public
poling
Testing
of Health Care Workers
I
N JULY, 1991 the Centers for Disease Control (CDC) published its recommendations for preventing transmission of human immunodeficiency virus (HIV) and hepatitis B virus (HVB) to patients during exposure-prone, invasive procedures. The recommendations were as follows: l All health care workers (HCWs) should adhere to universal precautions. l There is no basis on which to restrict the practice of HCWs infected with HIV or HVB who perform invasive procedures not identified as exposure prone, provided they follow recommended technique and comply with universal precautions and current sterilization/disinfection proce-
dures l Exposure-prone procedures should be identified by medical/surgical/dental organizations and institutions at which the procedures are performed. l HCWs who perform exposure-prone procedures should know their HIV and HVB status. l HCWs who are infected with HIV or HVB should not perform exposure-prone procedures unless they have sought counsel from an expert review panel and been advised under what circumstances, if any, they may continue to perform these procedures. Such circumstances, would include notifying prospective patients of the HCWs status before the patient undergoes procedures. l Mandatory testing of HCWs for HIV or HVB is not recommended. Compliance by HCWs with recommendations can be increased through education, training, and appropriate confidentiality.
The CDC report generated heated debate about whether the recommendations were a thinly disguised mandate for required testing and about the possible legal quagmire that had been created for health care institutions regarding patient exposure and risk (Feldblum, 1991). Congress leapt into the fray and conducted hearings about patients’ right to know the HIV status of their health care providers. I can not predict how the congressional hearings will have influenced legislation by the time you read this column; but, I do know that this is one of the hottest health policy
issues confronting us as nursing educators and as practitioners. The CDC approach is an exquisite attempt to balance our societal preference for privacy and protection from discrimination against a patient’s right to know. It may be too easy for nurses to think that these recommendations do not concern them-that they are the domain of medicine and dentistry in the land of exposure-prone invasive procedures as if that were foreign territory for nurses. Certain obstetric and gynecologic procedures are considered high risk, placing nurse midwives, for example, in an exposure-prone category. You can generate your own examples of nursing procedures that might qualify as exposure prone and invasive. The point is that nursing needs to be concerned with these recommendations both as a matter of education and as a matter of participation in the formulation of health policy. We and our students have an awesome opportunity and responsibility to participate in the debates concerning risk to patients, rights of privacy and protection against discrimination for health professionals, and professional self-regulation versus government intervention. The CDC recommendations do not provide final answers. Indeed, they raise several dilemmas and leave their resolution firmly in the hands of the health care professionals themselves. It is no simple matter to develop policies that touch on patient risk and exposure on the one hand and professional careers and livelihood on the other. How much risk to the patient is too much risk? (Gostin, 1991). How can institutions in the business of health care grapple with these issues on their own? Nurse academics can tap the resources of their colleges and universities to debate these issues from outside the system as a way of informing the process. First we must get engaged in the process. Failure to do so will leave one of the most critical health policy issues of the times to the political whims of government. For the sake of the health professions and those we serve, I hope we are up to the task. References Centers for Disease Control. ( 1991). Recommendations for preventing transmission of human immunodeficiency virus and hep-
JUDITH KRAUSS, RN, MSN Deanand Profssor School of Nursing Yale Unwmity 25 Park St, PO Box 9740 Neu Haum, CT 06536 Copyright
0
1992 by W.B.
Saunders
8755-7223/92/0802-0002$03.00/O
70
Company
atitis B virus to patients during exposure-prone invasive procedures. Morbidity and Mortality Weekly Repovt, 40, 1-8. Feldblum, C. R. (1991). A response to Gostin, the HIVinfected health care professional: Public policy, discrimination, and Parient safety. Law Medicine & He&h Care. 19, 1-2, 134139. Gostin, L. (1991). CDC guidelines on HIV or HVB-posirive health care professionals performing exposure-prone invasive procedures. I!AU Medicine G Health Care, 19, 1-2, 140-143.
Journal of Professional Nursing, Vol 8, No 2 (March-April),
1992:
p 70
poling
Testing
of Health Care Workers
I
N JULY, 1991 the Centers for Disease Control (CDC) published its recommendations for preventing transmission of human immunodeficiency virus (HIV) and hepatitis B virus (HVB) to patients during exposure-prone, invasive procedures. The recommendations were as follows: l All health care workers (HCWs) should adhere to universal precautions. l There is no basis on which to restrict the practice of HCWs infected with HIV or HVB who perform invasive procedures not identified as exposure prone, provided they follow recommended technique and comply with universal precautions and current sterilization/disinfection proce-
dures l Exposure-prone procedures should be identified by medical/surgical/dental organizations and institutions at which the procedures are performed. l HCWs who perform exposure-prone procedures should know their HIV and HVB status. l HCWs who are infected with HIV or HVB should not perform exposure-prone procedures unless they have sought counsel from an expert review panel and been advised under what circumstances, if any, they may continue to perform these procedures. Such circumstances, would include notifying prospective patients of the HCWs status before the patient undergoes procedures. l Mandatory testing of HCWs for HIV or HVB is not recommended. Compliance by HCWs with recommendations can be increased through education, training, and appropriate confidentiality.
The CDC report generated heated debate about whether the recommendations were a thinly disguised mandate for required testing and about the possible legal quagmire that had been created for health care institutions regarding patient exposure and risk (Feldblum, 1991). Congress leapt into the fray and conducted hearings about patients’ right to know the HIV status of their health care providers. I can not predict how the congressional hearings will have influenced legislation by the time you read this column; but, I do know that this is one of the hottest health policy
issues confronting us as nursing educators and as practitioners. The CDC approach is an exquisite attempt to balance our societal preference for privacy and protection from discrimination against a patient’s right to know. It may be too easy for nurses to think that these recommendations do not concern them-that they are the domain of medicine and dentistry in the land of exposure-prone invasive procedures as if that were foreign territory for nurses. Certain obstetric and gynecologic procedures are considered high risk, placing nurse midwives, for example, in an exposure-prone category. You can generate your own examples of nursing procedures that might qualify as exposure prone and invasive. The point is that nursing needs to be concerned with these recommendations both as a matter of education and as a matter of participation in the formulation of health policy. We and our students have an awesome opportunity and responsibility to participate in the debates concerning risk to patients, rights of privacy and protection against discrimination for health professionals, and professional self-regulation versus government intervention. The CDC recommendations do not provide final answers. Indeed, they raise several dilemmas and leave their resolution firmly in the hands of the health care professionals themselves. It is no simple matter to develop policies that touch on patient risk and exposure on the one hand and professional careers and livelihood on the other. How much risk to the patient is too much risk? (Gostin, 1991). How can institutions in the business of health care grapple with these issues on their own? Nurse academics can tap the resources of their colleges and universities to debate these issues from outside the system as a way of informing the process. First we must get engaged in the process. Failure to do so will leave one of the most critical health policy issues of the times to the political whims of government. For the sake of the health professions and those we serve, I hope we are up to the task. References Centers for Disease Control. ( 1991). Recommendations for preventing transmission of human immunodeficiency virus and hep-
JUDITH KRAUSS, RN, MSN Deanand Profssor School of Nursing Yale Unwmity 25 Park St, PO Box 9740 Neu Haum, CT 06536 Copyright
0
1992 by W.B.
Saunders
8755-7223/92/0802-0002$03.00/O
70
Company
atitis B virus to patients during exposure-prone invasive procedures. Morbidity and Mortality Weekly Repovt, 40, 1-8. Feldblum, C. R. (1991). A response to Gostin, the HIVinfected health care professional: Public policy, discrimination, and Parient safety. Law Medicine & He&h Care. 19, 1-2, 134139. Gostin, L. (1991). CDC guidelines on HIV or HVB-posirive health care professionals performing exposure-prone invasive procedures. I!AU Medicine G Health Care, 19, 1-2, 140-143.
Journal of Professional Nursing, Vol 8, No 2 (March-April),
1992:
p 70
