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Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
Employee Privacy vs. Patient Safety
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Employee Privacy vs. Patient Safety

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  • Rates are roughly the same as having unprotected sex
  • 95% of HIV occupational seroconversions, are caused by needlestick injuries preventable with practical, low-cost measuresNew methods are being developed to test needlestick resistant glovesDouble gloves for the procedures
  • Serostatus--status with respect to being seropositive or seronegative for a particular antibodySero-status refers to the term 'seroconversion' which is defined as the production of antibodies in response to an antigen
  • No definitive list of whether a procedure is exposure-prone or non-exposure prone, is up to the individual facility and / or review committees
  • Serostatus--status with respect to being seropositive or seronegative for a particular antibodySero-status refers to the term 'seroconversion' which is defined as the production of antibodies in response to an antigen
  • societal misperceptions that qualified health care providers must themselves be free from any physical or mental impairment“Direct threat” is defined as a significant risk of substantial harm to the individual or others in the workplace that cannot be reduced or eliminated through reasonable accommodation.Factors to be considered include: (1) the duration of the risk; (2) the nature and severity of the potential harm; (3) the likelihood that the potential harm will occur; and (4) the imminence of the potential harm. This standard must be satisfied in all instances where an individual with a disability is not hired or is removed from a position based on concerns about health or safety risks posed by the disability.
  • Incorporate use of safety devices and double gloving with needlestick resistant gloves when performing exposure prone invasive surgical proceduresIt isn’t specified for this particular nurse if she is doing exposure prone or non-exposure prone procedures
  • Transcript

    • 1. Employee Privacy vs. Patient Safety Consulting Firm #8 Teresa Long Francisco Lopez Fall 2012
    • 2. AIDS in the American Workplace  AIDS has profoundly impacted the American workplace  One in six U.S. worksites with greater than 50 employees and one in 15 U.S. worksites with less than 50 employees have or have had an employee or employees with HIV infection or AIDS (ACOEM 2008)  The AIDS epidemic brought a wide range of sensitive medical, social, and political issues with it  Confidentiality  Discrimination  Safety  As treatment has improved, more HIV positive and AIDS infected workers have become integrated into the workforce  Social stigmas still exist 2
    • 3. The Scenario  The administrator of a small hospital in Texas becomes aware that one of the operating room nurses is HIV positive, and is concerned about the risk this employee poses to patients in the operating room  Hospital employees are spreading confidential information about the nurse that should remain private  Several doctors and nurses have expressed that they do not wish the allegedly infected nurse to continue assisting with surgical procedures 3
    • 4. The Facts       Human immunodeficiency virus(HIV) causes AIDS HIV attacks the immune system, rendering the body susceptible to infections caused by viruses, bacteria, and yeasts HIV is transmitted via blood, semen, saliva and other bodily fluids. Three conditions are necessary for HIV to be transmitted:  An HIV source  A sufficient dose of virus(viral load)  Access to the bloodstream of another person HIV is not transmitted by casual contact Laws guarantee patients certain rights and require certain duties of health care providers Currently, there is no cure for AIDS Source: CDC 4
    • 5. How may HIV be Transmitted in a Healthcare Setting?  Transmission from patients to healthcare workers occurs via:  Percutaneous or mucosal exposure of workers to blood or other bodily fluids of infected patients  Direct inoculation of virus into cutaneous scratches, skin lesions, abrasions, and burns  Inoculation of virus onto mucosal surfaces of the eyes, nose, or mouth through splashes  Does not spontaneously penetrate intact skin  Airborne transmission does not occur  CDC retrospective case-control study determined average risk for HIV transmission  ≈0.3% following percutaneous exposure  ≈0.09% following mucous membrane exposure 5
    • 6. Mechanisms of Transmission  In the United States  No confirmed cases of transmission from patients to healthcare workers since 1999  Only one instance of patients becoming infected by a health care worker  Involved HIV transmission from one infected dentist to six patients  Investigations of more than 22,000 patients of 63 HIV-infected physicians, surgeons, and dentists have identified no other cases  Worldwide  French orthopedic surgeon—transmission to one patient during a prolonged surgical procedure  Spanish gynecologist—transmission to one patient during a Caesarean delivery 6
    • 7. Preventing Exposures  Transmission can be minimized via:  Practicing standard infection control precautions  Written protocols for reporting, evaluation, counseling, treatment, and follow-up of all occupational exposures 7
    • 8. Standard Precautions  Applies to:     Blood All body fluids, secretions, and excretions (except sweat) Non-intact skin Mucous membranes  Core elements:  Hand washing after patient contact or contact with blood or body fluids  Using barrier precautions (e.g., gloves, gowns, and facial protection) to prevent mucocutaneous contact  Minimal manual manipulation of sharp instruments and devices  Disposal of these items in puncture-resistant containers 8
    • 9. Needlestick Injuries  95% of HIV occupational seroconversions are caused by needlestick injuries (WHO)  One in five healthcare workers receive a needlestick injury every year  Preventable with practical, low-cost measures 9
    • 10. Preventing Needlestick Injuries Double gloving when performing exposure prone invasive procedures Use of safety devices 10
    • 11. The Risk  When standard infection control precautions are strictly adhered to, the majority of health care procedures pose no risk of HIV transmission from an infected health care worker to a patient  Healthcare procedures identified as exposure-prone invasive procedures pose a small risk of HIV transmission from an infected health care worker to a patient  There is a greater risk of a patient transmitting HIV to a health care worker 11
    • 12. Post-exposure Prophylaxis  Most medical procedures are safe if standard infection control procedures are followed  HIV has a short lifespan outside the human body  Promptly wash areas where splashing may have occurred  If fluids get into eyes or cuts in the skin, flush thoroughly with clean water  If exposure is suspected due to accidental needle sticks, etc.  Post-exposure chemoprophylaxis can reduce the risk of transmission 12
    • 13. Ethical Considerations  Health Care Workers who know they are HIV positive and perform exposure prone invasive procedures have an ethical obligation to self-report to the profession's regulatory body and must take all necessary steps to avoid transmission to patients 13
    • 14. American Medical Association H-20.912 Guidance for HIV-Infected Physicians and other Health Care Workers  General Considerations  A health care worker who performs invasive procedures and has reasonable cause to believe he/she is infected with HIV should determine his/her serostatus or act as if that serostatus is positive 14
    • 15. American Medical Association H-20.912 Guidance for HIV-Infected Physicians and other Health Care Workers  Patient Care Duties  An HIV- infected health care worker should be permitted to provide health care services as long as there is no significant risk of patient infection  A physician or other health care worker who performs exposure-prone procedures and becomes HIV-positive should disclose his/her serostatus to a state public health official or local review committee  Should refrain from conducting exposure-prone procedures or perform such procedures with permission from the local review committee and the informed consent of the patient  Must err on the side of protecting patients 15
    • 16. American Medical Association H-20.912 Guidance for HIV-Infected Physicians and other Health Care Workers  Local Review Committee  If an HIV-infected physician or other health care worker performs invasive medical procedures as a part of his/her duties, then the individual should request that an ad hoc committee be constituted to consider which activities can be continued without risk of infection to patients  Consideration should be given to adapting programs for impaired health care workers to serve those who are HIV infected  Any HIV- infected health care worker who repeatedly violates local committee-imposed practice limitations and/or universal precautions should be reported to appropriate authorities, such as the state licensure board, for possible discipline 16
    • 17. American Medical Association H-20.912 Guidance for HIV-Infected Physicians and other Health Care Workers  Confidentiality  AMA believes the confidentiality of the HIV- infected health care worker should be protected as with any HIV patient  Knowledge of the health care worker's HIV serostatus should be restricted to those few professionals who have a medical need to know  Except for those with a need to know, all information on the serostatus of the health care worker must be held in the strictest confidence 17
    • 18. HIPPA Laws  Balanced rule which provides federal protections for personal health information held by covered entities  Establishes patient rights  Permits disclosure of personal health information necessary for patient care  Pertains to all entities that transmit healthcare information electronically 18
    • 19. OSHA’s Bloodborne Pathogen Standard 1910.1030  Requires the development of written exposure control plans, the use of engineering and work practice controls to reduce exposures, and annual Health Care Worker training  Promulgated widespread adoption of standard precautions in U.S. hospitals  Skin and mucous membrane contacts frequently can be prevented with the use of barrier precautions, such as gloves, masks, gowns, and goggles  Percutaneous injuries require changes in technique and/or use of safety devices 19
    • 20. Health Care Workers and the Americans with Disabilities Act  Federal law prohibiting discrimination against individuals with disabilities  Applies to employees and applicants, but not independent contractors  Includes rules stating when employers may seek medical information from job applicants or employees  An employer may make disability-related inquiries or require a medical examination if there is reasonable cause for believing that the employee may pose a direct threat due to a medical condition  An employer may exclude an applicant or employee with a disability from a position if that person poses a direct threat to health or safety  A qualified individual with a disability is entitled to reasonable accommodation to perform a job or to enjoy the benefits and privileges of employment unless it imposes an undue hardship on the employer 20
    • 21. Source: The Center for HIV Law & Policy 21
    • 22. HIV Infected Health Care Workers: Management and Patient Notification  HIV infected health care workers have ethical and legal obligations to protect the health and safety of their patients  Informed patient consent required in Texas  HIV infected health care workers who do not perform exposure prone procedures but continue to provide clinical care to patients should remain under regular medical and occupational health supervision  HIV infected health care workers have a right to expect that their confidentiality will be respected and protected  When an employer or staff member is aware of the health status of an infected health care worker, there is a duty to keep such information confidential  HIV infected health care workers are entitled to the same rights of confidentiality as any patient seeking or receiving medical care  Employers must ensure that new and existing staff are aware of ethical and legal responsibilities 22
    • 23. The Recommendations  Define exposure prone invasive procedures used in the Weimer, TX facility with the help of a review committee  Determine if infected worker is involved in exposure prone invasive procedures  HIV positive health care workers may be assigned to assist in performing exposure prone invasive procedures on HIV positive patients  HIV positive health care workers may be reassigned to a position that doesn’t pose a risk to patients  Texas law requires informed written consent of patients before any exposure prone invasive procedure is performed 23
    • 24. The Recommendations  Ensuring the privacy of HIV infected health care workers  All health care workers and patients have the right to expect that their confidentiality will be respected and protected  Confidential healthcare information should be restricted to those with a need to know  Disciplinary action up to and including termination for staff members that violated the HIV positive health care worker’s right to privacy  Ensure all workers receive initial and annual refresher training regarding confidentiality and privacy laws 24
    • 25. Works Cited 1910.1030 Subpart A- General." Occupational Safety & Health Administration. United States Department of Labor, 22 June 2012. Web. 23 Nov. 2012. <http://www.osha.gov/pls/oshaweb/owastand.display_standard_group?p_toc_level=1>. "Recommendations and Reports." Centers for Disease Control and Prevention. Morbidity & Mortality Weekly Report, 02 May 2001. Web. 23 Nov. 2012. <http://www.cdc.gov/mmwr/preview/mmwrhtml/00014845.htm>. Macdonald, Michael G., Clare C. Obade, Bennett J. Yankowitz, and Richard A. Feinstein. "Texas Health Law." Web Locator. Practising Law Institute, n.d. Web. 23 Nov. 2012. <http://www.weblocator.com/attorney/tx/law/b27.html>. Evans, Nancy, BS. "HIV/AIDS Transmission and Infection Control." NursingCEU.com, a Division of Wild Iris Medical Education, Inc. Wild Iris Medical Education, Inc, 2011. Web. 23 Nov. 2012. <http://www.nursingceu.com/courses/353/index_nceu.html>. "HIV Infected Helath Care Workers: Guidance on Management and Patient Notification." Department of Health. Nov. 2001. Expert Advisory Group on AIDS, UK Advisory Panel for Health Care Workers Infeted with Blood-borne Viruses. 24 Nov. 2012 <http://www.heart-intl.net/HEART/011507/HIVInfectedHealth.pdf>. "H-20.912 Guidance for HIV-Infected Physicians and other Health Care Workers." American Medical Association Policies Related toPhysician Health. Feb. 2011. Department of Physician Health & Health Care Disparities. 24 Nov. 2012 <http://www.ama-assn.org/resources/doc/physician-health/policies-physicain-health.pdf>. "HIV and AID in the Workplace." Public Affairs. 17 Nov. 2008. American College of Occupational and Environmental Medicine. 24 Nov. 2012 <http://www.acoem.org/HIV_AIDS_Workplace.aspx>. "The National Legal Resource and Strategy Center for HIV Advocacy." The Center for HIV Law and Policy. The Center for HIV Law and Policy. 25 Nov. 2012 <http://hivlawandpolicy.org/>. Johnston, Lynn B., and John M. Conley MD. "Nosocomial Transmission of Bloodborne Viruses From Infected Health Care Workers to Patients." The Canadian Journal of Infectious Disease. July-Aug. 2003. U.S. National Library of Medicine. 24 Nov. 2012 <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094936/>. "Questions and Answers about Health Care Workersand the Americans with Disabilities Act." EEOC Home Page. 2 Feb. 2011. The Equal Employment Opportunity Commission. 24 Nov. 2012 <http://www.eeoc.gov/facts/health_care_workers.html>. "Guide to Health and Security of Health Information." The Offie of the National Coordinator for Health Information Technology. US Department of Health and Human Services. 24 Nov. 2012 <http://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide.pdf>. "Your Source for Safety." Ambitex University. 2009-2011. Tradex International Inc. 24 Nov. 2012 <http://www.gloveuniversity.com/>. "Health workers Occupational Health." Ocupational Health. 2012. World Health Organization. 24 Nov. 2012 <http://www.who.int/occupational_health/topics/hcworkers/en/in " 25

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