Some take-home points: Train HCWs, buy devices
The recent $12.2 million verdict in favor of a physician in training who acquired HIV occupationally underscores liability issues for medical schools. A warning that such verdicts may be coming appeared in an article by Janine Jagger, PhD, director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville, and colleagues.1 Key points and recommended interventions by the authors are summarized as follows:
• The nation’s 50,000 medical students face the daily threat of exposure to a bloodborne pathogen in their clinical training, yet may find themselves underinsured and with few medical options if they acquire an occupational infection. Because of their ambiguous occupational status, infected medical students may fall through the normal safety net of workers’ compensation and private insurance, leaving them at risk of financial destitution in the face of a debilitating illness. From an institutional standpoint, medical schools and teaching hospitals are potentially at risk for civil suits by infected students who have no other recourse for compensation.
• Altering the design of conventional devices to include safety features is the most promising method of protecting health care workers. The risk of percutaneous injury can be reduced by providing safety-needle devices, particularly for drawing blood and for intravenous access, procedures that are disproportionately associated with the transmission of bloodborne pathogens. Such devices are now available. Providing safety devices reduces the risk of infection for students and health care workers, and also reduces the potential liability of the training institution.
• Training students to draw blood and perform intravenous-access procedures has too often been limited to the model of "see one, do one, teach one," which by itself should no longer be considered adequate in the case of procedures that place students at risk for occupational infection. In addition to learning by this method, students should be required to demonstrate proficiency by using mannequins or other devices, or by serving as volunteers under supervision, before they perform procedures on patients. Also, students should not draw blood or perform intravenous-access procedures in patients known to be positive for bloodborne patho gens unless they are experienced and proficient. Criteria for medical students’ competence to perform such procedures need to be established. Such criteria will not eliminate the risk of exposure to bloodborne pathogens, but they will reduce it.
Reference
1. Tereskerz PM, Pearson RD, Jagger J. Occupational exposure to blood among medical students. N Engl J Med 1996; 335:1,150-1,152.
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