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From: Richard.DeWald@f70.n382.z1.fidonet.org (Richard DeWald)
Newsgroups: sci.med.aids
Subject: Re: Protective Clothing Practice
Message-ID: <39212@shemp.CS.UCLA.EDU>
Date: 22 Sep 90 14:45:04 GMT
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Approved: ddodell@stjhmc.fidonet.org (David Dodell)
Note:	Copyright 1990 by Daniel R. Greening.  Permission granted for
Note:	non-commercial reproduction.
Archive-number: 2502

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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