Re: Patient diagnosed HIV positive postoperatively

[Guest guest]

Dear All

/message/7264

This is in response to Dr. Sadhu Charan Panda'a mail on the subject.

It is unfortunate that the patient developed certain symptoms post operation

that led to a HIV test (trust consent, counseling protocols were followed!!!).

Do we understand that " sterilization " processes do not happen before / after

operation in respect to theater and instruments? Fail to understand the concern

here unless it is to push panic buttons some place.

Surgeons are well aware of risks of HIV infections in patients on whom invasive

procedures are planned.

Hence " Universal Precautions " which goes beyond HIV. If suspicion and fears

continue thay surely are not reasons to carry out HIV tests. There is no end to

this road.

There is also the problem of blood banks having a small percent of blood of

people in the window period. The paradox of needing " fresh " blood for use during

surgery vis a vis waiting for six weeks for antibody tests to come up with HIV

needs tackling. Can we afford a more expensive PCR test in blood banks?!! These

are questions that possibly arise in such cases.

It is sad two people died " soon after " transfusion, but if the patient was in

such advanced stage that could induce death immediately to two people then a

normal Tri-dot should have come up with the correct diagnosis.

I feel there are many gaps needing to be filled in this particular instance that

otherwise would only lead to lengthy speculations.

sincerely

Sreeram

Sreeram Varadadesikan

e-mail: <setlurs01@...>

[Guest guest]

Dear FORUM,

Re: /message/7264

Dr Sadhu Charan Panda's mail raises serious concerns.

This means that the standard protocol of blood transfusion was/is not being

followed in Orissa? No blood can be transfused without being tested for HIV

(amongst other infections).

The media also seems uniformed about this, else they should have investigated

further and pinned responsibility for unsafe blood transfusion practice. It also

seems starnge that a person who is to undergo operation himself has donated

blood for other patients.

And about the patient testing positive post operatively- if universal

precautions were taken and the OT etc appropriately sterilized after the said

operation, the chances are quite slim. But if this is the same hospital where

unsafe blood was transfused one cannot be sure whether this was done.

What is the issue? That the patient's HIV status was not known or that the

standard operating practices are being compromised upon?

Regards

Vandana Nair

Jaipur

e-mail: <nair_vandana@...>

[Guest guest]

Dear FORUM and Dr. Sadhu Charan Panda,

The accepted policy now is to consider all patients coming to your health-care

facility alike & potentially infectious and hence to practice standard

precautions, which will protect not only the health care professionals but also

each and every client/patient from HIV and many other infections. So there is no

need for testing the patient for this purpose.

This is the only practical approach to the problem. Even with mandatory testing

for all patients (which is ethically and legally incorrect), you cannot be

100% fool proof if you are not practicing these precautions. And there are

guidelines for post-exposure prophylaxis if something goes wrong beyond our

control.

For the second part of your mail:-

Blood transfusion received from an HIV infected person cannot cause immediate

death due to that reason. Either there happened a transfusion re-action or there

will be some co-existing fatal infection. And again if the lab is following the

guidelines - it is less likely that this person's blood is transfused to those

patients in need (with the exception of window period). They would have

discarded it without informing them. Mandatory testing is done at labs for the

purpose of screening; but the result is not made known to anyone as it is

unlinked anonymous testing.

Hope this helps,

With regards,

Dr.Nabeel.

Dr.Nabeel.M.K.

Alliance for Social Health Action (ASHA)

Academy of Medical Sciences,

Kannur Kerala

e-mail: <drnabeelmk@...>

[Guest guest]

Dear FORUM,

Re: /message/7264

Though these type of incidents are common, it is very painful to see or read

such tragedies freequently.

You are asking the group about preventing such incidents. But, do you think we

have enough resources, creativity and political will to communicate with proper

information ? Specially from organizations like NACO Or State HIV AIDS

preventive societies? These organizations are spreading " Only " wrong

information's like HIV Virus.

Yesterday, in Bangalore I saw a 3 mts film on Role of women in local governance,

produced by K'taka State HIV .. Prevention Society. The leading female artist

talks about HIV. Right to Live and women's Right to question about the issue in

family. But, through out the film she uses the word AIDS instead of HIV. And,

this film targeting rural audiences, role PR in controlling and creating

awareness about HIV. Just imagine about its impact on viewers.

Dr Sadhu Charan or other members in the group need to discuss about intangible

activities like creating awareness and educating the masses through social

communication.

Preventive activities are also equally important like curative activities.

Unfortunately preventive work is not statistic oriented to high light with

funders or on platforms while presenting a lecture but it plays a vital role in

the community.

This is not the first time we are coming across such type of films. I have

seen posters, banners, booklets with full of content and presentation errors.

Preventive activities are also as important as other policy matters.

Shamantha

Sarathi - A Resource Center for Communications

Bangalore

e-mail: <shamantha@...>

[Guest guest]

Dear FORUM,

Re: /message/7264

Bood transfussion system has improved a lot in recent years and lot

of training and C.M.E.programe are being carried out.

In gujarat state regional trainig programe and updates are being

done.i agree that 100%safe blood is a myth!

I am in this field since 24years and even licence were not issued and

no protocol was heard at present everybody knows SOP/TQM/GMP/etc.

We still needs to educate medical feternity to learn rational use of

blood and universal precaution and stigamtisation for HIV

Dr.Niloo Vaishnav

e-mail: <bhavnagarbloodbank@...>