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Enteric precautions for hepatitis patients
American Journal of
58 Letters to the Editor
INFECTION CONTROL
I am interested in what actions are recommended to avoid punctures that occur due to patient movement during the process of inserting the needle. Roberta Parker, R.N., B.S.N. Infection Control Coordinator Orlando Regional Medical Center Orlando. Fla.
Reply: The disposal system for needles in our medical center consists of needle cutters attached to plastic or corrugated paper disposable boxes. Very few of the innocent victim needle sticks were related to needles protruding from these boxes; most were related to needles left in the patients' beds, bedside areas, or regular trash containers. The majority of carlessness related to needle sticks occurred while recapping needles after administration of medications. after drawing blood, or after discontinuing heparin-lock and scalp vein needles. Therefore, we do not recommend recapping used needles and agree with the CDC recommendation. During our in-service education programs, we stress two major points. First, needlestick and puncture wounds are a problem and each individual should be alert to those situations where these incidents occur. Second, proper disposal consists of not recapping needles, cutting the needle in a needle cutter box, and discarding the needle hub, etc., in the box. If the needle has been capped, we suggest disposal in the needle box without uncapping or cutting since several of our incidents were associated with the process of uncapping used needles to cut them.
deposed, if there are lawsuits involving the following of these recommendations? For example, suppose a hospital dutifully follows the CDC recommendations and abolishes enteric precautions for hepatitis patients. If, then, a patient acquires hepatitis as a nosocomial infection from a patient with hepatitis and the patient alleges that this infection was transmitted because the patient with hepatitis was not in enteric isolation, will Drs. Favero et al. or anyone from CDC testify in behalf of the hospital that it is good medical practice to abolish enteric isolation for these patients? Will any of them testify that the standard of care the hospital owes its patients does not include putting hepatitis patients in enteric isolation? On the other hand, will Dr. Mayhall testify for the plaintiff that the hospital should have put hepatitis patients-at least those with hepatitis A and non-A/non-B hepatitis-in enteric isolation to protect the other hospital patients? In the opposite case, if a hepatitis patient and his family sue the hospital for being placed in enteric isolation needlessly (admittedly somewhat farfetched), would Dr. Mayhall testify for the hospital that this was necessary in spite of current CDC recommendations? Would the CDC testify for the patient that this isolation was unnecessary? If, as I suspect, neither side would be willing to testify either for the patient or the hospital, what effect then does this have on either of their recommendations? Doesn't this leave the hospital out on a limb with respect to its isolation policy? Perhaps this puts into perspective what weight to give various recommendations, articles, and editorials. Harry C. Nottebart, Jr., J.D., M.D. Richmond. Va.
Anita Anderson, R.N. Infection Control Nurse
Glenn R. Hodges, M.D. Chief. Section of Infectious Disease and Associate Professor of Medicine
James S. Reed, M.D.
Chief. Liver Disease Unit and Assistant Professor of Medicine Veterans Administration Medical Center Kansas City, Mo.
Reference. I. Favero MS, Maynard JE, Leger RT, Graham DR, Dixon
RE: Guidelines for the care of patients hospitalized with viral hepatitis. Ann Intern Med 91 :872-876, 1979 2. Mayhall CG: Isolation techniques for hospital patients with viral hepatitis: New guidelines premature. Infect Control 1:71-74, 1980
Enteric precaution. for hepatitis patient.
Reply:
To the Editor: In the past year, ICPs have been faced with conflicting opinions on enteric isolation for hepatitis patients. Favero et al.I from the Centers for Disease Control take one view and MayhalJ2 takes a different one in certain aspects. Whether one follows the CDC recommendations or Dr. Mayhall's, I have a different concern: will Drs. Favero et al. or Dr. Mayhall testify, or at least be
Dr. Nottebart's letter concerning conflicting opinions on guidelines for caring for patients hospitalized with hepatitis raises some interesting questions, but it also contains assumptions on his part that are not true. First, CDC's current guidelines for the care of patients hospitalized with viral hepatitis were published in the Annals of Internal Medicine, I in CDCs Hepatitis Surveillance Report,2 and expanded on sub-
58 Letters to the Editor
INFECTION CONTROL
I am interested in what actions are recommended to avoid punctures that occur due to patient movement during the process of inserting the needle. Roberta Parker, R.N., B.S.N. Infection Control Coordinator Orlando Regional Medical Center Orlando. Fla.
Reply: The disposal system for needles in our medical center consists of needle cutters attached to plastic or corrugated paper disposable boxes. Very few of the innocent victim needle sticks were related to needles protruding from these boxes; most were related to needles left in the patients' beds, bedside areas, or regular trash containers. The majority of carlessness related to needle sticks occurred while recapping needles after administration of medications. after drawing blood, or after discontinuing heparin-lock and scalp vein needles. Therefore, we do not recommend recapping used needles and agree with the CDC recommendation. During our in-service education programs, we stress two major points. First, needlestick and puncture wounds are a problem and each individual should be alert to those situations where these incidents occur. Second, proper disposal consists of not recapping needles, cutting the needle in a needle cutter box, and discarding the needle hub, etc., in the box. If the needle has been capped, we suggest disposal in the needle box without uncapping or cutting since several of our incidents were associated with the process of uncapping used needles to cut them.
deposed, if there are lawsuits involving the following of these recommendations? For example, suppose a hospital dutifully follows the CDC recommendations and abolishes enteric precautions for hepatitis patients. If, then, a patient acquires hepatitis as a nosocomial infection from a patient with hepatitis and the patient alleges that this infection was transmitted because the patient with hepatitis was not in enteric isolation, will Drs. Favero et al. or anyone from CDC testify in behalf of the hospital that it is good medical practice to abolish enteric isolation for these patients? Will any of them testify that the standard of care the hospital owes its patients does not include putting hepatitis patients in enteric isolation? On the other hand, will Dr. Mayhall testify for the plaintiff that the hospital should have put hepatitis patients-at least those with hepatitis A and non-A/non-B hepatitis-in enteric isolation to protect the other hospital patients? In the opposite case, if a hepatitis patient and his family sue the hospital for being placed in enteric isolation needlessly (admittedly somewhat farfetched), would Dr. Mayhall testify for the hospital that this was necessary in spite of current CDC recommendations? Would the CDC testify for the patient that this isolation was unnecessary? If, as I suspect, neither side would be willing to testify either for the patient or the hospital, what effect then does this have on either of their recommendations? Doesn't this leave the hospital out on a limb with respect to its isolation policy? Perhaps this puts into perspective what weight to give various recommendations, articles, and editorials. Harry C. Nottebart, Jr., J.D., M.D. Richmond. Va.
Anita Anderson, R.N. Infection Control Nurse
Glenn R. Hodges, M.D. Chief. Section of Infectious Disease and Associate Professor of Medicine
James S. Reed, M.D.
Chief. Liver Disease Unit and Assistant Professor of Medicine Veterans Administration Medical Center Kansas City, Mo.
Reference. I. Favero MS, Maynard JE, Leger RT, Graham DR, Dixon
RE: Guidelines for the care of patients hospitalized with viral hepatitis. Ann Intern Med 91 :872-876, 1979 2. Mayhall CG: Isolation techniques for hospital patients with viral hepatitis: New guidelines premature. Infect Control 1:71-74, 1980
Enteric precaution. for hepatitis patient.
Reply:
To the Editor: In the past year, ICPs have been faced with conflicting opinions on enteric isolation for hepatitis patients. Favero et al.I from the Centers for Disease Control take one view and MayhalJ2 takes a different one in certain aspects. Whether one follows the CDC recommendations or Dr. Mayhall's, I have a different concern: will Drs. Favero et al. or Dr. Mayhall testify, or at least be
Dr. Nottebart's letter concerning conflicting opinions on guidelines for caring for patients hospitalized with hepatitis raises some interesting questions, but it also contains assumptions on his part that are not true. First, CDC's current guidelines for the care of patients hospitalized with viral hepatitis were published in the Annals of Internal Medicine, I in CDCs Hepatitis Surveillance Report,2 and expanded on sub-