ER disease exposure

[Museless]

I wish there were a way to phrase this so I'd sound less like a goober, but there's not...

I've got ER on my 'short list' of possible specialty choices. Many aspects of the specialty are very appealing, and not just the self-serving ones (i.e. good lifestyle, etc.)

But. I learned during my first rotation (ob-gyn) that if I'm fully suited up for potentially messy procedures - gown, double-gloved, etc. - I'm a happy camper. I got really uneasy, however, called in on a red-tag delivery with just one glove on. My personal lifestyle is such that I have zero chance of contracting a blood-borne illness, barring an MVA and transfusion, and I'm afraid of bringing home HIV or Hep B to my husband or my (as yet hypothetical) children. I know the stats of seroconversion but still am nervous about the possibility.

Am I making a mountain out of a molehill here? How much exposure is there typically in ER? During one of our IV practice sessions second year, the ER nurse assisting our group got blood all over her bare hands and shrugged it off, "that happens all the time." Is it that common for everyone?

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[tonem]

You make every effort to protect yourself (never do anything invasive without protective equipment, no matter how urgent the situation might seem) but there are always situations in the ED where the patient makes it difficult. (ie: injecting local lidocaine into a patient that suddenly decides not to cooperate and forcefully pulls their arm away forcing the needle all the way though the arm and into your finger). While not isolated to the ED, it is probably more common. (to be fair hepatitis was a common job hazard for early transplant surgeons).

Incidently, I was just listening to an emergency medicine review tape by someone at USC talking about coming home from work one day with sore nalgas (from gamma globulin) and telling his wife "you like condoms right?" after being exposed to patient's blood in the ED.

 

[docB]

My worries for this topic are in order:
1. Hep C
2. TB
3. HIV
4. Mening
5. Out there stuff like bio weapons

Exposures are a part of the game but they can be minimized with forethought.

 

[ckent]

For the blood borne pathogens, I think that ER docs have around the same risk as many other physicians have, if not less (surgeons, intensive care physicians, etc). There is always time to put on gloves and practice universal precautions. As for the airborne pathogens, I agree that it is worrisome, but one of my ID professor explained it like this. Your patients didn't arrive in the ER in a bubble, they took the subway/bus, walked through the streets, so if you think about, you can catch the airborne stuff anywhere, you don't have to work in an ER to be exposed to it. You can still protect yourself when you think that someone is at high risk, but even general medicine people get screwed with things like TB and nobody thinking about it until it was too late (after everyone was exposed). Bioweapons are pretty scary, but unless you are an ER doc in NYC or Washington DC, your probabililty of being exposed before everyone recognizes what's going on is pretty low IMO. The only bioweapon that I know of that is really contagious right now is smallpox anyways, and you can always get vaccinated right after you know that you've been exposed.

 

[docB]

I and just about everyone else in my program volunteered for the smallpox vac initially but then we backed out. The reasons were that while the hospital said it would support the volunteers and it needed them to field a smallpox response team it would not give you time off if you got sick from the immunization nor would the hospital provided work comp or disability compensate anyone who had any long term sequalae. We also discovered that if we transmitted vaccinia to a patient (an AIDS patient for example) we had no protection from being sued by the patient. We were specifically told that should such a suit be brought it would not be covered under our med mal.
Consequently, we all bailed out. I guess anytime ACEP and AAEM agree on something (they both advised against immunization) you have to take notice.

 

[iwakuni_doc]

Smallpox - got the vaccine & was eager to get it...I had to take care of pt's who had received it prior to my vaccination.

Risk is a part of the life - you do everything you can humanly do to minimize that risk, but in the end it's the life & profession you chose. Needle-sticks happen - I've been in on surgeries on Hep C & HIV pt's and seen my friends get stuck...it is scary, but not a one of them was talking about no longer being a surgeon because of the risk. I've converted my PPD since being in Japan & am enjoying the fun of INH right now - again not something I'm real pleased about, but it comes with the territory.

That's my 2 cents...

 

[drpcb]

Exposure to infectious diseases in EM is a reality. Where I work, my riskiest cases are critical trauma cases where there are too many providers (the surgical and ED team) attempting to resuscitate one patient. Riskiest procedures are central line placement and chest tube insertion, in terms of bloodborne which essentially means Hep C and HIV exposure. I think HIV exposure is less concerning as I have a good bit of faith in the statistics with respect to a single needlestick from an unknown source followed by a complete course of postexposure prophylaxis. I will feel much better once an effective Hep C vaccine is developed.

If I can make it through residency without HIV or Hep C conversion, (I could care less about INH for a PPD conversion, or a dose of cipro for meningococcus,) I will be thrilled. It seems that most community ED physicians, and many at academic centers have a much lower exposure to bloodborne pathogens, since community ED's generally see less pathology, and at academic centers, the residents do the procedures. Therefore, I think residency is the riskiest time. Of course many of us have already suffered from a pesky methicillin resistant Staph Aureus cellulitis. One of us was hospitalized on vanco. All of us recovered without sequelae. Gastroenteritis, URI's, influenza and would you believe Hand Foot and Mouth disease are a regular occurence for us on our peds EM rotations.

I could go on and on. Perhaps we should wait for the next SARS outbreak????