Situation # 1

An HIV + patient is admitted to your Skilled Nursing Facility for rehab, S/P/ CVA; He is placed in a room with another man who has a history of Hepatitis B and is also S/P CVA. The patients have no indwelling devices or wounds. Two Nursing Assistants are voicing concerns about “catching” HIV or HBV from these patients.

Questions:

Do these patients require a private room?

Should they be on isolation?

Do they need special dishes from dietary?

Should they socialize with other patients?

Can staff “catch HIV or HBV from these patients?

How do you, as the DSD/Infection Control Nurse, respond to their questions?  

First, arrange for a Bloodborne Pathogens in-service for all staff. You have most likely been presenting mandatory, annual in-services on Infection Control and BBP, but a good review will help to put things in perspective. There is plenty of information in your Infection Control Manual, the usual educational videos and from The CDC and OSHA websites.

Reinforce transmission of Blood Borne Pathogens is through direct contact with blood and body fluids. Aids/HIV, HBV and HCV are not transmitted through the air, by touching intact skin, dinnerware or surfaces touched by an infected patient. There is no need for a private room or isolation in this case, because there are no open wounds, IV’s or indwelling devices. The patients are free to socialize, to go to the dining room, physical therapy, library, etc.

To recap: Gather staff for review of review Blood Borne Pathogen Standards and discuss the use of Standard Precautions, Personal Protective Equipment and prevention of potential exposure to blood and body fluids. 

Fear is created by erroneous perceptions and education is the key to correcting misguided assumptions. The Infection Preventionist is the ultimate educator in Long-term Care. Once staff understands the reasoning behind standards, policies and procedures, they will be enabled to participate in their patient’s care with confidence.   

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