NURSING PRACTICE IN RELATION TO BLOOD BORNE VIRAL INFECTIONS

Introduction
The nature of the modes of transmission of blood borne viruses, such as the human immuno-deficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and Hepatitis B and C, create particular health issues and problems for the community in controlling and containing the spread of infection. The traditional defence against infections, protective vaccines, is not yet available against HIV/AIDS and Hepatitis C infections. HIV/AIDS, because of the variable and often protracted delay before disease manifestation, the the high mortality rate and the nature of its transmission has raised social and moral issues leading to major ethical and political debate in the community. Discriminatory behaviour and attitudes have manifested in the wider community and in the population of health professionals against those infected with these diseases, and people suspected of being infected. Implications for nursing practice arise from both the health debate and the debate in the community in regard to the management and control of these infections and the rights of infected people and others.

 

Royal College of Nursing, Australia believes that:
Individuals infected with from blood borne viral infections have the right to the same entitlements to appropriate care and facilities as any other client.

Nurses have a tradition of providing nursing care without prejudice to any individual or group; nursing care is not compromised by the nature of the individual's diagnosis nor do nurses discriminate in their practice on these grounds.

Nurses seek to create and preserve a safe practice environment and to observe and practise care standards designed to protect or prevent the transmission of infection to clients, health workers or members of the community.

In all aspects of delivering nursing care, nurses support and observe the principles of informed consent, confidentiality and voluntarism; these are upheld in relation to disclosure of information about communicable diseases such as HIV/AIDS, Hepatitis B and C and in testing for these infections.

Clients or health professionals including nurses, who know that they are infected with or at risk of being infected with a blood borne virus, should be encouraged to voluntarily disclose their HIVor Hepatitis B or C status, where there is risk of transmitting infection to others or where the presence of infection is likely to impact on treatment or therapeutic options.

Nurses infected with these viruses, or at risk of being infected, should be provided with confidential, expert information and counselling and be supported in changing their area of nursing practice, if this is necessary, to reduce the risk of infecting others.

Rationale
Nurses in Australia subscribe to a Code of Ethics(1) which expresses the value of respect for persons and the commitment of Australian nurses to providing quality nursing care to all people. The code informs professional nursing practice in providing non discriminatory nursing care to clients, holding health information in confidence and adhering to the principle of informed consent in health matters.

Protecting clients, other workers and themselves from infection is a professional responsibility for nurses. Adherence to recommended, authoritative infection control policies and guidelines, such as the National Health and Medical Research Council's Standard Precautions and Additional Precautions,(2) is essential and responsible professional practice. Adherence has proven effective in minimising cross infection and in eliminating the need for universal screening. Universal screening for blood borne viral infections is not effective in controlling infections for the following reasons: the sensitivity and specificity of available diagnostic tests for blood borne viruses are variable; for each viral infection there exists "a window period" where diagnostic testing is unable to detect the presence of viruses in infected persons; the development of diagnostic tests follows some time after the emergence of new virus strains, therefore, screening will not eliminate persons infected with viruses for which there is no commonly available diagnostic test; the cost of initial and repeated screening for blood borne viruses is prohibitive. Nurses, therefore, recognise that the guidelines, applied conscientiously and universally, are the best defence against infection.

Responsible behaviour requires that health professionals, including nurses, be aware of their own status in regard to these infections. In the event of nurses being infected, appropriate professional behaviour is to act to ensure that they do not pose a risk to clients in their professional practice. "Health care workers involved in exposure prone procedures (blind cavity) be aware of their status and seek serological testing for HIV, Hepatitis B and C every 12 months, or sooner if a significant exposure to blood or body substances occurs in the interim."(3)

Royal College of Nursing, Australia recommends that:
Employers be encouraged to:

• Provide nurses with access to currently licensed and recommended vaccines.
• Ensure that adherence to Standard Precautions and Additional Precautions is maintained in the work place.
• Ensure that provisions to apply Standard Precautions and Additional Precautions with body and blood substances in health care institutions are adequately resourced in all areas and at all times.
• Have effective protocols in place to deal with incidences of accidental exposure to blood or body substances.

Ensure that accidentally exposed nurses have access to immediate counselling, support, expert advice and recommended treatments.

Royal College of Nursing, Australia resolves to:

• Act to inform its members of any changes in preventative practices and support services and advise on developments in the control of the infections.
• Advise its members, health ministers, nurse registering authorities, other professional groups and consumer groups of the position of the College on blood borne viral infections.
• Advise its affiliated organisations of the College's position and invite them to formally endorse the statement or to produce their own statements.
• Advise the Australian Council of Health Care Standards to include provision for the above recommendations in its accreditation standards for institutions, hospitals and clinics.

References
1 Australian Nursing Council Inc 1993 Code of Ethics for Nurses in Australia.
2  National Health and Medical Research Council Standard Precautions and Additional Precautions Endorsed April 1996 by the National Health and Medical Research Council and the Australian National Council on AIDS Infection Control in the Health Care Setting Guidelines for the Prevention of Transmission of Infectious Diseases.
3 ACT Department of Health and Aged Care 1999 Management of Human Immunodeficiency Virus, Hepatitis B Virus and Hepatitis C Virus Infected Health Care Workers.

Revised with the assistance of Dianne Dreimanis MRCNA

Authorised by Board of Royal College of Nursing, Australia
Date of Issue: August 1996
Revised: April 1999
To be reviewed: April 2003