Treating an HIV positive patient

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I think the relevant issue here is that it is a load of bull that protecting oneself with REASONABLE measures is considered discrimination. AIDS advocacy groups have politicized the issue into absurdity.

When a new patient comes in to be treated, they generally fill out a Patient Information sheet. I've never seen one that asks about ethnicity, skin color, or sexual preference. And, if a doctor asked, I don't see why he/she wouldn't be booted from the profession.

However, ignoring the potentially low (but still dangerous) risk of a healthcare provider being infected by a patient, what about the health of the patient? Shouldn't we need to be aware of T4, CD4, or platelet counts when working on an HIV/AIDS compromised patient? We'd be opening ourselves up to serious legal consequences if something critical happened to the patient while they were under our care.

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typeB-md said:
i am not a dentist but a medical student. we are allowed to deny treatment based on the fact that someone has HIV/Hep, etc. you guys should get your ADA lobbyists in action up there at the capitol.

ADA's Code of Ethics 4.a.1

A dentist has the general obligation to provide care to those in need. A decision not to provide treatment to an individual because the individuals has AIDS or is HIV seropositive, based solely on that fact, is unethical. Decisions with regard to the type of dental treatment provided or referrals made or suggested, in such instances should be made on the same basis as they are made with other patients, that is, whether the individual dentist believes he or she has need of another's skills, knowledge, equipment or experience and whether the dentist believes, after consultation with the patient's physician if appropriate, the patient's health status would be significantly compormised by the provision of dental treatment. :hardy: :hardy:
 
Midoc said:
To wear gloves with everyone is not discrimination since you are treating everyone the same way.

For the record I have treated patients with HIV, HepB/C and I did not feel uncomfortable treating them in the same manner I have treated other patients.
For the record, I never double-glove and I treat HIV, Hep C, Hep B, and democrats every day.

But "treating everyone the same way" is poor medicine. Just like every treatment plan is individualized to the patient, the methods we use are individualized as well. Am I being discriminated against if my dentist makes me have cleanings every 3 months instead of every 6 months because I refuse to brush my teeth?
 
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KatieJune said:
the problem with that is that the majority of those with HIV don't know they have it....its best to just treat everyone the same (as if they are infected and take proper precautions....)

Yep.

Alot of patients lie.
 
toofache32 said:
For the record, I never double-glove and I treat HIV, Hep C, Hep B, and democrats every day.

But "treating everyone the same way" is poor medicine. Just like every treatment plan is individualized to the patient, the methods we use are individualized as well. Am I being discriminated against if my dentist makes me have cleanings every 3 months instead of every 6 months because I refuse to brush my teeth?

Gotta watch those lefties.... they are rabid!
 
dentheartthrob said:
The efficacy of wearing two gloves is as the same as wearing one since that (lets face it) being punctured by a sharp hand instrument (curettes, scalers, explorers etc...etc...) contaminated with blood will pierce through both layers and will have the same likely hood of transmitting a communicable disease. ”


I disagree....

The logic behind double gloving is not that it won't pierce through both gloves, but that having 2 gloves increased the likelyhood that the blood or contaminat will be wiped clean by the time in makes it through both gloves.

This logic stems from the fact that it is more dangerous to get poked by a hollow tip (needle) than a blade......there is more chance a contaminant will be expressed into your tissues with a hollow tip than a blade because the glove(s) will wipe the blade clean.



ps. toofache......i bet we treat twice as many democrats as you do
 
north2southOMFS said:
I disagree....

The logic behind double gloving is not that it won't pierce through both gloves, but that having 2 gloves increased the likelyhood that the blood or contaminat will be wiped clean by the time in makes it through both gloves.

ok point taken, but then what would be the reason for discrimination then?
 
JavadiCavity said:
I think the relevant issue here is that it is a load of bull that protecting oneself with REASONABLE measures is considered discrimination. AIDS advocacy groups have politicized the issue into absurdity.
QUOTE]

yup yup. guess they're more concerned of getting they're feelings hurt than having extra precautionary measures taken.
 
dentheartthrob said:
ok point taken, but then what would be the reason for discrimination then?


The reason for discrimination is so I have less of a chance of contracting a blood bourne pathogen. Do I discriminate by double gloving and face-shielding for only HCV and HIV pt's...yes, but only for my own safety, not because i want to single people out. If that hurts peoples feelings....I'm sorry but i can't help that.......when did it become a law that you are not allowed to hurt the patients feelings? (In the normal USA not la-la-land California) If someone thinks they should put their heath care providers health and well being in jeapardy just so they don't get their feelings hurt...I think they are a little too self centered. Just my opinion though.
 
north2southOMFS said:
The reason for discrimination is so I have less of a chance of contracting a blood bourne pathogen. Do I discriminate by double gloving and face-shielding for only HCV and HIV pt's...yes, but only for my own safety, not because i want to single people out. If that hurts peoples feelings....I'm sorry but i can't help that.......when did it become a law that you are not allowed to hurt the patients feelings? (In the normal USA not la-la-land California) If someone thinks they should put their heath care providers health and well being in jeapardy just so they don't get their feelings hurt...I think they are a little too self centered. Just my opinion though.

well i cant argue with that since its probable in the near future that i'll be double gloving also with patients with blood bourne transmissable diseases just to set my mind at ease.
 
Around here "democrat" is slang for another group of people, a group which makes up about 85% of my patients.

BTW, nice post toofache.
 
tx oms said:
Around here "democrat" is slang for another group of people, a group which makes up about 85% of my patients.

BTW, nice post toofache.
Actually, I really did mean it as a cheap shot against the political party and was trying to be funny. It seems there's another connotation I don't know about.

Don't read anything into it...
 
toofache32 said:
For the record, I never double-glove and I treat HIV, Hep C, Hep B, and democrats every day.

But "treating everyone the same way" is poor medicine. Just like every treatment plan is individualized to the patient, the methods we use are individualized as well. Am I being discriminated against if my dentist makes me have cleanings every 3 months instead of every 6 months because I refuse to brush my teeth?


By "treating everyone the same way" I meant your actions toward the patient rather than your treatment plan for the patient. The treatment can include anything reasonable (including asking for CBC, CD4 counts, etc.) but my point was to alter the actions of the dentist (beyond the universal precautions) due to a certain characteristic of the patient is discrimination. This really only applies to double gloving since protective eyeware and or face shields are included in universal precautions.
 
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Midoc said:
...to alter the actions of the dentist (beyond the universal precautions) due to a certain characteristic of the patient is discrimination.

This still makes no sense. I'm obviously talking to a brick wall. HIV is not a "characteristic" of a patient...it is part of the patient's health status that must be addressed just like every other health condition.

Universal precautions is irrelevant. Every hospital has a special sterilization and "room preparation" protocol for known HIV, Hep B, and Hep C carriers. This includes wrapping all the clinic chairs & OR beds with extra plastic barriers, and using a more stringent disinfectant technique after the patient is gone.

It seems obvious that you have never actually worked with any really sick patients. HIV is a walk-in-the-park compared to some of the other infectious diseases out there, and comparatively more difficult to contract. Why do we always put tuberculosis patients in their own hospital rooms in isolation? Not only is this not "discrimination", this is hospital and OSHA policy. Most states have a sanitorium for these TB patients so they can be forced take their meds every day for 6 months.

These are not discriminatory issues, they are public health issues.

I think you are confusing the term "discrimination" with the way I discriminate against fat-chicks at bars.
 
nothen2do said:
Just because he has a PhD from anywhere, doesn't mean his views are not bullheaded and crap. Sounds like you believe HIV is a myth, and so I'm happy that I will never recieve any treatment from you in the future.
Excellent point. Look at the Ph.D bearing schmuck from the University of Colorado who shot his mouth off comparing the employees of companies in the WTC to Adolf Eichmann. A Ph.D is no guarantee that you know anything, or have the ability to intelligently argue anything. Just as a DDS does not guarantee that someone is a good dentist.
 
ISU_Steve said:
Excellent point. Look at the Ph.D bearing schmuck from the University of Colorado who shot his mouth off comparing the employees of companies in the WTC to Adolf Eichmann. A Ph.D is no guarantee that you know anything, or have the ability to intelligently argue anything. Just as a DDS does not guarantee that someone is a good dentist.

that makes no sense.
 
toofache32 said:
This still makes no sense. I'm obviously talking to a brick wall. HIV is not a "characteristic" of a patient...it is part of the patient's health status that must be addressed just like every other health condition.

Universal precautions is irrelevant. Every hospital has a special sterilization and "room preparation" protocol for known HIV, Hep B, and Hep C carriers. This includes wrapping all the clinic chairs & OR beds with extra plastic barriers, and using a more stringent disinfectant technique after the patient is gone.

It seems obvious that you have never actually worked with any really sick patients. HIV is a walk-in-the-park compared to some of the other infectious diseases out there, and comparatively more difficult to contract. Why do we always put tuberculosis patients in their own hospital rooms in isolation? Not only is this not "discrimination", this is hospital and OSHA policy. Most states have a sanitorium for these TB patients so they can be forced take their meds every day for 6 months.

These are not discriminatory issues, they are public health issues.


I completely agree. Those who have taken issue with double gloving should see the lengths that hospitals go to when dealing with infectious patients. My boyfriend is currently working in the OR, and whenever a MERSA patient (what they refer to them as) comes in for surgery they remove nearly everything from the room, and attempt to completely sterilize it when the surgery is done. When they go to pick up the patients the nursing assistants are completely decked out in protective gear. The patients may feel bad or embarrassed, and some mention this, but everyone understands that it is a health precaution, not discrimination.

Personally I feel that it is the dentist's duty to take whatever precautions are necessary to prevent transference, which could in turn infect their family and other patients. If hospitals can go to such great lengths with Hep C patients, for example, I do not understand why a dentist should not increase their protection as well.

My mother worked in a Hospital blood bank in SF during the 1980's, and she saw two of her coworkers contract HIV through needle pricks. It may be a rare occurance, but I have seen the increadible damage that can result. As a dentist, I will take every precaution I deem necessary, in the most discrete way possible.
 
HuyetKiem said:
ADA's Code of Ethics 4.a.1

A dentist has the general obligation to provide care to those in need. A decision not to provide treatment to an individual because the individuals has AIDS or is HIV seropositive, based solely on that fact, is unethical.

Unethical, but not illegal. Of course, the ADA can't make any statements about the legality of such an issue, so we'll have to look elsewhere for legalese.
 
toofache - read the last sentence of my previous post. I'm talking primarily about double gloving in a general dentist's off with known HIV patients and how that offers little or no additional protection. I was not even remotely talking about taking steps that are necessary to protect the dentist and other patients. I was only talking about steps that are unnecessary and are only done because the dentist is paranoid about HIV.

The paranoia about HIV was what I was originally trying to address. My point was that universal precautions in a dental office are adequate for HIV infected patients.
 
Known HIV patient (if they actually tell you) + double gloves, I'd bet that you'd be more likely to stick yourself. Think about it, until you've worked on many HIV patients you're going to be nervous (as was already posted you shouldn't be as nervous by HIV patients as Hep C patients), then you throw on a second pair of gloves which will DECREASE your dexterity, if that's not the recipe for try to make the situation potentally risky I don't know what is.

I'm speaking as a veteran of 2 HIV positive patient sticks in my career(so far). One was I punctured the back of my hand through the glove on a surgical bur after a bloody full bony lower wizzy extraction (Lesson learned either always remove the bur from the handpiece when done or turnt the bur away from you ;) ). Number 2 (also an oral surgery case), I stuck myself with the tip of an east/west elevator while doing a full mouth exo on a 25 year old female with AIDS (not just HIV positive). Both were during my residency, I took the cocktail both times (always know where the nearest bathroom is for the first few days :eek: :D ), and all my subsequent test have been negative(over a 6 year span now).

The best bet to avoid a situation like this is to jst asume that EVERY one of your patients has some type of communicable disease and use the same universal precautions/mindset with every time you walk into an operatory. This way it will become second nature to you, and in the rare instance that you are seeing a patient that has some type of communicable disease, you'll be much more comfortable with the scenario and less likely to "slip up" for a brief second. You need to accept that it's an occupational hazard of the job and get on with it, afterall you don't just think that they pay us the big bucks in private practice for nothing do you :hardy: :D
 
DrJeff said:
... then you throw on a second pair of gloves which will DECREASE your dexterity, if that's not the recipe for try to make the situation potentally risky I don't know what is...
My thoughts exactly! Plus it also gives you a false sense of security, imo.
I volunteered in a free dental clinic before dental school. We had patients with Hep A to Z :D We informed whoever would be involved in the tx, privately. We used heavy duty gloves to transfer instruments during sterilization, double bag, autoclave them separately.
 
Like I said before, I don't double-glove. I just don't understand the discrimination part of it.
 
gloves5iw.gif

Double-glove is not a discrimination. The only discrimination I can think of is tactile discrimination!
Surgeons have done it. "Double glove for surgical procedures" is the Universal Precaution for med schools.
 
lnn2 said:
gloves5iw.gif

Double-glove is not a discrimination. The only discrimination I can think of is tactile discrimination!
Surgeons have done it. "Double glove for surgical procedures" is the Universal Precaution for med schools.


The picture you showed is that of an indicator glove under a surgical glove. The purpose is just to let you know there is a hole. The indicator is usually green and can easily be seen after a tear. These are not worn by every surgeon but are more likely to be seen during surgeries involving lots of sharps ie wires, screws, pins; or those less eloquent procedures like all orthopedic surgeries. I can't comment on any increased protection, only that this is not the primary function.
 
omfsres said:
The picture you showed is that of an indicator glove under a surgical glove. The purpose is just to let you know there is a hole. The indicator is usually green and can easily be seen after a tear...
Thanks for the info! :thumbup:
I posted that pic just to show that double-glove isn't a discrimination against HIV+ patients. It's almost impossible to use that method in general dentistry.
I think that sterile gloves which are used in oral surgery is adequate for protection.
 
KatieJune said:
Its interesting, though, that one of the regional exams will not allow HIV positive patients to be treated during the exam.....I'm suprised no one has sued them over this....yet.



Also, even if you get a needle stick from someone with HIV, its still 1:1000 chance you'll get the virus and if you get a splash its even lower. Still good idea to be careful though....

I think that this can be done legally because the examination is a special controlled environment, unlike generalized dental treatment the a person is asking for and paying for.
 
Since when, extra protection considered as discrimination???

Kicking a patient out of the office due to blood pathogens or simply not providing a service for the same reason, in fact, is an act of discrimination.
 
It's like half of you guys have never heard of universal precautions. Besides, the least of your worries are HIV. The chance of you getting HIV exposure from a puncture or cut is far less than Hepatitis (as mentioned before)

Practice the same infection control on all your patients, and you'll have the best of luck.

Scoop method of needle capping,
Put a 100 ml cup over the handpiece to protect the bur and yourself
Safety goggles or face shield (both you and your patient)
Try not to leave your finger near your injection site... your mirror is pretty good at that.
More that you'll be taught by your colleagues, and you can pick and choose which you like. Just keep consistent and you'll be as golden as possible.

BTW, physicians also have HMOs, does that mean that we should, too? Sorry, but I'll keep my autonomy and ethics as is per ADA code.
 
drPheta said:
BTW, physicians also have HMOs, does that mean that we should, too? Sorry, but I'll keep my autonomy and ethics as is per ADA code.
huh?
 
Working as a nurse we rairly know of patients with aids. HIV tests don't show in there lab results and only the docs will know after they call the lab. We also cannot draw a test without the patients consent for the test. I just treat all the patients the same. The possibility of contacting HIV from a stick is very slim and like others have said there are many other diseases to worry about. Hospitals don't discriminate or isolate HIV patients unless they are actively immunocrompramised, just like cancer patients. This is a reverse isolation room to keep other diseases out, not to keep the HIV in. This is not considered discrimination it is just a part of treatment that goes along with the diagnosis. It is just like how TB, MRSA, VRE, Chickenpox, C-Diff and many other diseases have there own types of isolation, it is to keep people safe. Like others have said, I don't double glove with a known infective patient because it really does decrease dexterity and it increases hand fatigue which leads to more needlesticks. In my carreer of 10 years I have only had one needle stick when a syringe bounced out of a sharps container and got me in the hand. Even though it was a 100 year old Hopi lady I got tested, you never know.
 
captaintripps said:
that makes no sense.

Hey Captain,

I promised myself I wasn't going to post anymore. Most people just want to listen to themselves and cut down other people. But it was painful seeing you get attacked for having an open mind about science.

It's kind of discouraging to see how assumingly educated professionals and future professionals receive ideas that are "outside of the box." Creative and critical thinking are important skills for any profession, but especially for those based on science.

We know so little about even common viruses. We have no cure for the common cold. We know even less about retroviruses. What's so crazy about acknowledging the fact that the link between HIV and AIDS may not be entirely clear? Maybe saying that there's no link is extreme, but if you take everything at face value and become satisfied with what we know and don't question scientific authority, what are we left with? A flat earth and a sun that revolves around it.

Not to say that there aren't some great scientific minds in dentistry. Actually there are many. William Morton would have won a Nobel Prize if they had existed at the time of his work. But I think as a profession, a lot of us have a problem thinking outside of the box. We become complacent. We just memorize the handouts.

So whether Duesberg and his proponents are right or wrong, his work is relevant because it challenges us to learn more. He's not crazy. He just has a scientific mind.

Do you know why nerds like Star Trek? Because it's imaginative and...sexy :love: . The rest of us watch reality television, because it's mundane and doesn't challenge us to think. "Why did they vote off Constantine? Why? Oh god Why???" shouts Everyman.

J

P.S. I would like to dedicate this soapbox rant to my favorite (and recently deceased) comedian Mitch Hedberg. I would kill all of you to hear him tell one more joke.
 
johnkimdmd said:
...
P.S. I would like to dedicate this soapbox rant to my favorite (and recently deceased) comedian Mitch Hedberg. I would kill all of you to hear him tell one more joke.
He's my favorite comedian as well! I like his style of delivering jokes. Some of my favorite quotes:

"I can't get into flossing, I can't. People who smoke say you don't know how hard it is to stop smoking. Yes I do. It's as hard as it is to start flossing. You seem jittery. Yeah, I'm about to floss."

"I played golf....I did not get a hole in one, but I did hit a guy and that's way more satisfying. Your supposed to yell FORE, but I was too busy mumbling that ain't no way that's gonna hit him."

"When someone hands you a flyer, it's like they're saying here you throw this away."

"I got my hair highlighted, because I felt some strands were more important that others."

"I'm against picketing, but I don't know how to show it."

"I hate turkeys. If you stand in the meat section at the grocery store long enough, you start to get mad a turkeys. There's turkey ham, turkey bologna, turkey pastromi,.Some one needs to tell the turkey, man, just be yourself."

"I got into and argument with a girlfriend inside of a tent. That's a bad place for an argument, because I tried to walk out and slam the flap. How are you supposed to express your anger in this situation? Zipper it up real quick?"

"This product that was on TV was available for four easy payments of $19.95. I would like a product that was available for three easy payments and one complicated payment. We can't tell you which payment it is, but one of these payments is going to be hard."

"I was going to get my teeth whitened, but I said screw that, I'll just get a tan instead."

"I was at this casino minding my own business and this guy came up to me and said your gonna have to move you're blocking a fire exit. As if there were a fire, I wasn't gonna run. If you are flamable and have legs you are never blocking a fire exit."

"I don't own a cell phone or a pager. I just hang around everyone I know, all the time. If someone wants to get a hold of me they just say "Mitch," and I say "What?" and turn my head slightly."

"I'm sick of following my dreams. I'm just going to ask them where they're going and hook up with them later."

"My friend said to me "You know what I like? Mashed poatoes," I was like, Dude, you gotta give me time to guess. If your going to quiz me, you must put a pause in there."

"An escalator can never break. It can only become stairs. You would never seen an Escalator temporarily out of order sign, just Escalator temporarily stairs. Sorry for the convenience."

"I've been working the colleges and I always buy the shirts from the college, because they're quality shirts. But people always get the wrong idea. I'm walking around wearing a Washington U shirt and someone says "Hey Washington U, Did you go there?" Yeah! It was a Wednesday."

"Alcoholism, is a disease, but it's the only disease that you can get yelled at for having. Dammit Otto, your an alcoholic. Dammit Otto, you have Lupis. One of those two doesn't sound right."
 
drPheta said:
It's like half of you guys have never heard of universal precautions. Besides, the least of your worries are HIV.

Universal precautions are the *minimum* precautionary measures. Universal precautions weren't put into place in order to prevent patients from feeling they were discriminated against, they were put into place to give a baseline upon which professionals could practice. With a fairly high level of precaution in place as the standard, accidents would be prevented.

And you're right, of course, about the HIV.
 
It was in response to someone in medicine a few posts back telling us to lobby to allow us to deny treating HIV patients. What a bunch of crock... absolutely no ethics.
 
tx oms said:
Exactly, he is a PhD of some sort and you don't even seem to know of what.

I treat known HIV infected people regularly. We get referrals from medicine and infectious disease to see the patients. I don't do anything differently. I wear one pair of gloves and sometimes a mask with face shield, depending on what I'm doing. I know it's difficult to contract HIV and rest comfortably in the fact that my single gloves will be fine. If somehow they got pierced I'd wash my hand for a while.

As for HIV infected individuals feeling they are shunned, I don't care. I treat them the same and don't get worked-up about it. Some people do. Look, if you engage in risky behaviour things happen, one of which is HIV and the stigma it comes with. It's the way people are. You don't want the risk of HIV and it's stigma? Keep you wee-wee away from your buddy's bung hole, don't shoot up, and don't sleep around. Otherwise, be prepared to roll the dice.

I have treated many known and probably unknown HIV infected patients.

I wear one pair of gloves, a mask and a face shield (hate the scatter spray crap).

It is no big deal.
 
Blue Tooth said:
Exposures happen. I had one on a HIV patient. It's just an occupational hazard. You can't refuse treatment for a patient with any communicable disease (except maybe TB). Just act like the adult and professional you are.


what this guy said.

I'm finishing up..and I believe I still have 2 HIV+ patients in my practice. I believe there was not a time in my 2 years that I did not at least 1 known HIV+ patient in my practice.

a classmate of mine DID have a needlestick accident with an HIV+ patient.
not a fun ordeal.
 
no dentist can refuse treatment to an HIV positive patient. Extra precautions can be taken but anything else is HIV discrimination. This is a huge issue that occurs in the workplace and unfortunately, also in health care.

Why should you refuse to care for ANY patient becuase of their health status unless you were not trained adequately to perform the procedure.

Many dentists DO discriminate against HIV patients, it is ridiculous, they double glove, they send them out to specialists.

Every patient is treated with gloves etc, and when you take those same precautions with HIV + patients then the risk is quite minimal
 
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