Friday, April 22, 2011

Is the Edmonton HCV/HIV Scenario Setting Us Back Decades?

As noted yesterday on the blog in Edmonton a healthcare worker tested positive for HIV and HCV, because this infected worker was present during the neuro-surgical procedures patients were contacted for testing. Due to privacy issues the worker's role in the operating room wasn't specified. Officials have said and I quote
"The expert panel determined the risk here was very, very low, if not zero, because there were no breaches of infection-control practices identified with any of these particular patients,"  

I have deep empathy for the patients who fear the possibility of contracting HIV or HCV after undergoing surgery at the facility. These patients may not fully realize how low the risk is for transmitting bloodborne pathogens from infected worker to patient. As mentioned on the blog yesterday unless the healthcare worker had deliberately put patients at risk, (which is not the case) the risk is extremely low.

Today in the media we learned that the health minister has asked for a review into the testing of health workers for bloodborne illnesses.

In retrospect this could be comparable in some ways to the AIDS hysteria seen in the 1980's . A time when the transmission of AIDS was erroneously fueled in the media.

During that time so little was known about AIDS. I remember, and you may also when a small panic broke out among actors in California as the news broke that Rock Hudson had sadly died from AIDS. The public, and fellow actors feared for the health of actress Linda Evans because she shared an on screen kiss with the actor.

In respect to the Edmonton patients this correlation may pale in comparison, which is understandable. Rock Hudson was not a nurse or physician working in a medical setting, however, if these innocent patients had a clear understanding of how HIV, or HCV is transmitted in this particular case, the patients may find comfort in knowing  their fear is unfounded. 

The Facts

As noted yesterday on this blog according to Academy of Orthopaedic Surgeons the risk for transmission from infected healthcare professional to patient is low.

Three conditions are necessary for Healthcare professionals-HCPs to pose a risk for transmitting a bloodborne virus to patients. 
First, the HCP must be viremic (i.e., have infectious virus circulating in the bloodstream).

Second, the HCP must be injured or have a condition (e.g. weeping dermatitis) that allows direct exposure to his/her blood or other infectious body fluids.

Third, the HCP’s blood or infectious body fluid must gain direct access to a patient’s wound, traumatized tissue, mucous membranes, or similar portal of entry.

What appears to be slowly evolving in the aftermath of this worker testing positive is the same mentality witnessed decades ago, with the Health Minister calling for mandatory testing of all health workers in Alberta. As noted in the Edmonton article;
This incident has raised the question of whether regular testing of health care workers for infectious diseases should be carried out for ensuring patient safety.
According to Health Minister Gene Zwozdesky, the position needs to be strengthened, as it is mandatory to get health workers in Alberta tested for blood-borne illnesses. If, a worker does test positive, they have to notify regulatory bodies.
Heather Smith, President of United Nurses of Alberta does not believe mandatory testing is needed, but does say it is important to continue using universal precautions."
Liberal Leader David Swann agrees, as it would involve a huge economic investment, including the medical legal issues that would crop up.

I comprehend and recognize the documented rare isolated cases of the transmission of bloodborne pathogen's from healthcare worker to patient. Which only underscores the importance for the use of universal precautions, as Heather Smith pointed out in the article. What I don't understand is that in 2011 Mr. Gene Zwozdesky, the Health Minister, calling for mandatory testing in a country which last time I checked practiced sophisticated medicine. In my humble non medical opinion Mr. Zwozdesky is stepping back into a time where no medically educated or otherwise man/woman should go. By doing so he is negatively, and irresponsibly confirming the Edmonton's patients deep routed fear for contracting HIV or HCV in the mentioned setting, when he should be placing emphasis on the research/facts from Scientists and medical authorities who have established  the risk is low. I can only assume the Minister was misquoted, because I can not grasp his solution and hope it will hold little merit with the officials in his country.

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