Richard.DeWald@f70.n382.z1.fidonet.org (Richard DeWald) (09/22/90)
I am a nursing student and I work in an area Emergency Room..
In a message of <19 Sep 90 11:04:30>, Adam Selene (1:107/269) writes:
AS>+ The twenty five or thirty health workers who have become infected
AS>in the past 10 years ( out of 250,000 + cases worldwide ) experienced
AS>either a major exposure to fresh whole blood ... or a needlestick
AS>injury.
It is important to note that there have been many, many more needlestick
injuries than there have been cases of infection. At the last infection
control conference I attended (beginning of September 1990), they estimated
that the chances of infection with HIV from a needle stick injury to be on the
order of 1%. For Hepatits B, the chance of infection was said to be about
30%.
AS>+ In the same time period, more than 3,000 health workers have died
AS>of the immediate effects of hepatitis ... and another 3,000 probably
AS>WILL die of liver diseases, including cancer, as a direct result OF
AS>their hepatitis.
We do have a vaccine for Hepatitis B, this may account for some of the lesser
attention it gets. It is expensive, sometimes painful, and time consuming to
get vaccinated for Hepatitis B, though. Not enough emphasis is given over to
urge employees to do it. One hospital I work at offers it for free to ALL
employees, the other offers it free to licenced employees.
In a precipitous (unexpectedly fast) delivery the other day, I very easily
could have gotten splashed on open skin with a copious amount of blood and
amniotic fluid. I would have had several pages of paperwork to fill out and
I would have later gotten stuck for a Hepatitis workup. I have to admit, what
went through my mind as that blood gushing near my uncovered arm was "I hope
she's HIV-." But, realistically, what I really have to worry about is
Hepatitis B.
AS>+ Sooooo ... it's probably more accurate to say that the "mask,
AS>gown, goggles, and glove" gear is routine protection against hepatitis
AS>... which happens ALSO to protect against the exetremely remote chance
AS>of AIDS infection.
Protection against "blood-borne pathogens" is the formal terminology. Most of
us who think believe that if not now, at some point in the future, we will be
faced with additional blood-borne pathogens. This is good practice to get
into. To be able to deliver safe care without emotionally alienating patients
is an important next step to take.
AS>+ And, yes, you're right. Emergency and Operating room
AS>personel probably SHOULD make "goggles and gloves" a routine precaution
What used to be called "blood and bodily fluids precautions" is now routine
practice. Gloves are not indicated except when there are weeping skin wounds
or when you expect to be exposed to blood or bodily fluids. They are never
necessary to do things like taking vital signs. Goggles are only necessary
when you expect things to get really wild. They are routine practice in
delivering babies, for example.
AS>+ However, what is being discussed is a "full biohazard suit"
AS>donned ONLY for dealing with PWA patients -- and what's worse, donned
AS>for "protection" during NON-invasive procedures.
I have to echo that what started this thread was a horror story of
tragic/comic proportions that is probably still played out every day. I
cannot excuse or condone the homophobia of my coworkers in health care. It is
sickening. I do what I can, but that's not much. I still have my own battles
to fight.
AS>+ Now, I know doctors and nurses who make it a point NOT to use
AS>goggles, or to glove when giving routine care to PWAs ... they wash
AS>their hands with surgical soap before and after each patient contact
AS>ANYWAY.
We are supposed to do this with every patient as a routine infection control
procedure. I do. Handwashing is far and away the most important and
effective menas of controlling infection in a hospital. I was my hands 20-30
times a day. A fifteen second scrub with surgical soap is what is
recommended. It is habit for me to glance at the clock when I put soap on my
hands. So, I spend 5-6 minutes out of 480 (8 hours) washing my hands. No one
will ever convince me that is a waste of time.
But, I don't think I am controlling HIV when I do this, though that scrub is
more than enough to kill HIV. I really am trying to minimize the spread of
much more (forgive the pun) pedestrian pathogens.
AS>+ And I know one Emergency/Trauma/Surgical nurse whose training
AS>as a Navy "Fleet Support" Medic left him most comfortable starting
AS>I.V.s, by TOUCH, without gloves -- and who continues the practice
AS>though he works at at Belleview Hospital's Emergency room -- where they
AS>estimate that 25% of their patients are HIV+. Sound silly? Well,
AS>not really. His "needlestick" accidents are all when "going in" ...
AS>coming OUT, he treats the needle point as if it were poisoned.
I wear a glove on the dominant hand when starting an IV in case I have to plug
a hole in a hurry. The non-dominant hand I leave ungloved so I can feel for
veins. I do this on all patients. I am really supposed to wear gloves on
both hands, but I am also not supposed to ride my bicycle without a helmet.
THAT unsafe practice is much more likely to get me hurt. It is important to
maintain one's perspective.
AS>+ The biggest step to reducing needlestick infections in general
AS>was to "lose" the practice of re-capping the IV needle (a practice
AS>left over from the day of NON disposable needles) ... and instead
AS>dropping the whole assembly, syringe, needle and alcohol pad into "the
AS>Sharps" -- a plastic container designed for this sort of thing.
Recapping a needle is convenient. You can drop it in your pocket without
having to worry about getting stuck with it. It is STRICTLY forbidden
everywhere I work because of the remote chance that you may re-use that
needle, thinking it is clean. They have sharps containers everywhere in the
hospital, at every bedside, to discourage recapping.
To give you an idea of the hysteria surrounding this, for months after being
trained to give injections, I was confused about recapping. I thought it was
also forbidden after drawing up meds. So, I went to a great deal of trouble
before someone clarified this for me. I feel stupid now, but EVERYWHERE you
turn there was a sign saying "Do not recap." It is still done.
AS>+ But dressing like an astronaut to take a patient's "vitals"
AS>... that's just uncalled for -- and patients are right to object to the
AS>practice.
Absolutely correct.
Richard DeWald, BSN Student
Univ. of TX - Austin.
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