National Nurses United

NewsBriefs.REV_April 5/8/10 12:05 AM Page 11 Veterans Affairs Nurses Seek New Policy to Protect Needle Stick Victims NATIONAL S uzanne seta, rn, says she's always been a careful nurse. But that didn't stop her from being stuck with a needle contaminated with the blood of one of her patients at a Veterans Affairs hospital. It was 1999 and Seta was working on a research project, drawing the blood of a patient she knew well, an older man who had Hepatitis C and had recently had unprotected sex. There was no sharps container in the exam room, so Seta went to recap the needle until she could dispose of it properly—and stabbed her finger instead. "Oh my gosh," she remembers thinking. "It was one of those moments where you just want to stand there and cry." The patient agreed to be tested for HIV. But because test results weren't available quickly at the time, Seta had to make a splitsecond decision about whether to start taking antiretroviral drugs that could prevent her from becoming infected—without knowing whether the patient had actually tested positive. Seta chose to take the medicine—a decision she now says left her with crippling side effects from the powerful drugs that she still suffers to this day. Today, testing for HIV and other bloodborne diseases has improved dramatically. But some registered nurses who may have been exposed to such diseases still face an agonizing decision about whether to start preventive drug therapy, because of hospital policies that don't require the source patient to be tested, or don't grant affected nurses access to test results. The National Veterans Affairs Council says it's a dilemma nurses shouldn't have to contend with, and is lobbying the Department of Veterans Affairs to change its position on the issue. "We want the VA to recognize that healthcare workers have a right to know the patient's infectious disease status if there is an exposure," said council president Alice APRIL 2010 Staggs, RN. "Chemotherapy as prophylaxis is quite effective for HIV if you start taking it within a couple of hours of being exposed. If we have one more piece of information, if we know the person is positive, that can help in making an informed decision." Veterans Affairs policy requires that patients provide separate, verbal or written consent before being tested for infectious diseases, including in needle-stick cases. Antiretroviral drugs can save the life of a nurse exposed to HIV, but the side effects can be severe. Becky Johnson, RN, was stuck twice with a needle while working with patients in an HIV clinic in the VA system. The drugs she took the first time raised her liver enzymes to dangerous levels and frequently made her vomit, she said. "I think my husband thought I was going to die," she said. The second time around, W W W. N A T I O N A L N U R S E S U N I T E D . O R G Johnson said, she opted against the medicine and "just prayed to God." But the consequences of not taking preventive medicine can be just as serious, nurse advocates said. Ken O'Leary, RN, president of the nurses' union at a VA facility in North Carolina, said he once represented a nurse who contracted hepatitis from a patient. The office of employee health at the hospital obtained test results for the patients but didn't show them to the nurse, only reassuring her that everything was fine, he said. It was only months later, when the RN started turning yellow from liver failure, that she discovered she was infected. VA Council leaders emphasize that they recognize patients' privacy concerns, but want a policy that balances those concerns with healthcare workers' rights. Some private hospitals, for example, have patients sign a blanket consent form when they begin treatment granting the hospital the right to test their blood for infectious diseases in the event that a healthcare worker is exposed to it. Several states, including Ohio, Florida and Georgia, have laws granting healthcare workers exposed to a patient's blood the right to know whether the patient tests positive for HIV. State laws don't apply to the VA system, however. "It doesn't make sense that we're treating disease, yet we don't have the right to know what we're exposed to," said O'Leary. Nurse leaders are preparing to meet with VA officials to discuss the issue. Seta, meanwhile, has undergone treatment for liver disease and had two knees replaced due to rheumatoid arthritis. Though she cannot prove her ailments are a result of the cocktail of antiretroviral drugs she took, both are known side effects of the medicines. The patient whose blood she was exposed to, it turns out, was HIV-negative. —Felicia Mello N AT I O N A L N U R S E 11

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