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Do nurses have the right to know?
Oct 7, 1998

I am a nursing student and I was wondering if there was anything out there about whether or not I have a right to know in one of my clients has AIDS/HIV? What is your opinion on the ethical issue on health care workers knowing or not?

Response from Ms. Breuer

This may surprise you, but I don't have an opinion on the "ethical issue" in your question, because I don't think there is one. It's a workplace safety issue instead. You have not only the right but also the obligation to treat all blood/semen/vaginal fluid/breast milk as if it is infectious. Universal precautions are the only protection you can rely on. Here's why:

1. Most people with HIV don't know it, and couldn't answer you if you asked.

2. Many are in the window period, and would test negative if you tested them.

3. Someone in the window period may test negative, but is more infectious than s/he will be again for years. A good time to be careful around their blood!

4. "Knowing" could encourage some health care workers to be careful only around the body fluids of someone known to be HIV positive, and sloppy around others. Poor infection control!

5. According to the CDC estimate released on 8/10/98:

800,000 health care workers will be injured by patient needles this year. 2000 will test positive for new infections with hepatitis C. 400 will get hepatitis B. 35 will contract HIV. Hepatitis C is ten times more likely to be transmitted this way than HIV.

Now what do you want to know more: the HIV status, or the hepatitis C status?

6. During the 1970's many health care workers in the U.S. were working with people who had HIV, but none knew it; the virus hadn't been discovered yet. Why did they not become infected? Because they were protecting themselves against hepatitis B. Universal precautions will keep you from becoming infected with the bugs whose names we may not even know yet.

So I encourage you to reframe the question: given that HIV, hepatitis B and hepatitis C are out there in the populations you will be treating, and there may be infectious diseases we have not discovered yet, is the failure to maintain universal precautions an ethical issue? I think it is.

Nancy Breuer

Fatigue and low energy getting in the way.
A co-worker just informed me that he has Aids

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