Should People With Infectious Diseases Be Allowed in EMS?

[mstovall]

I don't have a problem as long as the route of infection is minimized. How many people are out there that are infected and don't know it? Are we going to require testing of every individual like we do TB test (yearly basis in KY)? Are we going to dictate that services, which are already struggling financially go through the means of testing everyone multiple times a year? Are we going then to award worker's comp claims as individuals have been exposed on ocassion and not know it?

While we may think initially that we would want rules, how are we going to actively enforce said rules and what are we going to do in the mean time between test? What about those that have been exposed, are we going to take them off the streets until their test come back? And what about things like HIV that may not be detectable for several years, do we continue to pay individuals to sit on the side line for their window to clase? It would take much then for people to use this to their advantage.

While we may wish to do something about this, not only are their legally recousre for infected individuals, but there is just the impractibility of enforcement of the issue.

JMHO,

Michael

[stcommodore]

Somebody said something here about a "negitive" skin test and chest xray, but from what I'm told once you have a positive test be it from an exposure (common in health care) or from active TB your not to have a skin test again because you'll always be positive.

[DwayneEMTP]

Man, I guess I'm going to disagree with just about everyone here.

And I have to tell you that it hurts my heart to even see HIV even mentioned in this context amongst medical professionals...

Hep, I don't see the issue. If you have the habit of involving yourself in behavior that causes you to bleed on your patients then that behavior should certainly get you removed from the truck, not your HIV or Hep status. This is CRAZY!

And the "Do no harm" argument is very weak.

I would be willing to bet that more patients with HIV, HEP, pulmonary compromise, and the aged, to a power of 10 at least, have been injured or killed by the EMS worker with dirty hands/tools, influenza, or even this years cold. I’ve heard a million time, “Oh God. I should have stayed home, but I need the overtime….” Of course, I know no one HERE has ever done such an irresponsible thing…Yeah.

This is an illogical, knee jerk, non medical idea that discriminates against those with little to no risk of harming their patients (MY knee jerk reaction to TB is no, but I'd have to review it a bit) based on panic. I would be disappointed to see it supported on Monetel or some other such silly show, but to see it supported here is disturbing.

Not the question, I love the question, I simply expected it to fall flat as everyone shot coffee through their noses at the mere thought of it.

It has no place in EMS unless you can come up with better excuses than listed above.

It belongs with the "You can’t shop with an IV!!!" thread.

(My opologies if I was a little vague about how I feel about this...)

Dwayne

[ccmedoc]

Somebody said something here about a "negitive" skin test and chest xray, but from what I'm told once you have a positive test be it from an exposure (common in health care) or from active TB your not to have a skin test again because you'll always be positive.

Negative skin tests are suggestive of no infection or exposure, and in the absence of signs and symptoms are taken as that. Anyone infected, or that has had a BCG in the last 10 years may test positive with the mantoux test. Any exposure will also probably test positive. Diagnosis is by sputum culture, not xray. You can be skin positive and TB negative..

To be cleared as non-infectious after having TB, you must have three clear sputum cultures. These cultures should be taken every 2-4 weeks during drug therapy which lasts from 6-12 months. Skin tests are not used to clear someone as non-infectious at this point.

(BCG=bacillus Calmette-Guerin vaccine[sp?]...used in some european and eastern countries)

[DwayneEMTP]

How would you feel being a patient having someone with an infectious disease working on you...... enough said

I am a medical professional. (sort of) I don't freak out over nonsense.

I would have no issue with it at all unless the person treating me claimed that anal sex, sharing dirty needles, or some other means of exchanging contaminated bodily materials was suggested for my treatment. (again, pending review of TB. Even then if they were masked I wouldn't have an issue with it)

In which case I would demand a second opinion.... :shock:

Dwayne

Edited to clarify a poorly worded sentence. No contextual changes made.

[VentMedic]

Somebody said something here about a "negitive" skin test and chest xray, but from what I'm told once you have a positive test be it from an exposure (common in health care) or from active TB your not to have a skin test again because you'll always be positive.

A positive (now called "significant") reaction indicates infection with TB. Someone who is infected with TB has the TB bacteria (Mycobacterium tuberculosis) in their body. The body's defenses are protecting them from the bacteria and they are asymptomatic . This is referred to as latent TB. It is also something many RTs and RNs have to look forward to in their careers. Once you test positive you will get periodic (usually yearly) CXRs to check for signs of active disease.

If someone has active TB, it can be confirmed by AFB cultures by sputum. They are sick and may be able to spread the disease to other people. This is a no-brainer since it is airborne.

This is pulmonary tuberculosis as there are other areas of the body that can be affected.

As far as the other infectious diseases, I agree with Dwayne.

The CDC has spelled this out in guidelines for hospitals and other agencies to follow. The healthcare works (HCWs) that are infected are probably the most informed of all about protection. Many people with HIV have been positive for 20 years with few symtoms and many work in healthcare. While it is possible for the HCW to infect the patient, it is usually the reverse. Depending on your job description, it is the discretion of the employer as to what position you may hold clinically. It has been determined that nurses, RTs and even paramedics may not present much risk for direct exposure to their patients in many areas of health care settings.

When you are given your employee phyical, you can ask for an employee rights statement concerning this if you do happen to test positive. Employers should routinely monitor their employees to ensure their vaccinations are up to date. Hep B titers should be ran periodically since that may have to be renewed. When I turned 40 my varicella titer came back negative (rechecked for false negative) even though I had be positive for 32 years. I then had to take the varicella vaccine.

I would bet that an immunosuppressed patient has more chance of catching something deadly from an inadequately cleaned ambulance or equipment and poor hand/glove practices than from an infected HCW.

[Just Plain Ruff]

I disagree to a point with you Dwayne.

We as healthcare professionals know better and most patients do not.

If you are infectious you should not be working period. If it's a lifetime of infectious status then you should not be working. Many ofyour patients are immunocompromised enough as it is and adding our infection to their mix can be a deadly thing.

Working when you have active TB is just criminal and negligent. If you pass an infection on to a patient it's no-one's fault but your own and if you knew you were infectious and worked anyway then it should be criminal.

HIV - You give that to a patient and you are just as guilty as the above.

I don't see where the issue is, we are healthcare providers and we know what diseases do. If you knowingly work while you have something then you are in the wrong plain and simple.

I don't mean to sound simple but you infect someone then you are responsible. I for one do not want to have that on my head.

Hepatitis a is just as bad -

If you don't wash your hands on a regular basis then any infection you pass to a sick patient making them sicker is on your head.

I have rarely gone to work sick. No matter how much money I was going to lose. If I'm sick I'm sick and I am rarely sick so I know that when I get sick I am really sick.

I agree with you to a point Dwayne but not completely.

[ccmedoc]

I would have no issue with it at all unless the person treating me claimed that anal sex, sharing dirty needles, or some other means of exchanging contaminated bodily materials was suggested for my treatment. (again, pending review of TB. Even then if they were masked I wouldn't have an issue with it)

TB being a reportable disease, any health care worker with an infection would probably not be working. As for the other diseases, HIV, Hepatitis; if you or the health care worker with them take precautions, I doubt any sharing of body fluids would be at issue.

If the person in question were to stick someone after sticking themselves, well...

Keep wounds covered and wear gloves and a mask when warranted to prevent body fluid mixing, thats all. The stigma is probably worse than the health risk..

My opinion, nothing more...

[DwayneEMTP]

...I think that there should better schooling and programs to help people [s:f33b3396ad]with these disease processes so they can work[/s:f33b3396ad].

"approach problems with logic instead of emotion..."

I could agree with that sentence Brock.

Dwayne

[JPINFV]

I would have no issue with it at all unless the person treated me claimed that anal sex,

Well, there are some legitimate medical tests that... [link safe for work]