Surgery and HIV/Hep C

[Stellar Clouds]

Do the surgeons at your school allow medical students to scrub in on patients with known HIV or Hep C? My school has no official policy against it, but I have worked with several attendings that will not allow medical students to scrub if the patient is positive.

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[evilbooyaa]

No. Attendings let me scrub in on all cases, including HIV and Hep C cases. Everyone just moved a little slower and with more precision to double ensure that no one got a needle stick.

 

[Bacchus]

We did not scrub in for HIV or HCV infected patients.

 

[JRjcu08]

Does your hospital screen every operative patient for Hep C and HIV? Seriously doubt it. There's no logical reason to not scrub in on *known* patients with these diseases if you're willfully scrubbing in on patients whose statuses are unknown.

 

[Stellar Clouds]

Does your hospital screen every operative patient for Hep C and HIV? Seriously doubt it. There's no logical reason to not scrub in on *known* patients with these diseases if you're willfully scrubbing in on patients whose statuses are unknown.

Actually yes, the hospital I worked at screened everyone for HIV and most people for Hep C.

 

[JRjcu08]

Actually yes, the hospital I worked at screened everyone for HIV and most people for Hep C.

For real?? I have never heard of any hospital having mandatory HIV (or Hep C) screens outside of testing a patient after an accidental needle stick to an employee. For one, it's a legal nightmare... and furthermore, mandated testing imposes an enormous cost on the hospital (average $50 to test one patient) for a disease with such a low prevalence in the US. There are states with laws that mandate OFFERING testing to patients, which they can always refuse except in cases of newborn screens, occupational exposures, and a few other non-hospital issues (life insurance policies, sex offenders, participation in federal programs, etc.).

I understand wanting to minimize your risk, but this is a bit ridiculous. When you graduate, are you going to refuse to see patients with HIV or Hep C in your own practice? Are you going to try to mandate that all of your patients be tested? This is why standard precautions exist.

 

[Textbookversion]

Does your hospital screen every operative patient for Hep C and HIV? Seriously doubt it. There's no logical reason to not scrub in on *known* patients with these diseases if you're willfully scrubbing in on patients whose statuses are unknown.

obviously the risk in a known patient >>>>> risk in average surgery patient so there is a logical reason to only avoid scrubbing in on known patients.

as per the point about real practice not being able to avoid HIV+ patients, obviously the risks of an experienced surgeon sticking himself <<<<<<< medical student with two thumbs. surgery selects for, and gives relevant practice in the art of avoiding stabbing things you don't want to, while the general med school population includes future psychiatrists.

critical thinking skills exhibited in your posts are rubbish.

 

[JRjcu08]

obviously the risk in a known patient >>>>> risk in average surgery patient so there is a logical reason to only avoid scrubbing in on known patients.

as per the point about real practice not being able to avoid HIV+ patients, obviously the risks of an experienced surgeon sticking himself <<<<<<< medical student with two thumbs. surgery selects for, and gives relevant practice in the art of avoiding stabbing things you don't want to, while the general med school population includes future psychiatrists.

critical thinking skills exhibited in your posts are rubbish.

Really? Unless the hospital is screening everyone (which is likely no) any patient with unknown status could potentially be infected. If not walking on eggshells in all procedures, it really doesn't make sense to not scrub on known positive patients-- just be more careful.

So then, should surgical interns not scrub in on pts with HIV? What about medicine interns on their surgery rotation? They all have the equivalent training as a "future psychiatrist" up to that point. And to your other point, I worked with surgeons who have been in practice for decades that get stuck during a procedure. It's called an ACCIDENTAL exposure for a reason. The surgeon is not the only participant here leaving everyone else in the room out of his/her control.

 

[greatnt249]

What about medicine interns on their surgery rotation? They all have the equivalent training as a "future psychiatrist" up to that point.

What God-awful hospital do you work at where medicine interns are required to do a surgery rotation? Unless, of course, you're referring to non-US residencies or the traditional DO internship.

 

[Bacchus]

obviously the risk in a known patient >>>>> risk in average surgery patient so there is a logical reason to only avoid scrubbing in on known patients.

as per the point about real practice not being able to avoid HIV+ patients, obviously the risks of an experienced surgeon sticking himself <<<<<<< medical student with two thumbs. surgery selects for, and gives relevant practice in the art of avoiding stabbing things you don't want to, while the general med school population includes future psychiatrists.

critical thinking skills exhibited in your posts are rubbish.

I have to agree with you. Med students are a liability. There's too much that could go wrong with us. There's no reason to have an extra pair of unnecessary hands present.

 

[JRjcu08]

http://forums.studentdoctor.net/showpost.php?p=3073247&postcount=8

Zombie thread, but the above post pretty much sums up my opinions.

And if med students are just a liability, why are we scrubbing into any surgical procedures at all?

 

[tco]

WTH is happening in this thread? Questioning safety practices to questioning why medical students scrub in on cases?

The cost of running HIV and Hep C screening tests are not the same as the cost of the tests to the patient. If the hospital is running the test for physician and student safety, they aren't eating the same cost billed to the patient.

I know that our hospital runs Hep C/HIV tests on all high risk patients before surgery. I don't know about all unknown patients.

As to why medical students scrub in on cases - because you're going to be there one day. You're going to be treating a patient that has had surgery, and it's essential to have background information on why the surgery was performed and what the patient's post-op care included. Plus, you might need to look at a wound or two in your career...Unless you're going into psychiatry.

I don't understand your argument, unless you're proposing that we change the way medicine is taught, which is something that I'm a huge advocate for. However, I still believe that every specialty needs to rotate through medicine and surgery (I actually feel that those should be the only required rotations @ 12 weeks each). Those rotations are the backbone of all of medicine.

 

[Stellar Clouds]

WTH is happening in this thread?

I'm wondering the same thing. All I wanted was a few simple answers to a simple question, but apparently someone was just flabbergasted that a hospital would test patients for HIV and decided to completely derail my thread.

 

[JRjcu08]

Do you people not understand theoretical questions?

OP asked if school won't let students scrub in on known HIV/hep c cases. Answer should be that students scrub in on all cases. You can't cherry pick the cases you participate in just as you can't choose what infectious diseases your future patients may have. These are awful infectious diseases to contract, but the likelihood of a student getting stuck and also subsequently developing the disease is quite low (I've seen figures around 2.5% chance even after being stuck by a known positive carrier). Wear gloves, two if you really must, move slowly and carefully. Be aware if your surroundings and colleagues. This is how healthcare professionals minimize their risk of getting an ID from a patient.

I did not say students should not be scrubbing in- it is important for all, no matter if you're doing psychiatry or ortho, to see what's involved pre/intra/postoperatively. Plus, it's kind of a rite of passage of the third yr med student, just like an OB rotation. (That said, 4-6 weeks of this would be sufficient for those not pursuing a surgical field... If I had to do 12 weeks of surgery rotations I'd gouge my eyes out.)

Pre screening high risk patients is fine and should be done (still in most cases it's within the patient's legal rights to refuse this testing). Pre screening everyone who walks in the door is absurd, it is not cost-effective and from a statistics standpoint it won't improve outcomes. I've been to hospitals where I suggested screening a high-risk patient (promiscuous + IVDU) and was even then told it was not cost effective and that they could do it as an outpatient in their own.

If you wanted to posit a yes/no question then why didn't you just create a poll? Otherwise, forums are for discussion.

 

[cheruka]

Early on in third yr, I asked about this at the community hospital where I rotated. They basically said- we take the same precautions for everyone. That is what I do- I treat everyone like they have Hep C/HIV. And I always see patients that my attendings do. Just don't share body fluids, wear gloves, be safe to the best of your abilities.

 

[Bacchus]

I wish a GS resident or attending would comment on this.

 

[JRjcu08]

I wish a GS resident or attending would comment on this.

Maybe this can count for now-
From Baylor SOM, the DeBakey dept of surgery (he was a big deal, no?), in regards to their gen surg rotation:

"Students are allowed to scrub in on cases with HIV and hepatitis patients. This has been confirmed with the Office of Student Affairs. However, if you feel uncomfortable, then please do not scrub in. That being said, there are many interesting and educationally valuable cases at the VA. I strongly feel that each case should have a student scrubbed in."

 

[Textbookversion]

JR you are just embarrassing yourself in this thread.

 

[JRjcu08]

JR you are just embarrassing yourself in this thread.

Not sure how. Typically when people disagree with arguments that others present, they provide backup sources as to why. Or you can just continue to tell me I'm an idiot instead of presenting anything to support your thoughts/reasoning.
Ill restate that the OP started a thread for discussion on a particular topic. Carry on.

 

[Smurfette]

I wish a GS resident or attending would comment on this.

Comment on what, exactly?

Where I went to med school, students were specifically barred from scrubbing in on HIV/HepC/HepB patients. The school was very clear about this, although patients were not routinely tested, but on rotations off-site (we got sent out to other locations for some rotations), this was not enforced. Some faculty at the main hospital took this one step further, and wouldn't even let us round or care for such patients.

In my residency program, students were NOT exempt from caring for or scrubbing in on these patients. (no routine screening, either). Sometimes we would try and give the student a pass on scrubbing, if it was bound to be a difficult/painful case, but if the attending asked about the student.... Also, certain rotations had a higher risk of this (like transplant or vascular, with dialysis patients and ESLD patients with a high incidence of HepC) so students assigned to those rotations usually couldn't refuse.

Personally, as an attending, I am inclined to let the student decide if they want to scrub and make it clear I'm not "testing" them by giving them an option. If the student is interested in participating in the case and knows the HIV/HepC status, the student can make his/her own decision on that. Afterall, any patient *could* have something bloodbourne...in these patients, we just know it for a fact.

 

[Bacchus]

I think that's a reasonable policy. If it were a procedure I had not had the chance to see in the future I'd probably scrub in.

With that said, I did GS at a strong community program, but only usually saw bread and butter cases. Also, there was not a high prevalence of HIV/HCV in the community. There were 2 cases I was told specifically not to scrub, but they were procedures I had seen before.

 

[survivordo]

Does your hospital screen every operative patient for Hep C and HIV? Seriously doubt it. There's no logical reason to not scrub in on *known* patients with these diseases if you're willfully scrubbing in on patients whose statuses are unknown.

My first thought is to agree with you, however, the more I think about it I would say having an inexperienced medical student scrubbed in to the case does increase the risk of needle stick for everyone, including the medical student. Obviously you are going to have the a number of patients who are unknown positives but why not mitigate the risk with known positives?Perhaps there is literature on this but I don't have the energy to look it up!

Survivor DO

 

[sgemmell]

I can see why some places would not allow med students to scrub on cases of known HIV or Hep C patients. Having a medical student scrub on any surgery increases risks of needle sticks or other potential complications due to the inexperience of the student.

That said, when I was on surgery I did scrub in on a patient w/ known Hep C. It was just a lap chole though. I did the closures on that patient. Knowing the surgeon I was with, I doubt he would've allowed me to scrub on either of the subtotal gastrectomies we did had either of those patients been Hep C or HIV positive.

 

[Armadillos]

Does your hospital screen every operative patient for Hep C and HIV? Seriously doubt it. There's no logical reason to not scrub in on *known* patients with these diseases if you're willfully scrubbing in on patients whose statuses are unknown.

You have heard of this great thing called probability, right? Some old French dudes put a lot of thought into it awhile back, you might want to look into it.

 

[omarsaleh66]

I thought med students werent allowed to scrub in on HIV/Hep C cases because medical students weren't covered like residents are in terms of occupational health/workmans comp.

As a med student I scrubbed in on HIV/Hep C but was given the option not to. At the hospital I work at now, med students are not allowed to scrub in on high risk patients.

I personally deal with alot of Hep C/HIV patients on a daily basis, Always be careful with the needle sticks as well as wear eye protection. I got splashed the other day by an HIV + and was glad my eyes were covered.

 

[Textbookversion]

Not sure how. Typically when people disagree with arguments that others present, they provide backup sources as to why. Or you can just continue to tell me I'm an idiot instead of presenting anything to support your thoughts/reasoning.
Ill restate that the OP started a thread for discussion on a particular topic. Carry on.

You have heard of this great thing called probability, right? Some old French dudes put a lot of thought into it awhile back, you might want to look into it.

This.

 

[Thanatos]

We don't have an official policy on this, but I think being a doctor means taking care of sick people. Some of them will certainly have diseases you would rather not have, which is why we take precautions, and be sure you take them. Every time.

I would never force a student to scrub an HIV case, because I'm not a huge prick and frankly where I work the students have significantly more power than me anyway. I do think though that if you are backing out of caring for someone because they have some big frightening disease (HIV or hep c, then tb, then SARS, then what?) you need to re-examine what you want and why you're here, because we take care of ppl regardless.

 

[Stellar Clouds]

Interestingly enough, the house staff manual at my residency program (different from my medical school) has a statement concerning HIV and Hep C positive patients:

Faculty and house staff should be guided in the clinical situation first by safety and second by educational benefits. In order to provide the appropriate level of care for patients and safety for learners in the clinical setting, medical students and less experienced house officers will not be required to perform a first time procedure on patients who are hepatitis C positive, HIV positive or have other known diagnoses that would put the medical student or resident at risk.

 

[fishsnack]

I've been prevented from scrubbing at times because the resident I was with didn't scrub with me and didn't want a potentially clumsy pair of hands in the field. This has NOTHING to do with my protection, but more with his.

Going into a surgical residency myself, I will likely use the same rationale. If I don't know how a student handles themselves in the OR, or I know they have 2 left hands, they won't be scrubbing with me.