if you can foresee any. Basically I am always standing beside the patient, peering into this mouth and using the hi-vac to suck all the blood and fluids in its mouth, and occassionally pour saline water when the doc is drilling the bones to lower the temperature. Definitely plenty of contact with blood, saliva, and other fluids of unknown nature. I'm so worried. Would really appreciate all of your input, pls dont flame me, as I have already qualified, I am no doctor, and no intention of becoming one. I'm just an assistant working for the salary before entering university to study another course. Thnx!!

Every hospital will have disposable masks with eye shields or some other form of eyeguards -- ask for them. If not, then you could probably pick up some cheapo glasses with non-prescription lenses and wear them. Yes you don't want infectious diseases getting in your eyes or mouth. Odds of transmission in this way are going to be far lower than directly introducing it with a needle, but generally people protect themselves from this with appropriate eyewear.

 

[yonanz]

Every hospital will have disposable masks with eye shields or some other form of eyeguards -- ask for them. If not, then you could probably pick up some cheapo glasses with non-prescription lenses and wear them. Yes you don't want infectious diseases getting in your eyes or mouth. Odds of transmission in this way are going to be far lower than directly introducing it with a needle, but generally people protect themselves from this with appropriate eyewear.

Thanks. I'm actually wearing a pair of glasses and I dont know if this is sufficient enough to prevent against infectious diseases. Are glasses good enough to guard my eye against infectious diseases?

I'm also wearing a mask all the time. But once in while I realised whenever I get stuffy I tend to subconsciously lower the mask to expose my nose so I can breathe better. After a short while I will realise this and quickly lift my mask up back to position.

In the few short-lived moments when my nose is exposed, will I risk being infected especially when small amounts of fluids/bloods get onto/into my nose? And do you think that the risk is negligible?

 

[yonanz]

Well, if you believe what was said in this very thread, yonanz, your risk is minimal. Although, you should be wearing scrubs, a face shield, and mask and gloves, of course. At a very minimum, you do need eye protection.

The question I have is : if you're not going into dentistry or medicine, why are you assisting? Did you spend time or money to get training to act as an assistant? I'm just curious as to what your actual job position is : I wouldn't think a dentist would pay someone to shadow unless they had some level of educational credentials in order to be there.

Yup, I'm mostly wearing mask, scrubs and gloves, but not face shields. Im wearing a pair of glasses actually, and I'm worried if this is enough to protect me against infectious diseases getting to my eye via fluid splatter i.e blood, in small quantities. My mask is on all the time, but as I have mentioned in my previous reply, sometimes I tend to subconsciously lower my mask for a short-lived moment to allow my nose to breathe better, and thus exposed my nose for a few seconds. I'm v worried if any fluids such as blood which lands onto/into my nose during these moments could risk transmitting infectious diseases. I hope not.

Hehe, to ans your question, I'm shadowing because I was given this privilege and thought it was too good an opportunity to pass it up. Despite the fact that I'm not going into med/dentistry, I felt that it is definitely a good experience and exposure to learn more about the medical/dental field. Nope I didnt spend a single cent or time to train for the assisting; I learn on the job itself. Haha, I actually personally know the dentist himself. So very kindly he offered me the opportunity to assist him. That's why I always say, networking n being nice to people is very impt in life

 

[lazycat]

That's why I always say, networking n being nice to people is very impt in life [/QUOTE]

absolutely aagree !!!!
( i have also assisted for a dentist several months before starting med school, it was fun and usefull)

 

[RunningKing]

The complete lack of writing skills and poor ability to critical reason that many of the people (er future Drs of America) on this thread have thus far exhibited scare me much more than touching a patient with AIDS. Seriously.

 

[cpants]

Thanks. I'm actually wearing a pair of glasses and I dont know if this is sufficient enough to prevent against infectious diseases. Are glasses good enough to guard my eye against infectious diseases?

I'm also wearing a mask all the time. But once in while I realised whenever I get stuffy I tend to subconsciously lower the mask to expose my nose so I can breathe better. After a short while I will realise this and quickly lift my mask up back to position.

In the few short-lived moments when my nose is exposed, will I risk being infected especially when small amounts of fluids/bloods get onto/into my nose? And do you think that the risk is negligible?

If there is as much splatter as you are saying, glasses are not enough. If there is airborne blood and guts on a regular basis, you need a face shield which will go over your glasses. Pulling the mask down defeats the purpose of it, which is keeping germs away from the patient. You are pretty unlikely to catch anything other than a common cold from airborne exposure (unless the pt has TB or pertussis). Train yourself to keep the mask on. Wear it slightly looser and see if that helps with the breathing.

 

[Mr hawkings]

The complete lack of writing skills and poor ability to critical reason that many of the people (er future Drs of America) on this thread have thus far exhibited scare me much more than touching a patient with AIDS. Seriously.

First of all some of the posters on this thread are not located in America and are not "future doctors of america" as you state. I hope you dont really think that everyone on this board is in America.

Secondly, your post contains a couple of grammar errors. Obviously, when you are trying to write a quick post in response to a question, you sometimes make carless mistakes in writing that you would not make in a written piece of work or even in your spoken word.

So relax.

 

[lazycat]

The complete lack of writing skills and poor ability to critical reason that many of the people (er future Drs of America) on this thread have thus far exhibited scare me much more than touching a patient with AIDS. Seriously.

first, off course, i am not US student, i am learning med in a developing country, english is not my native language and i am learning it as a second language.
second, this is medical forum, where we can share and debate our ideas about med fields, this is not a english literature forum, where you have to type correctly tense of verb or display your eloquence.
third, some kind of silly ideas are not harmful! main purpose we join this forum for experience and sharing knowledge or difficult situations in med. some one would think you are so childish or ridiculous or poor ability to critical reason, it does not mean you do not have right to post your idea.

 

[Deepa100]

first, off course, i am not US student, i am learning med in a developing country, english is not my native language and i am learning it as a second language.
second, this is medical forum, where we can share and debate our ideas about med fields, this is not a english literature forum, where you have to type correctly tense of verb or display your eloquence.
third, some kind of silly ideas are not harmful! main purpose we join this forum for experience and sharing knowledge or difficult situations in med. some one would think you are so childish or ridiculous or poor ability to critical reason, it does not mean you do not have right to post your idea.

Sure. It is just so much easier to understand when the idea is written in proper English. That's all.

 

[yonanz]

I don't get the fuss. This is an informal forum. There's no need to be grammatically perfect in my opinion. Some people just want to be anal and make a mountain out of a molehill.

 

[Mr hawkings]

I don't get the fuss. This is an informal forum. There's no need to be grammatically perfect in my opinion. Some people just want to be anal and make a mountain out of a molehill.

My point exactly.

 

[Tired]

Once I explain to patients that their disease is God's punishment for being bad people, they tend to be okay if I don't participate in their care.