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Exposure to HIV in a population of dental workers
I am a dentist who employs a rather alarmist hygienist. She claims to personally know dental workers who are HIV positive and "could not have gotten it any other way" than through their work. To my knowledge, there has never been a confirmed transmission to a dental worker (meaning a negative test was performed immediately after exposure and the worker seroconverted later.) There are seven unconfirmed cases where no testing was done after exposure, but no other risk factors were present.
My question is: Was there or was there not a true percutaneous exposure in those seven unconfirmed cases? I have always assumed so but can find no confirmation. Do you have access to that data?
I see a lot of a lot HIV positive patients and am a Ryan White provider. I may need to sack this hygienist.
My question is: Was there or was there not a true percutaneous exposure in those seven unconfirmed cases? I have always assumed so but can find no confirmation. Do you have access to that data?
I see a lot of a lot HIV positive patients and am a Ryan White provider. I may need to sack this hygienist.
Too true, Nursegirl. It's funny how even people who are educated on transmission rates and routes can be paranoid about contracting this virus in one setting and very lax about it in another.
Certainly, you are in a sticky situation, and can completely understand your concern over her perhaps saying inappropriate and even misleading/incorrect statements.
Personally...she sounds as if she needs to educate herself or find a new profession. Of course, any job where you are working with sharp instruments and have exposures to blood, there will be a risk...just as in the medical field.
Thing is...FIRST of all that risk is probably very small, even WITH a sharps exposure, secondly....this is where following proper and consistent procedure pretty much will guarantee the safety of the worker.
ONE thing I would certainly mention to her is the fact that for every patient who is HIV+ that you knowingly treat, there could be 10 who do NOT know their status...therefore maintaining Universal Precautions regardless of WHO the patient is is sufficient to protect onesself. Of course, telling her this may also spin her out of control.
I think you just need to put it straight to her...that even IF the seven dental workers were truly exposed in that manner...does she realize what an extraordinarily LOW number that is? That..... beside those "questionable" seven...what about everyone else?
With any job, we take risks...and if she is THAT concerned about it...genuinely...what more can you do to reassure her? If you provide the gloves, masks, etc to keep your employees safe...and ensure that she is using proper techniques during procedures, there isn't much else YOU can do.
I would think maybe one more (as I'm sure there have been MANY) heart to heart talk with her expressing your concern about statements she is making and her refusal to assist with some patients...and the liability issues for you..along with the facts about protecting onesself in the workplace...is all I think you can do at this point. And if *I* were you, I would honestly tell her that regardless of what dental office she works in....she will assume risks. Back to the Universal Precaution topic...if it is BECAUSE you are treating HIV+ patients, and b/c of your affiliation with the Ryan White organization...then it WOULD be in her best interest to find different employment. I just sincerely hope she realizes that for every risk one KNOWS about, there are a few that one does NOT. If she is in that midset, then she clearly needs further education on infection control and Universal Precautions.
I applaud that you are trying to do what is best, and I'm sure you are really stuck between a rock and a hard place. Bottom line is...you of course would likely have to put your patient's best interests first.
Best of luck to you, I hope it works out...and I know you were looking for a more definitive answer on the alleged seven exposures, I apologize that I cannot elaborate on that as I am not familiar with that at all...only from my viewpoint being in the medical field.
Sadly, I could tell you horrid stories of my fellow Nursing colleagues who triple glove and gown up to deliver a lunch tray to an AIDS patient, yet does not bat an eye when starting an IV without gloves in the next room...on a patient they do not KNOW his or her status. It is very sad, and VERY frustrating to say the least...and not once have I ever been able to make these co-workers see the error of their ways.
Personally...she sounds as if she needs to educate herself or find a new profession. Of course, any job where you are working with sharp instruments and have exposures to blood, there will be a risk...just as in the medical field.
Thing is...FIRST of all that risk is probably very small, even WITH a sharps exposure, secondly....this is where following proper and consistent procedure pretty much will guarantee the safety of the worker.
ONE thing I would certainly mention to her is the fact that for every patient who is HIV+ that you knowingly treat, there could be 10 who do NOT know their status...therefore maintaining Universal Precautions regardless of WHO the patient is is sufficient to protect onesself. Of course, telling her this may also spin her out of control.
I think you just need to put it straight to her...that even IF the seven dental workers were truly exposed in that manner...does she realize what an extraordinarily LOW number that is? That..... beside those "questionable" seven...what about everyone else?
With any job, we take risks...and if she is THAT concerned about it...genuinely...what more can you do to reassure her? If you provide the gloves, masks, etc to keep your employees safe...and ensure that she is using proper techniques during procedures, there isn't much else YOU can do.
I would think maybe one more (as I'm sure there have been MANY) heart to heart talk with her expressing your concern about statements she is making and her refusal to assist with some patients...and the liability issues for you..along with the facts about protecting onesself in the workplace...is all I think you can do at this point. And if *I* were you, I would honestly tell her that regardless of what dental office she works in....she will assume risks. Back to the Universal Precaution topic...if it is BECAUSE you are treating HIV+ patients, and b/c of your affiliation with the Ryan White organization...then it WOULD be in her best interest to find different employment. I just sincerely hope she realizes that for every risk one KNOWS about, there are a few that one does NOT. If she is in that midset, then she clearly needs further education on infection control and Universal Precautions.
I applaud that you are trying to do what is best, and I'm sure you are really stuck between a rock and a hard place. Bottom line is...you of course would likely have to put your patient's best interests first.
Best of luck to you, I hope it works out...and I know you were looking for a more definitive answer on the alleged seven exposures, I apologize that I cannot elaborate on that as I am not familiar with that at all...only from my viewpoint being in the medical field.
Sadly, I could tell you horrid stories of my fellow Nursing colleagues who triple glove and gown up to deliver a lunch tray to an AIDS patient, yet does not bat an eye when starting an IV without gloves in the next room...on a patient they do not KNOW his or her status. It is very sad, and VERY frustrating to say the least...and not once have I ever been able to make these co-workers see the error of their ways.
Hi Teak,
It's a complicated issue, but there are several reasons I might need to sack this hygienist. First, it is illegal to refuse to treat an HIV positive patient because he or she is HIV positive. Second, it morally reprehensible to refuse to treat HIV positive patients because they are HIV positive. Third, it creates disharmony in my practice to have an employee making alarmist statements of doom and gloom when the actual risk of transmission in the healthcare setting is infinitesimally small. Fourth, I don't know what she says to patients about this as I am not always in the room with her; however, there is the risk of huge civil liability if she is making false or misleading statements.
Again, I hoped to find out if anyone knew if the 7 unconfirmed cases of HIV transmission to dental workers involved percutaneous exposure during treatment.
It's a complicated issue, but there are several reasons I might need to sack this hygienist. First, it is illegal to refuse to treat an HIV positive patient because he or she is HIV positive. Second, it morally reprehensible to refuse to treat HIV positive patients because they are HIV positive. Third, it creates disharmony in my practice to have an employee making alarmist statements of doom and gloom when the actual risk of transmission in the healthcare setting is infinitesimally small. Fourth, I don't know what she says to patients about this as I am not always in the room with her; however, there is the risk of huge civil liability if she is making false or misleading statements.
Again, I hoped to find out if anyone knew if the 7 unconfirmed cases of HIV transmission to dental workers involved percutaneous exposure during treatment.
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