Should People With Infectious Diseases Be Allowed in EMS?

[Just Plain Ruff]

I've been thinking more and more on this topic.

I'm not going to change my mind that those with HIV, Hep a-c and Active TB should not be on the ambulance.

For those of you who have no problem letting someone like the above work, Do you want them taking care of you after you have been involved in a MVA or some type of illness strikes.

If you don't have an issue with it then I guess you are a better person than I but I can tell you that if the person said to me I have hiv and I'm going to be starting an IV on you, you can bet your butt that I'm going to have issues. No matter how good that guy is, no matter that he has not missed an iv in the last 2000 attempts there is still a risk.

I choose to mitigate that risk.

I would also not work with any of the conditions above.

If that makes me a bad person in your eyes so be it. But I will not be guilted into changing my mind.

Wouldn't you hate to be the one infected and pass that infection on to another person in your care?

Same goes with not washing your hands, not keeping clean and passing on some infection such as MRSA or god forbid VRSA. Or giving an elderly person pneumonia or the flu because you had to come to work that day for the overtime.

Why don't those of you who feel it's ok to work with those types of conditions go to your infection control nurse or staff member and ask them this question.

"If I had HIV, Hepatitis (a b or c), influenza, pneumonia, Active TB, or any number of other communicable diseases, would you allow me to continue working on the ambulance? And if you would allow it why?"

I will do the same.

If any of you can come back here and say your infection control person said that it was ok to do so then I'll change my tune but I'll bet my next paycheck that your infection control person will say NO FReakin way!

[katgrl2003]

These statistics are taken directly off the CDC's website

HBV

Healthcare personnel who have received hepatitis B vaccine and developed immunity to the virus are at virtually no risk for infection. For a susceptible person, the risk from a single needlestick or cut exposure to HBV-infected blood ranges from 6-30% and depends on the hepatitis B e antigen (HBeAg) status of the source individual. Hepatitis B surface antigen (HBsAg)-positive individuals who are HBeAg positive have more virus in their blood and are more likely to transmit HBV than those who are HBeAg negative. While there is a risk for HBV infection from exposures of mucous membranes or nonintact skin, there is no known risk for HBV infection from exposure to intact skin.

HCV

The average risk for infection after a needlestick or cut exposure to HCV infected blood is approximately 1.8%. The risk following a blood exposure to the eye, nose or mouth is unknown, but is believed to be very small; however, HCV infection from blood splash to the eye has been reported. There also has been a report of HCV transmission that may have resulted from exposure to nonintact skin, but no known risk from exposure to intact skin.

HIV

The average risk of HIV infection after a needlestick or cut exposure to HIV-infected blood is 0.3% (i.e., three-tenths of one percent, or about 1 in 300). Stated another way, 99.7% of needlestick/cut exposures do not lead to infection. The risk after exposure of the eye, nose, or mouth to HIV-infected blood is estimated to be, on average, 0.1% (1 in 1,000). The risk after exposure of non-intact skin to HlV-infected blood is estimated to be less than 0.1%. A small amount of blood on intact skin probably poses no risk at all. There have been no documented cases of HIV transmission due to an exposure involving a small amount of blood on intact skin (a few drops of blood on skin for a short period of time).

Think of something else. How many people may be infected and not know it? I've known several people that had HCV for several years and didn't know it. One person had it for 15 years before she found out.

Yes, there are risks. But there are risks in everything. I risk getting more infections from my patients than they do from me. How many of us have leprosy, TB menigitis, and other outlandish diseases that we don't share with those around us? That's just a few of the diseases I've been exposed to in the past few weeks. (Gotta love it when the hospitals don't tell us either.)

I've been immunocompromised for almost 8 years now, ever since I finished chemo. Should I be working on an ambulance? According to most of you, no. I've had HCV my entire life. That's another check against me. I stopped testing positive after the chemo. It's been in remission (dr's words) since July 2000. How would anyone know I ever had it if I didn't tell them? It wouldn't show up on any blood test, and my employers don't have access to my medical records.

This kind of knee-jerk reaction is only going to cause one thing. Panic. Patients will assume all medical people have some kind of infection, and those that do will try to hide it. I've always been open about this. My employers know, my partner knows, and any time someone, like those vampires at the labs, comes in contact with my blood, I tell them.

I'm careful. I don't take any unnecessary risks. Why should I be denied doing something that I love?

-Kat

Oh Ruff? I think this means you will have to change your tune. My boss is our infection control person, and he's known about it since day one. He has said he would have no problem having me treat him. So, do I get your next paycheck?

[Just Plain Ruff]

yeah, I think it's gonna be around 15 bucks. But my next paycheck will be much higher.

I'm still waiting on other infection control people to chime in.

I think that my next paycheck will be pro-rated to those who say they have no problem with it. The more that say ok you can work then I'll have to divide it by that many people so you might just get a nickel or all 15 bucks.

ok so kat, your boss has no problem with anyone working with TB??? If he has a problem with that then you lose my paycheck.

What I wonder is this, what's the liability of providers who know they are infected and continue to work? What is the liability for the ambulance service who knowingly allows an infected person to continue to work.

Would you want to be .3% or the 1.8% who gets the disease? not me.

I don't think I'm gonna change my tune anytime soon. But I'm not infected so in the end it does not affect me.

[katgrl2003]

Ok, so I lose your paycheck. TB he has a problem with.

-Kat

[VentMedic]

TB is not an issue here because if you insist on working with positive AFB in the sputum then a court order will be issued and you will be in isolation either in a regular hospital or a special hosptial like A.G. Holley in lockup. This a directive of public health orders from the Federal level.

Once your sputum is clear, you are okay to be in public. If you are not compliant with your meds during the next few weeks or months, you may be placed under a house arrest type monitoring system or put into a secure facility in a hospital throughout the course of your therapy.

People with Hep B, Hep C and HIV are not isolated from general population.

The sad and bad aspect when attitudes are involved that discriminate, your partner may keep many secrets from you including their HIV status. I also see the brotherhood of FF/EMS disappear when someone who is openly dx'd with HIV. People, who should be better informed, run especially if it develops into AIDS when the person could most use the support It seems that there is a stigma about the disease itself more than the actual virus.

[VentMedic]

Ruff,

Today at the hospital, I count 5 RNs (Hospital), 1 RRT and 1 Paramedic (EMS) with HIV that are actively on shift now. One RN has been dx'd since '91 and has remained working in patient care areas. I know there are at least 2 RNs with Hep C and probably more but their infection status has never been an issue. I also don't know and don't make it an issue to know what other clinical people are infected.

I have also lost more co-workers who were RRTs, EMTs, Paramedics and RNs to AIDS than I care to think about. Many struggled to remain working in some aspect of healthcare for as long as they could for the insurance. Of course, when their CD4 count dropped they went to a low risk area. I can not tell what stress some narrow minded attitudes can place on people who are already dealing with a difficult situation.

We do occasionally hear about someone getting treated for MRSA. They disappear from the schedule for a few days during treatment. And yes, if several patients become infected we can identify the source and will do that with a MRSA outbreak by culturing the nares of employees.

If someone is utilizing good hygiene and universal precautions there should not be an issue. I would let any of the staff I mentioned start an IV (and one has) on me.

You don't need to know the HCW's HIV status unless you have sex with them or there is an incident involving blood. Chances are it while probably be your blood and not theirs that causes the incident during an invasive procedure that would be of concern.

How often do you routinely get checked for Hep () or HIV? Varacella titer? Pneumonia Vaccine?

[Just Plain Ruff]

since I'm not actively in the field anymore I don't get checked any more.

But when I was in the field I was checked by my family doctor, at my expense, every 6 months.

I've explained myself and my position to you in a pm. I've also explained to the group and I'm not going to do it again. If this makes me look bad or obstinate or prejudicial then so be it.

The same question I have of you vent, how often do you get tested?

[gvandellen]

Ruff,

You talk about a risk in starting an IV? What Risk? Are you say that while he is starting a line he will pierce his own finger contaminating the needle and now in that same motion stick you with said tainted needle or a magical drop of blood drops onto the exposed area? If so then I also believe that you believe in the existence of aliens and right now they are plotting your capture. That is paranoid.

Do an experiment for me....Put on a pair of 14mil EMS field gloves, take a lancet and stick your finger or poke it with a 16G IV, now try to get blood out of that glove. If it runs out of the glove then I might raise an eyebrow.

[Just Plain Ruff]

Good lord, I've explained myself already. I'm not gonna do it again. It's my opinion and belief and that's all it is.

I also don't drink and drive, I don't do drugs, I don't have sex outside of marriage and I certainly don't steal, do I need to explain my stance on those positions too?

I will bow out of this conversation at this point because I can see where this is goin..

[Eydawn]

Agreed... Ruff's position is clear, for his stated personal and professional reasons. Ya can't change him, so let him be.

I'm thinking a little more deeply about this than I had been previously. For example, I was under the impression that a resolved TB infection and subsequent drop-off in antibodies would then lead you to have a negative skin test. At least, that's how it was explained to me by a nurse, when I wondered why I had to get 2 of the PPD tests within 2 weeks of each other (being "two-stepped", as it was referred to) since if I tested negative then, I would theoretically test negative 2 weeks later. Still have to go read more about that one.

If someone is negative for HepB or HepC on a blood test, even though they've had a previous infection, I don't think it precludes them from working in the healthcare setting. I do, however, think that anyone who's "active" should be very careful.

We all know it's a long shot and much less likely for us to transmit something like Hepatitis to a patient than it is to transmit something like the common cold... but in the majority of patients, Hepatitis transmission would have much longer lasting and more severe repercussions. That would be a life altering event.

As for HIV? I'm still on the fence. Not because I fear being infected with HIV from one of my healthcare providers, but because of the stressors involved on the person with the HIV infection and the secondary infections they tend to get. If someone comes in with bad pneumonia, and my HIV + coworker gets it (whereas most of us didn't), it's going to be around us for longer than it would have previously, and now it's more likely that I'm going to get it too. No? Not saying that all HIV+ people are disease-mongers; far from it. Just saying in the work environment, it will increase chances of us being exposed if a susceptible coworker gets it.

I would think that someone with HIV would want to spend time living life, not working, but then again for some work is life.

I think if you do have something extra nasty hiding in your system, you had better be extremely aware of risks to you and those around you, and take precautions. If you do, then sure, keep working as long as you're able to satisfy the job requirements.

Still pondering, however!

Wendy

CO EMT-B