Medical, Aids Testing In Healthcare Workers

Aids Testing In Healthcare Workers

Author	Message
Daniel Hag #1 / 25	Aids Testing In Healthcare Workers Quote: > I agree. It is not just healthcare workers who > should be tested but everyone involved including the > patient. However, test results take time and that isn't > always available. If the medical staff is known to be > free from infection then one side of the equation is safe > and preventive measure can be followed for the other side. I work PRN (CAT Scan) once a month at a Trauma Level I County hospital (if you're going to get exposed, it's the place to do it). Most of our patients (because we're on the border) are unable to pay for their services. I imagine that the insurance companies will begin to really scream if healthcare workers and patients are required to be screened. In my area it really won't make a difference, due to the fact that I've already completed their exam at least 60-90 minutes before any labs begin to come back (on true STAT Traumas). It really doesn't matter to me whether or not the test is optional or mandatory...personally, I'd like to be tested once a year. Getting the hosptial to loosen the purse strings and cough up for more protective goggles and gowns would be nice as well (we have a train yard that a lot of the illegal alliens often slightly "mistime" their jump onto moving boxcars...leads to a lot of head trauma and amputations). -- Uucp: ...{gatech,ames,rutgers}!ncar!asuvax!stjhmc!381!61!Daniel.Hagan
Wed, 12 Jan 1994 23:06:05 GMT

747.. #2 / 25	Aids Testing In Healthcare Workers I think the various healthcare workers I've heard discuss this issue are letting themselves off too easily. If a provider has a communicable disease, this seems to be something that a patient has a legitimate right to know. We don't treat other infectious diseases the way we treat AIDS. If a surgeon has hepatitis B, she is usually not allowed to operate; if an internist has tuberculosis, we don't say "well, if everyone followed respiratory precautions all the time, we wouldn't have to worry about Tb." This is very different than the reverse situation of infected patients. All patients must be cared for, and so it makes sense to apply universal {filter} precautions. Providers have chosen to assume this risk. Patients have no expectation of a risk for infection when they go to the doctor. It is absurd to argue that there is virtually no risk during invasive procedures. In many operations, someone with their hands in the field gets jabbed or cut, often drawing {filter}. This is not to say that I agree with the Helms' bill. I have no idea whether it is cost effective to test providers for AIDS, and it seems quite likely that the money could prevent more cases of AIDS spent in other ways. But it seems absurd to argue that doctors should not be legally required to let patients know if they are infected with HIV and perform invasive procedures. Certainly I would not choose to go to a surgeon who was infected with Hepatitis B or HIV. Are their doctors who would? If not, then how can you argue against informing patients of such infections. David Rind
Fri, 14 Jan 1994 00:38:09 GMT

Steve Dy #3 / 25	Aids Testing In Healthcare Workers I don't know, David. I think some of your examples are alarmist: HIV is certainly not TB when it comes to ease of transmissibility. I think, too, the legitimate worry about invasive procedures (provided we have a real good agreed-upon definition of same) is one thing, but this societal hysteria fueled by the Helms bill is really seeking to eliminate HIV-infected health workers from all areas of medical care, even areas outside of surgery (and perhaps some areas of dentistry) where it makes no difference whatsoever to a patient whether or not a healthcare worker is HIV-positive or not. I know of a young kid who has just finished his second year in medical school who is now seriously thinking about just bagging the whole endeavor because he learned 6 months ago that he is HIV positive. I don't presume to know just what the best way is to fight this trend. However, it strikes me as a little naive to simply dismiss the current reaction to the Helms bill as simply a case of "special-casing" HIV infection. -- Steve Dyer
Fri, 14 Jan 1994 06:06:08 GMT

Amitava Bisw #4 / 25	Aids Testing In Healthcare Workers Quote: >If a provider has a communicable ^^^^^^^^^^^^ Quote: >disease, this seems to be something that a patient has a legitimate >right to know. Let's talk about this for a second, it's a very important point. Can you see how the likelihood aof actually transmitting the disease is directly relevant to this analysis, even if you revise your position to state that the patient has the legitimate right to know about such probabilities? Quote: > We don't treat other infectious diseases the way we >treat AIDS. This is a HUGE part of the problem. There is risk in any medical procedure, and particularly in invasive procedures. And I agree that the pt has a right to know the risks, but the pt should also understand the probability of these risks. By mandating the disclosure of HIV status, the risk is implicitly blown way out of proportion, and that's what we health providers are concerned about. Quote: > If a surgeon has hepatitis B, she is usually not allowed to operate. I was not aware of this. I don't see how, using safe procedure and given that the surgeon is physically well enough to operate, there is sufficient risk to justify constraining her abilities. If you have evidence suggesting that the risk of a surgeon transmitting HepB or HIV to the patient given the above conditions is significant, please forward it to me, I would be interested in seeing it. Quote: >if an internist has tuberculosis, we don't say "well, if >everyone followed respiratory precautions all the time, we wouldn't have >to worry about Tb." Why not? So long as the internist is able to practice and these "respiratory precautions" render the likelihood of transmission negligible, then why shouldn't the internist practice? I am a med student. I have Hep A antibody in my {filter}. That means that I had Hep A at some point in the past. There is a real but infinitesmal possibility that I have live virus in my {filter}, thus I cannot give {filter}. Ever. Are you suggesting that I be barred from surgery as well? Quote: >All patients must be cared for, and so it makes sense to apply universal >{filter} precautions. Providers have chosen to assume this risk. Absolute agreement from me. Quote: >Patients >have no expectation of a risk for infection when they go to the doctor. Perhaps, but that exceptation does not mean that there is no risk. There is always risk. I think patients should assume that all doctors are HIV+, and demand safe procedure. Not only would this help the HIV situation, but it would probably go a long way in cutting down on many iatrogenic and nosocomial infections. Quote: >It is absurd to argue that there is virtually no risk during invasive >procedures. In many operations, someone with their hands in the field >gets jabbed or cut, often drawing {filter}. If there is such a risk, then don't you think that at least one person would have contracted the disease by now? Remember, the Fla. dentist is thought to have used rather poor, dirty and therefore dangerous technique. I can understand the "better safe than sorry" view, but in this case, the cost of mandatory testing and reporting is, IMHO, much too costly to justify the tiny increase in safety over mandating safe procedures. Quote: >Certainly I would not choose to go to a surgeon >who was infected with Hepatitis B or HIV. What about herpes or syphillis or in my case, Hep A? I would hate to lose a thoughtful person such as yourself as a patient because of unwarranted fear caused by people who seem to be more interested in scaring people for their own gain instead of constructively trying find solutions. Quote: >Are their doctors who >would? If not, then how can you argue against informing patients >of such infections. Test or no tests, disclosures or no disclosures, there is always the likelihood of getting HIV from your surgeon. Even if she is HIV neg. There is also a small but non-zero likelihood of dying in a bubble-bath accident or being struck by lightning. The question is, at what risk does severe avoidance behaviour become paranoid and irrational? If you think that it is reasonable to live in a cavern to avoid being hit by lightning, then it is reasonable to require mandatory testing and disclosure of HIV status by health pros. I appreciate your comments, even though I disagree with many of the assumptions your thoughts seem to be based on. A calm discussion of this issue is at the same time imperative and rare. Thanks, Ami
Fri, 14 Jan 1994 08:26:45 GMT

747.. #5 / 25	Aids Testing In Healthcare Workers In response to my posting, Steve Dyer writes: Quote: >I don't presume to know just what the best way is to fight this trend. >However, it strikes me as a little naive to simply dismiss the current >reaction to the Helms bill as simply a case of "special-casing" HIV >infection. I didn't mean to imply that all the reaction to the Helm's bill was related to "special-casing" HIV. I think there is legitimate concern about the motives behind the law, and the penalties imposed by it. The fact that politicians are, as always, playing politics, is hardly a shock. We must not allow ourselves to become part of a mob mentality or play along with public hysteria, but that does not relieve us of the responsibility to think about the welfare of patients. Quote: Amitava Biswas writes: >Let's talk about this for a second, it's a very important point. Can you see >how the likelihood aof actually transmitting the disease is directly relevant >to this analysis, even if you revise your position to state that the patient >has the legitimate right to know about such probabilities? Yes, the probabilities do matter. The best estimates of risk of HIV from a single contaminated {filter} exposure are about 1/250. I don't know how often {filter} from a given surgeon contaminates the field, but I'd be surprised if it is less than 1/10 operations for abdominal procedures. Risks on the order of 1/2500 are certainly high enough for a patient to want to know about them. Quote: >I am a med student. I have Hep A antibody in my {filter}. That means that I had >Hep A at some point in the past. There is a real but infinitesmal possibility >that I have live virus in my {filter}, thus I cannot give {filter}. Ever. Are you >suggesting that I be barred from surgery as well? I doubt this is correct. I've never heard of chronic Hep A infection. If the {filter} bank cares that you have antibody to Hep A, it is probably because they consider it a marker of risk for other infections. I've never heard of this either, however. {filter} banks do look for elevated liver enzymes as a marker, though. Quote: >If there is such a risk, then don't you think that at least one person would >have contracted the disease by now? Remember, the Fla. dentist is thought to >have used rather poor, dirty and therefore dangerous technique. AIDS has a rather long latency period. I certainly don't think that there is going to be a lot of surgeon to patient transmission, however there is likely to be some. Quote: >Test or no tests, disclosures or no disclosures, >there is always the likelihood >of getting HIV from your surgeon. Even if she is HIV neg. >If you think that it is reasonable to live in >a cavern to avoid being hit by lightning, then it is reasonable to require >mandatory testing and disclosure of HIV status by health pros. Again, I was never arguing for mandatory testing. I suspect that this would be a tremendous waste of money. What I am saying is that healthcare providers are too easily dismissing the idea that a person performing invasive procedures who already knows that he or she is infected with HIV should make patients aware of this fact. There is no good reason to believe that the risks in such a situation are so tiny as to be negligible. If someone has a convincing reason to believe that the risk I estimated above of 1/2500 in significant surgical procedures is an order of magnitude low, I would feel differently. David Rind
Fri, 14 Jan 1994 05:03:34 GMT

Brian Hjel #6 / 25	Aids Testing In Healthcare Workers Quote: >I am a med student. I have Hep A antibody in my {filter}. That means that I had >Hep A at some point in the past. There is a real but infinitesmal possibility >that I have live virus in my {filter}, thus I cannot give {filter}. Ever. Are you >suggesting that I be barred from surgery as well? This is not true. Perhaps you mean you have Hep B core antibody. Although I spend most of my time in the lab doing PCR studies on human retroviruses, a large part of my clinical duty is counseling {filter} donors who test positive for one or another virus. No US {filter} bank, to my knowledge, tests for Hep A. -Brian
Fri, 14 Jan 1994 22:02:25 GMT

#7 / 25	Aids Testing In Healthcare Workers
Fri, 19 Jun 1992 00:00:00 GMT

Mark Draug #8 / 25	Aids Testing In Healthcare Workers [...] Quote: >Perhaps, but that exceptation does not mean that there is no risk. There is >always risk. I think patients should assume that all doctors are HIV+, and >demand safe procedure. Not only would this help the HIV situation, but it >would probably go a long way in cutting down on many iatrogenic and >nosocomial infections. [...] >Remember, the Fla. dentist is thought to have used rather poor, dirty >and therefore dangerous technique. Demanding safe procedure sounds like a good idea to me. I know a couple people who got infections shortly after a surgical procedure and they weren't having a good time. However, I'm not sure what to look for regarding safe or unsafe procedures. Some things seem obvious, but I don't really know enough to spot potential problems. Also, I'm sure that if I tell my doctor to use safe procedures he would be a little insulted and, in any case, claim he always played it safe. How would I know? So, how about a little education for the unlearned? What should we watch out for, and what should we do if we see a problem? And what should us patients do to protect ourselves at home? Thanks. -- ----------------+ Academic Computing Center, Illinois Institute of Technology +1 312 567 5962 \| 10 W. 31st Street, Chicago, Illinois 60616
Sat, 15 Jan 1994 07:19:56 GMT

#9 / 25	Aids Testing In Healthcare Workers
Fri, 19 Jun 1992 00:00:00 GMT

Amitava Bisw #10 / 25	Aids Testing In Healthcare Workers Quote: >Yes, the probabilities do matter. The best estimates of risk of HIV from >a single contaminated {filter} exposure are about 1/250. OK, even without a reference, I can buy this. Quote: >I don't know how >often {filter} from a given surgeon contaminates the field, but I'd be >surprised if it is less than 1/10 operations for abdominal procedures. This really is the heart of the matter, and we've all been playing around what the actual probabilities are. Does anyone have any real stats for this kind of thing? And if so, are there any measures we can take to reduce this sort of contamination short of removing the surgeon from the arena. One in ten surgeons cutting themselves during an operation seems pretty high to me, but again, I'd rather see some authoritative stats on this. Quote: >Risks on the order of 1/2500 are certainly high enough for a patient >to want to know about them. Absolutely. Lets get some experienced input into this discussion and see whether this estimate is even close. Quote: >I doubt this is correct. I've never heard of chronic Hep A infection. >If the {filter} bank cares that you have antibody to Hep A, it is probably >because they consider it a marker of risk for other infections. I've never >heard of this either, however. {filter} banks do look for elevated liver >enzymes as a marker, though. I've gotten some mail on this, and my current guess is that Red Cross Nurses have been misunderstanding me when I tell them I'm pos for Hep A and assume I mean Hep B, or that someone is just lying to me. What you say makes sense, which is why I keep asking {filter}mobiles if they'll take my {filter}, and they always refuse. Besides, for what relevant bug would Hep A antibody be a marker? I'm pretty sure I got it in India, so maybe I had E. histolytica or something? But so what? Are they afraid I had malaria? Don't they test for it? Quote: >AIDS has a rather long latency period. yes, but invasive procedures have also been going on for a long time. Quote: > I certainly don't think that >there is going to be a lot of surgeon to patient transmission, however >there is likely to be some. Again, let's get some authoritative numbers: #of health care workers performing invasive procedures #of invasive procedures performed #of unexplained HIV pos. that had safe invasive procedures etc. (the statisticians can tell us what else is relevant, I hope) Quote: >providers are too easily dismissing the idea that a person performing >invasive procedures who already knows that he or she is infected with >HIV should make patients aware of this fact. There is no good reason >to believe that the risks in such a situation are so tiny as to be >negligible. If someone has a convincing reason to believe that the >risk I estimated above of 1/2500 in significant surgical procedures >is an order of magnitude low, I would feel differently. OK, campers, let's get to it: This is a call for Truth, in the search for a Rational Response!!! :-) Regards, Ami
Sat, 15 Jan 1994 14:27:25 GMT

#11 / 25	Aids Testing In Healthcare Workers
Fri, 19 Jun 1992 00:00:00 GMT

Amitava Bisw #12 / 25	Aids Testing In Healthcare Workers Quote: >Demanding safe procedure sounds like a good idea to me. I know a >couple people who got infections shortly after a surgical procedure >and they weren't having a good time. >However, I'm not sure what to look for regarding safe or unsafe >procedures. Some things seem obvious, but I don't really know enough >to spot potential problems. I'm sure my list is not exhaustive, and I don't mean to pretend that it is. If anyone would like to add on to it, please do. This is just a good start: Wear gloves. Preferably double gloves. Use new gloves for each patient. Make sure there are no open sores anywhere. Always wash hands. Always use sterile instruments. [Please add more: does someone have an "official precaution list"?] Quote: >Also, I'm sure that if I tell my doctor to use safe procedures he >would be a little insulted and, in any case, claim he always played it >safe. How would I know? A conscientious doc shouldn't be insulted when you asked her to do her job. It's impractical and inefficient to follow the doc and staff around to check their instrument cleaning techniques and such, but it's pretty evident whether they're putting on a new set of gloves. See if they wash their hands. If they claim to have washed after the last patient, notice if they wash when they're done with you. Finally, there are no guarantees.Ideally, the doc/pt relationship is built on trust, and if you don't trust the doc, get a new one. I know that's not real helpful, but it is true. Incidentally, this is also why I don't think patients should be forced to divulge their status: another incentive for docs to be safe. Again, more ideas are welcome and solicited. Quote: >So, how about a little education for the unlearned? Hear hear! For me too, thank you. Quote: >What should we watch out for, and what should we do if we see a problem? I'm all in favor for making unsafe procedure legally actionable. In fact, it is probably malpractice. Can anyone confirm/deny this? Quote: > And what should us patients do to protect ourselves at home? Don't use dirty needles, and do use a {filter} when you're not ABSOLUTELY sure. Incidentally, have you seen the very funny cartoon in Sunday, July 28 New York Times, The Week in Review section on this subject? Scene: outside the clinic voice 1: Do you engage in any at risk behavior? voice 2: No voice 1: Any history of infectious disease? voice 2: No Scene: Inside the exam room Doc to patient: But enough about me... Looking forward to more information, Ami
Sat, 15 Jan 1994 14:50:40 GMT

gordon e. ban #13 / 25	Aids Testing In Healthcare Workers Quote: >Also, I'm sure that if I tell my doctor to use safe procedures he >would be a little insulted and, in any case, claim he always played it >safe. How would I know? >So, how about a little education for the unlearned? What should we >watch out for, and what should we do if we see a problem? And what >should us patients do to protect ourselves at home? Very difficult question for the layman. We know who does and doesn't, but the layman has a hard time finding this out. I would say stick to large medical centers with medical schools. In this setting, the individual surgeon has a boss (the department chairman) and others who are responsible for setting and maintaining standards. A surgeon in a small hospital can be a little tin god, with no adequate checks and balances. The hospital may not like some of what he does, but can't afford to have him move his surgery to a competitor. -- ---------------------------------------------------------------------------- Gordon Banks N3JXP \| "It ain't what you don't know. ----------------------------------------------------------------------------
Sun, 16 Jan 1994 01:17:27 GMT

#14 / 25	Aids Testing In Healthcare Workers
Fri, 19 Jun 1992 00:00:00 GMT

Ken Mitch #15 / 25	Aids Testing In Healthcare Workers Quote: >... I don't know how >often {filter} from a given surgeon contaminates the field, but I'd be >surprised if it is less than 1/10 operations for abdominal procedures. Much, much less. -Ken Mitchum
Sun, 16 Jan 1994 01:57:19 GMT

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