Do patients and health care workers have the legal right to know each other's HIV status? Professor Flanagan argues that they do not. Given that with appropriate precautions the risk of transmitting HIV in the health care setting is extremely small and that the discriminatory consequences of HIV disclosure can be extremely high, it is suggested that the right of a patient or a health care worker not to disclose their HIV status must outweigh the other's "right to know."
Five in-patient and out-patient tuberculosis (TB) care facilities in two regions of Russia.
To identify barriers and motivators to the use of infection control measures among Russian TB health care workers.
In this qualitative study, a convenience sample of 96 health care workers (HCWs) was used to generate 15 homogeneous focus groups, consisting of physicians, nurses, and laboratory or support staff.
Barriers and motivators related to knowledge, attitudes and beliefs, and practices were identified. The three main barriers were 1) knowledge deficits, including the belief that TB was transmitted by dust, linens and eating utensils; 2) negative attitudes related to the discomfort of respirators; and 3) practices with respect to quality and care of respirators. Education and training, fear of infecting loved ones, and fear of punishment were the main motivators.
Our results point to the need for evaluation of current educational programs. Positive health promotion messages that appeal to fear might also be successful in promoting TB infection control. Individualized rewards based on personal motivators or group rewards that build on collectivist theory could be explored.
Notes
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Health care workers compliance with guidelines, universal precautions, in connection with tasks that could involve contact with patient's blood is unsatisfactory. In a previous paper, we identified different forces that undermine compliance. Socialization into infection control, routinization, stereotyping, perceptions of patients' wishes and the presence of competing values and norms are examples of such forces.
The aim of this article is to describe and analyse different forces that promote adherence to universal precautions. Behavioural variations are seen as a consequence of differences between wards with regard to the safety culture. Safety culture is conceptualized as the outcome of a constant interplay between deactivating and reactivating forces. In this article the focus is on the latter.
The grounded theory approach. Data were collected through interviews with nurses and assistant nurses.
The charge nurse, informal leaders, students, infection control nurses, type of work, availability of equipment, blood-exposure incidents and media-coverage of infectious diseases are described as potentially important for compliance. The properties these agents must possess in order to be influential are also described.
The outcome of an occupationally acquired infection can be fatal. Hence it is important that health care workers take protective measures. The results imply that mere information about safe practices alone is insufficient to achieve that goal. All factors of importance for compliance must be taken in to consideration in clinical work and in education.
Infections among health-care workers (HCWs) have been a common feature of severe acute respiratory syndrome (SARS) since its emergence. The majority of these infections have occurred in locations where infection-control precautions either had not been instituted or had been instituted but were not followed. Recommended infection-control precautions include the use of negative-pressure isolation rooms where available; N95 or higher level of respiratory protection; gloves, gowns, and eye protection; and careful hand hygiene. This report summarizes a cluster of SARS cases among HCWs in a hospital that occurred despite apparent compliance with recommended infection-control precautions.
Occupational and Environmental Medicine Program, Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences at McMaster University, Hamilton, ON.
Source
Can Oper Room Nurs J. 2007 Dec;25(4):8, 10-1, 19-20 passim
In 1991, Bernadette Stringer, a long time BC Nurses' Union health and safety representative, learned about the death of a 48 year old Victoria, B.C., OR nurse who had sustained a hepatitis C contaminated needlestick. This incident led to a study evaluating the hands-free technique's ability to decrease the risk of percutaneous injury, glove tear and mucocutaneous contamination during surgery that Ms. Stringer carried out in partial fulfillment of her Ph.D. (granted in 1998, by McGill University's Joint Departments of Epidemiology, Biostatistics and Occupational Health, in the Faculty of Medicine). That study's main findings were published in 2002 in one of the British Medical Journal's publications, Occupational and Environmental Medicine. The following article will discuss aspects of Bev Holmwood's case, review the literature on the hands-free technique, and describe a new study that has again evaluated the hands-free technique's effectiveness.
