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Nursery concerns
Sep 24, 2002

Thank you for this web site!! I am the volunteer coordinator at our church and recently one of our precious babies was found to be HIV positive. This is a new situation for me and I want everyone concerned to be happy and safe and healthy. We have a very loving nursery, babies kiss babies all the time. Should I be concerned, are there particular procautions we should take when nursery workers change diapers? I do not want to panic anyone or make anyone uncomfortable, but I do feel like I should know if there is any risk involved. Thank you.

Response from Ms. Breuer

Congratulations, and thank you. You're seeking information before setting policy. I'll bet you think that's what everyone does, but I wish it were so!

First, let's review fluids capable of transmitting HIV: blood, semen, vaginal secretions and breast milk. Not saliva. That wipes kissing off the menu of concern. Let them kiss to their hearts' content.

And unless you have mothers breast-feeding who are children not their own, HIV transmission through breastfeeding is not a risk in your environment. Take that one off the menu of concern.

Semen and vaginal secretions: they have a few years before they start exchanging these fluids. Take those off the concern menu.

That leaves blood alone on the concern menu. You probably already have a protocol for dealing with human blood: never come into contact with human blood without wearing latex gloves, treat all blood as if it's infectious. That's standard, and protects everyone from HIV, hepatitis B and C and the general range of bloodborne diseases. Because it's possible for there to be blood in the feces of a small one with HIV, setting a gloves-while-changing-diapers policy would increase your level of safety, in case a nursery worker has broken skin on the hands. Even that is a precaution that some people might think is unnecessary, but I'd rather err on the side of safety. Using them protects your entire nursery population from any one baby's hepatitis A (transmitted by fecal contamination of hands or food) as well as hepatitis B and C (blood transmission). If you move to that policy, please remember that the gloves go on when someone changes any baby's diaper, not just the diaper of the HIV-identified baby!

Which brings me to the reason I'm most grateful that you submitted this question. The baby who has HIV also has privacy rights. You have the obligation not to disclose to anyone else (other parents, nursery workers, pastoral staff included) the HIV status of the baby without the clear permission of the parent(s). Other babies in the same nursery are not at risk from that baby's HIV, but your whole nursery setup is at risk from potential ignorance and discrimination on the part of the people in the church who haven't learned enough about HIV yet to understand.

So how do you respond when parents ask why you're suddenly changing diapers with gloves on? (A different pair of gloves for every diaper change, by the way...no moving from baby to baby with the same gloves!) "Increased safety for all the babies and the nursery workers. We run a very clean nursery here." There you go.

Thank you for writing, and please write again if you face problems with this. Congregations have fallen apart over such issues as this, without good reason, just because panic is so much more infectious than HIV is.



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