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Clinical Trial Evaluates Effectiveness of Zidovudine
AORN JOURNAL
M A Y 1989, VOL. 49, NO 5
Letters to the Editor
Data on Gloves Dkputed
I
n the article “Operating room practices: Myth or science?”, which appeared in the February issue of the Journal, Joseph A. Moylan, MD, FACS, is quoted, I believe, incorrectly. His sagacious insight into infection control practices is commendable,but I believe commentsattributed to him are misleading and may lead the readers to make false assumptions. He is quoted as stating, “European countries lead the United States in the use of antisepticimpregnated gloves,” and that these gloves “do not break down as easy as latex gloves, and they do not reintroduce bacteria colonization once punctured.” If the gloves are not latex, what are they made of? Data described in the article indicates that latex gloves have a higher rate of permeability to blood than to water. If an intact latex glove is a barrier to viral pathogens (human immunodeficiency virus [HIV] 120 nanometers and hepatitis B virus [HBV] 42 nanometers), it follows that gloves also must be a barrier to blood. When evaluating barrier effectiveness, one must first define barrier resistance in realtionship to penetrant potential. This statement would appear to be contradictory. He also is attributed as saying that the HIV is unable to penetrate lutes. I believe the reporter meant to use the term latices. Polymer latices are stable dispersions of very small particles of water. They account for 60%or more of the total weight of latex and usually are less than 5 micrometers in diameter. They trap water molecules around polymer particles giving a glove its barrier 1194
attributes against interparticle coalescence. MARGARET F. FAY,RN, MA MEDICAL AFFAIRS/CLINICAL CONSULTANT MINNEAPOLIS Editor’s response. Thank you for clarifying the issue of permeability and the term latices. Upon further investigation it does appear that we summarized Dr Moylan’s presentation concerning gloves in a confusing manner. Dr Moylan did say that European countries lead the United States in the use of antiseptic-impregnated gloves. He said that the antiseptic-impregnatedgloves are not stronger than latex gloves, however, they minimize bacterial colonization once punctured. It appears that the data presented in this presentation came from a study of surgical gloves conducted by A G Dalgleish and M Malkovsky, which was published in the February 1988 issue of the British Journal ofsurgery (pages 171-172). The data indicate that there was no penetration of HIV through the intact gloves under study. It is important to note that seven high-quality gloves were studied, the conclusions of this study and the information provided in the Journal article are not to be applied to all latex gloves.
Clinical Trial Evaluates Eflectiveness of Zidovudine
I
read with interest the article “Occupational hazards in the OR,” which appeared in the January issue of the Journal, and I thought that Journal readers would be interested in a clinical trial being conducted by Burroughs Wellcome Co.
AORN JOURNAL
MAY 1989, VOL. 49, NO 5
On April 29, 1988, Burroughs began a doubleblind, placebo-controlled trial to evaluate the potential effectiveness of prophylactic zidovudine (Retrovirm), formerly AZT, to health care workers who have had recent significant occupational exposure to blood or blood components that were infected with human immunodeficiency virus (HIV). Exposure may have resulted from penetrating wounds from contaminated needles or other sharp objects or splashes onto abraded skin or mucous membranes. Health care workers who experience such exposure should contact the toll-free number, (800) HIV-STIK ([SO01 448-7845), as soon as possible after exposure. The company will consult the physician of the exposed worker regarding his or her participation in the study, and the physician will be sent medication (either Retrovirs or a placebo), study protocol and materials, and other pertinent information. The study has received full approval from the Institutional Review Board of the National Institute of Allergy and Infectious Disease (NIAID), Bethesda, Md. The study will be reviewed on a regular basis by NIAID to assess its progress, and NIAID will make recommendations regarding its continuation. SANDRA NUSINOFFLEHRMAN, MD HEAD,DEPARTMENT OF ANTIMICROBIAL THERAPY BURROUGHS WELLCOME Co. RESEARCHTRIANGLE PARK,NC
RCT Issue Continues to Provoke Comment
A
fter reading numerous articles on the American Medical Association’s (AMA) registered care technologist (RCT) proposal, there are a few points that I found most disturbing. The AMA says that the RCT will assist with bedside care and report to the head of the unit who is an RN, yet he or she would be accountable to the physician and would be certified by the state medical board. If something happens, who is liable? Is it the nurse to whom the RCT reports or is it the physican who was out of the hospital when the incident occurred and who was to
supervise the RCT? A basic RCT would be able to administer routine nonintravenous medications with supervision. Does the AMA seriously expect RNs to agree to supervise RCTs? The RCT program would be geared toward high school students with an emphasis on lowincome groups and those who are unsure of their choice of careers. This does not sound like a career that would attract intelligent, caring, and hardworking students, yet that is what the medical profession wants and all patients deserve. If the AMA’s plan to train RCTs is implemented in July, there could be an increase in liability suits and an increase in physician and hospital liability insurance rates due to the lack of quality care. If the AMA truly wants to increase support services for nurses, it should realize that its proposal is not a panacea. It is degrading to the nursing profession, and if passed, may actually increase the shortage of nurses. More importantly, it may cause fragmented, unsafe patient care. SUEZICKEFOOSE, RN OTORHINOLARYNGOLOGY O R STAFF NURSE CLEVELAND CLINIC FOUNDATION
Congress Thoughts
A
t Congress I listened to four outstanding nursing leaders stumble over the question “why don’t nurses have power?” One nursing leader responded that she believed nurses have the power, but she does not know why nurses do not use it. Do O R nurses have power? Yes, nurses have a great deal of power. Nurses have to be strong to work in the O R and survive. Do nurses have power at an AORN Congress? Of course we do. Why? Because we are unified, and we come together as more than 8,000 nurses who represent a force to be reckoned with. Then what happens? We split up, go back to our respective hospitals, units, and chapters, and spread the word to a few interested nurses. Enthusiasm fades, and we settle into our routines until it is time to plan for another Congres and again talk about the major problems facing nursing. Nursing does have power, but power can only be effective if it is harnessed. We must band together through our organization and recruit
d1195
M A Y 1989, VOL. 49, NO 5
Letters to the Editor
Data on Gloves Dkputed
I
n the article “Operating room practices: Myth or science?”, which appeared in the February issue of the Journal, Joseph A. Moylan, MD, FACS, is quoted, I believe, incorrectly. His sagacious insight into infection control practices is commendable,but I believe commentsattributed to him are misleading and may lead the readers to make false assumptions. He is quoted as stating, “European countries lead the United States in the use of antisepticimpregnated gloves,” and that these gloves “do not break down as easy as latex gloves, and they do not reintroduce bacteria colonization once punctured.” If the gloves are not latex, what are they made of? Data described in the article indicates that latex gloves have a higher rate of permeability to blood than to water. If an intact latex glove is a barrier to viral pathogens (human immunodeficiency virus [HIV] 120 nanometers and hepatitis B virus [HBV] 42 nanometers), it follows that gloves also must be a barrier to blood. When evaluating barrier effectiveness, one must first define barrier resistance in realtionship to penetrant potential. This statement would appear to be contradictory. He also is attributed as saying that the HIV is unable to penetrate lutes. I believe the reporter meant to use the term latices. Polymer latices are stable dispersions of very small particles of water. They account for 60%or more of the total weight of latex and usually are less than 5 micrometers in diameter. They trap water molecules around polymer particles giving a glove its barrier 1194
attributes against interparticle coalescence. MARGARET F. FAY,RN, MA MEDICAL AFFAIRS/CLINICAL CONSULTANT MINNEAPOLIS Editor’s response. Thank you for clarifying the issue of permeability and the term latices. Upon further investigation it does appear that we summarized Dr Moylan’s presentation concerning gloves in a confusing manner. Dr Moylan did say that European countries lead the United States in the use of antiseptic-impregnated gloves. He said that the antiseptic-impregnatedgloves are not stronger than latex gloves, however, they minimize bacterial colonization once punctured. It appears that the data presented in this presentation came from a study of surgical gloves conducted by A G Dalgleish and M Malkovsky, which was published in the February 1988 issue of the British Journal ofsurgery (pages 171-172). The data indicate that there was no penetration of HIV through the intact gloves under study. It is important to note that seven high-quality gloves were studied, the conclusions of this study and the information provided in the Journal article are not to be applied to all latex gloves.
Clinical Trial Evaluates Eflectiveness of Zidovudine
I
read with interest the article “Occupational hazards in the OR,” which appeared in the January issue of the Journal, and I thought that Journal readers would be interested in a clinical trial being conducted by Burroughs Wellcome Co.
AORN JOURNAL
MAY 1989, VOL. 49, NO 5
On April 29, 1988, Burroughs began a doubleblind, placebo-controlled trial to evaluate the potential effectiveness of prophylactic zidovudine (Retrovirm), formerly AZT, to health care workers who have had recent significant occupational exposure to blood or blood components that were infected with human immunodeficiency virus (HIV). Exposure may have resulted from penetrating wounds from contaminated needles or other sharp objects or splashes onto abraded skin or mucous membranes. Health care workers who experience such exposure should contact the toll-free number, (800) HIV-STIK ([SO01 448-7845), as soon as possible after exposure. The company will consult the physician of the exposed worker regarding his or her participation in the study, and the physician will be sent medication (either Retrovirs or a placebo), study protocol and materials, and other pertinent information. The study has received full approval from the Institutional Review Board of the National Institute of Allergy and Infectious Disease (NIAID), Bethesda, Md. The study will be reviewed on a regular basis by NIAID to assess its progress, and NIAID will make recommendations regarding its continuation. SANDRA NUSINOFFLEHRMAN, MD HEAD,DEPARTMENT OF ANTIMICROBIAL THERAPY BURROUGHS WELLCOME Co. RESEARCHTRIANGLE PARK,NC
RCT Issue Continues to Provoke Comment
A
fter reading numerous articles on the American Medical Association’s (AMA) registered care technologist (RCT) proposal, there are a few points that I found most disturbing. The AMA says that the RCT will assist with bedside care and report to the head of the unit who is an RN, yet he or she would be accountable to the physician and would be certified by the state medical board. If something happens, who is liable? Is it the nurse to whom the RCT reports or is it the physican who was out of the hospital when the incident occurred and who was to
supervise the RCT? A basic RCT would be able to administer routine nonintravenous medications with supervision. Does the AMA seriously expect RNs to agree to supervise RCTs? The RCT program would be geared toward high school students with an emphasis on lowincome groups and those who are unsure of their choice of careers. This does not sound like a career that would attract intelligent, caring, and hardworking students, yet that is what the medical profession wants and all patients deserve. If the AMA’s plan to train RCTs is implemented in July, there could be an increase in liability suits and an increase in physician and hospital liability insurance rates due to the lack of quality care. If the AMA truly wants to increase support services for nurses, it should realize that its proposal is not a panacea. It is degrading to the nursing profession, and if passed, may actually increase the shortage of nurses. More importantly, it may cause fragmented, unsafe patient care. SUEZICKEFOOSE, RN OTORHINOLARYNGOLOGY O R STAFF NURSE CLEVELAND CLINIC FOUNDATION
Congress Thoughts
A
t Congress I listened to four outstanding nursing leaders stumble over the question “why don’t nurses have power?” One nursing leader responded that she believed nurses have the power, but she does not know why nurses do not use it. Do O R nurses have power? Yes, nurses have a great deal of power. Nurses have to be strong to work in the O R and survive. Do nurses have power at an AORN Congress? Of course we do. Why? Because we are unified, and we come together as more than 8,000 nurses who represent a force to be reckoned with. Then what happens? We split up, go back to our respective hospitals, units, and chapters, and spread the word to a few interested nurses. Enthusiasm fades, and we settle into our routines until it is time to plan for another Congres and again talk about the major problems facing nursing. Nursing does have power, but power can only be effective if it is harnessed. We must band together through our organization and recruit
d1195