Employee Privacy vs. Patient Safety

Consulting Firm #8 Teresa Long Francisco Lopez Fall 2012

Employee Privacy vs. Patient Safety

2

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

AIDS in the American Workplace

3

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

The Scenario

4

Source: CDC

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

The Facts

5

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

How may HIV be Transmitted in a Healthcare Setting?

6

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

Mechanisms of Transmission

7

Transmission can be minimized via: Practicing standard infection control precautions Written protocols for reporting, evaluation, counseling,

treatment, and follow-up of all occupational exposures

Preventing Exposures

8

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

Standard Precautions

9

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

Needlestick Injuries

10

Double gloving when performing exposure prone invasive procedures

Preventing Needlestick Injuries

Use of safety devices

11

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

The Risk

12

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

Post-exposure Prophylaxis

13

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

Ethical Considerations

14

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

American Medical Association H-20.912 Guidance for HIV-Infected Physicians and other Health Care Workers

15

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

American Medical Association H-20.912 Guidance for HIV-Infected Physicians and other Health Care Workers

16

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

American Medical Association H-20.912 Guidance for HIV-Infected Physicians and other Health Care Workers

17

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

American Medical Association H-20.912 Guidance for HIV-Infected Physicians and other Health Care Workers

18

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

HIPPA Laws

19

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

OSHA’s Bloodborne Pathogen Standard 1910.1030

20

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

Health Care Workersand the Americans with Disabilities Act

21Source: The Center for HIV Law & Policy

22

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

HIV Infected Health Care Workers:Management and Patient Notification

23

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

The Recommendations

24

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

The Recommendations

25

"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

Works Cited