Surgical care of the HIV-infected patient: a moral imperative

Nurses' professional care obligation and their attitudes towards SARS infection control measures in Taiwan during and after the 2003 epidemic

This study investigated the relationship between hospital nurses' professional care obligation, their attitudes towards SARS infection control measures, whether they had ever cared for SARS patients, their current health status, selected demographic characteristics, and the time frame of the data collection (from May 6 to May 12 2003 during the SARS epidemic, and from June 17 to June 24 2003 after the SARS epidemic). The study defines 172 nurses' willingness to provide care for SARS patients as a professional obligation regardless of the nature of the disease. A conceptual model was developed and tested using ordinal logistic regression modelling. The findings showed that nurses' levels of agreement with general SARS infection control measures and the lack of necessity for quarantining health care workers who provided care for SARS patients were statistically significant predicators of the nurses' fulfilling of their professional care obligation. Suggestions and study limitations are discussed.

Are universal precautions realistic?

In concluding whether universal precautions are necessary, it certainly appears that we need something to reduce the significant problem of HIV transmission to health-care providers. As occupational risk goes, it exceeds the occupational risk of a number of other high-risk professions. Unfortunately, we do not know if universal precautions are effective. We also do not know the true compliance rate in use of universal precautions, nor whether they have an impact on transmission even if effectively used. What are the alternatives? They are not great, but some have not been adequately explored or implemented. Re-engineering around needle use in the hospital is clearly the most likely area to produce concrete results, because needlesticks are overwhelmingly the greatest source of infection, but this has not been encouraged to the degree it could be, even with systems already developed. Universal testing does not appear to be a viable alternative, for numerous reasons already discussed. Finally, are universal precautions more important for other pathogens than HIV? I would say yes. Hepatitis B, hepatitis C, and nosocomial infections are more important both as public health issues and as health-care provider prevention issues. If universal precautions are effective in reducing any of these, they are worthwhile.

Impaired physicians: what should patients know?

What should patients know about the degree to which their physicians may be impaired—unable, in the words of the American Medical Association (A.M.A.), “to practice medicine with reasonable skill and safety to patients by reason of physical or mental illness, including alcoholism and drug dependence”? What patients do in fact find out about such matters as alcohol or other drug abuse by, say, the surgeon or the anesthesiologist in charge of their care is another matter altogether; most patients learn about such impairment the hard way. But what should they know beforehand, if at all possible?