Risk of HIV infection through touch?

[Spectre]

(I know that someone may not see the logic in posting this in a CQC forum. The sad fact is, that winning a fight and contracting a lingering, eventually fatal disease is not victory at all in my eyes. With this in mind, I believe this to be germane.)

I have recently begun working security part-time in some Midtown (Atlanta) clubs. The clients are all clubs that are largely or almost entirely gay. I am not "homophobic"- I believe in everyone's right to free choice, provided those choices do not infringe on other's rights- but I am concerned about some potential health risks. I have lived a life that many would describe philosophically as "clean" or "moral". Scientifically, I could be described as extremely low-risk for any type of STD. With the emergence of HIV as a widespread, unstoppable killer, I have been concerned for years at the possibility of contracting a killer STD through nonsexual conduct.

My question is this: am I at risk for catching AIDS through checking id's or touching someone's arm? With the volume that goes through these clubs, I know that I must have come into contact with quite a few HIV carriers in the past few nights, but wonder if the risk is so low as to be statistically insignificant. (And, who really trusts a government study, anyway?)

Any information or resources given will be appreciated.

[Mort]

Spectre,
HIV can only be transmitted if certain bodily fluids are permitted to enter the bloodstream. These fluids are blood, semen, and possibly saliva. Consequently, in the two scenarios you presented, no risk is apparent, unless you were to somehow come in contact with open sores on an HIV carrier while checking ID or touching arms. This seems unlikely. If you are in a physical altercation with an individual, however, caution is warranted. I am unqualified to comment on preventative measures to be taken in such cases, as I am not in the security business.

I hope this helps,
Mort

[This message has been edited by Mort (edited 01-04-99).]

[Mike Mello]

Hey Spec,

You might want to consider wearing clear style glasses and carrying surgical gloves with you when you work. Most of us do now working with the public, with valid concerns over contact with blood, saliva etc...

[HS]

Spectre, on the lines of Mikes answer if you have a cut/ open wound or the like on your figer/hand/arm - anything that makes contact be <a>VERY careful !
May be a chance in a Million of contacting Aids/ Hep B or C but why risk it ?...Stay safe

[This message has been edited by HS (edited 01-04-99).]

[Jeff White]

Spectre,
Wear the glasses, carry the gloves. You might get some of the lined gloves made by Hatch. They look like a regular leather glove but will protect you in an altercation. Might be more PC with your employer too. Remember the uproar when the Secret Service wore surgical gloves when they greeted the Gay Rights activists at the White House a few years ago?

Also get the hepatitis B shots. It's expensive but worth it. First responders (ambulance, police, fire personnel) are required to have them. A series of three shots given over a period of 3 months IRRC.
Jeff

[olazul]

Spectre-
"am I at risk for catching AIDS through checking ID's or touching someones arm?"- no. I suppose one could come up with a theoretical scenario where you "could", but the odds are exceedingly small.
Think about this-
if you get stuck with an HIV infected hollow needle through a glove the odds of catching HIV are 1/250. The odds from a fluid splash to mucus membraes is much much smaller than this. There have been no cases of trasmission from closed mouth kissing and only one case from open mouth or "french" kissing(an addicts gums are very unappealing).
There have only been 5 documented cases of transmission from a blood(or other fluid) splash to the mucus membranes(eyes and nose) or skin.
In the realm of infectious disease it is a very wimpy virus. You will not get HIV from casual contact.

Of course with this said there is the single unexplainable case of the dentist spreading the virus to patients.

Some reasonable precautions to take would be to wear(or have) some thin leather gloves. I take it you are a "bouncer" and would think your highest risk(albeit small) would be from punching someone in the mouth and recieving a laceration from a tooth. That is to say as long as you are not dating the customers- JUST KIDDING! Sorry, couldn't resist. Not that there's anything wrong with that(seinfeld). If you wear glasses then ok, but as you are not around splurting body fluids this may be diminishing returns-you decide. You might want to carry a pair and wear them if things get dicey(people spit). Also- do not wear latex gloves as these will tear on teeth, chins, etc very easily.

By the by, HIV is present(diminishing amounts I believe) in blood, semen, vaginal fluid, breast milk, saliva and tears. It is not found in sweat or feces. Also there have been no documented cases of transmission by insects.

Jeff- very good point about the Hep B vaccination. You are more likely to die from an exposure to Hep B than HIV. Really. It is much more transmissable than HIV and 2-3% of people die from contracting this disease. The vaccination schedule is 3 shots over 6mos. however and make sure you get a test that shows seroconversion(whether the shots took). Up to 10% of people are not "immune" after the series and have to repeat it at least once more.
But don't take my word for it. Look up www.cdc.gov, it's a good place to start for infectious type enlightenment.

but for the grace of God go I,

Olazul

[Rob Pincus]

Spectre,

When I first moved to Nashville I did some work with one of the security companies taht is very big in town here. They have very few "good" jobs and are mostly a joke, but in order to get the good jobs and to get in good with the owners, I worked the unwanted gay-club position a few times. I carried rubber gloves, and put them on before breaking up the one fight that took place while I was there. I didn't wear glasses, but I know that the one guard that worked that spot regularly did.
You should consider having a one-way CPR mask handy too. Gall's sells little pouch kits with disposable masks and rubber gloves. along with a few alcohol wipes.

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-Essayons

[Dennis]

Spectre,
Latex gloves may provide adequate protection in most cases. However, according to tests done by Texas Dept of Health, latex gloves are somewhat porous and HIV is an exceptionally small virus permitting (in one test case) the virus to seep through the pores of the glove. Also, a small hole in a latex glove might not be noticed (until the glove fills with a stranger's blood?).

Our local EMS folks wear "high risk" or "Nitrile" gloves at scenes with body fluid contamination. Second method, less favored by EMS, is to "double-glove" (wear two latex gloves on each hand). Least favored, simple latex gloves.

Remarkably, in the local Emergency Department (McKenna Memorial Hospital, New Braunfels, TX), they only wear latex gloves (one pair) regardless of the mess!

If "authorities" and "professionals" disagree, I don't know what the facts/risks are; but, I wear only high-risk gloves - even when I must buy them.

Depending upon which "authority" you believe, HBV is 200 to 600 times as contagious as HIV. TB is another threat as are streptococcus, influenza, etc. etc....

When I was working as a Security Officer, I wore latex gloves inside thin leather gloves if there was ANY hint of possible use of force. (The black leather gloves added a little bit to "ethical presence".) It worked for me, but I am sure opinions, customs, and policies vary.

Whatever you decide, Spectre, hope for the best, prepare for the worst, and stay safe. Good luck.

[Spectre]

Gosh, I love you guys! :) This type of feedback is exactly why I love TFL. I especially like olazul's very informative posts, but they're all great, and very much appreciated.

I did believe my risks from checking id's or re-entry stamps to be slight. The reason my boss loves working these places is because there appears to be virtually no violence compared to straight clubs, (example: I worked two bars Saturday night for 14 hours. I probably saw upwards of 1000 people. No fights.) though I will have to consider carefully if such a situation develops. (Spartacus advised "breaking up" violently quarelling lovers suchly: "You guys stop. Stop it, I said! You better stop." :)

Another thing that concerns me is the risk of catching something while hauling out partyers who have gone down on "G", which is evidently one of the drugs of choice in these bars. These folks tend to spew sometimes, so I could get some gastric slime on me...yuck.

[Bushwhacker]

If you wear the gloves for a long time your hands will have a tendecy to sweat, I've used baby powder to help.

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Justice For One, Justice For All.

[JJB]

Spectre,
You've gotten a lot of good, and accurate information from the TFL crowd here. I want to reinforce the statements that Hep B and Hep C are more contagious than HIV, and can be fatal.
We teach our hospital attendants that anytime they come into contact with any body fluid, use what are generally known as universal precautions. That is use barrier techniques for management, cleanup and cpr.
Another issue that comes up sometimes, probably more since more people are using latex gloves, is that people can develop severe allergic reactions to latex. It wouldn't hurt to look for alternative material gloves -- I do not have a brand to suggest however. Maybe someone else can add info along that line.
Use a little common sense, manage the environment, think ahead and you should be alright.

Jim in IN



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-- TANSTAAFL

[Rob Pincus]

You could wear one of those rubber jump suits with the built in hood/mask deal, perhaps one of the patrons there can tell you were to get one.

Just make sure all the zippers are closed.

(and don't ask me to come meet you at work when I'm in town next month. ;))



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-Essayons

[Spectre]

Smart *ss. :) Don't worry Rob- all you'd have to do is take your shirt off, sweat, and wave your arms frantically!

Thanks to the info given, I got my first Hepatitis innoculation today. I again want to thank everyone who posted for helping to give me the information I need to keep me safe. Watch 6.

[Jeff Thomas]

Rob made an excellent point re: CPR. On a vacation a few years ago we stopped at the entrance to Yellowstone Park. Another car stopped as well, and the couple (older) were kind enough to take our family photo. Then the woman explained they had just come from CA where they had buried their son. He had been an EMT in LA during the 1992 riots, and had contracted AIDS while performing CPR on one of the rioters.

Look at the bright side. You'll probably pick up some great tips on wardrobe selection. ;)

[Spectre]

Jeff and Rob: not to be callous, but if anyone that is not a very close friend or family needs CPR, they'll have to wait for the EMT's. Health issues aside (and, these are my chief concerns, BTW), I would not want to face the legal problems (being sued) if someone died in spite of CPR administration. No-one (other than EMT's) is obligated to perform CPR.

[GLV]

No one is obligated to do CPR, unless it is a moral obligation. GLV

[Dennis]

Ummm, I'm neither a doctor nor an attorney, but I am a CPR Instructor/Trainer with the American Heart Association and the National Safety Council. IMHO, if the CPR is appropriate patient treatment, I believe you are obligated to perform CPR if you have already started or if it is part of your job description. This includes First Responders, lifeguards, Firefighters, most medical professionals, anybody working as a First Aid person, etc.

In EMS, I was obligated to do CPR when on-duty (and the patient needed it).

Good news: I had the ambulance equipment to improve my personal safety (e.g. bag-valve-mask (aka Ambu bag); lotsa gloves, eye protection, gowns, suction unit, etc.)

Bad news: The ambulance equipment would not yet be there if I was first on the scene (as a "First Responder"). So... I carried (and still carry several pairs of gloves, a CPR Microshield (1-rescuer CPR on patients over 6 y/o), and a pocket mask (for 2-rescuer CPR or patients less than 6 y/o).

The American Heart Association says (in writing) there is not one documented case of a rescuer contracting HIV/AIDS doing CPR mouth-to-mouth. (They don't say what documentation they would require and they don't mention Hepatitis, TB, etc...)

The Center for Disease Control says that the saliva of a full-blown AIDS patient has too little HIV to be contagious.

Me? I preach in every 1st Aid or CPR class:
1. The choice of going mouth-to-mouth with your patient is YOUR choice.
2. I will go mouth to mouth only with six people in the world - my wife, my kids, my mom, & my grandson. Any exception to that rule would be very, very rare. You don't know where the patient's mouth has been! (I mention Monica Lewinsky as an example.)
3. I act as though ALL body (bodily) fluids have every disease in the world. I tell my students:

"If it's wet, and it's NOT yours, don't play in it!".

When I teach LEOs, I tell them, "Never let anybody bite you. That's why God invented PR-24s - let the (expletive deleted) chew on that!"

BTW, you might hear that the dried blood from an HIV patient can no longer be contagious. That's a lie.

Although the HIV/AIDS virus "probably" dies when the blood dries, hepatitis, TB and other germs live much, MUCH longer. If you have to clean up blood, vomit, or ANY bodily fluid, I strongly recommend you exaggerate the threat and wear gloves, long sleeves, and especially eye protection. If bleach won't hurt what you're cleaning, one part bleach to nine parts water is a good cleaning solution (stronger is NOT better) and soak it for at least 15 minutes.

Items contaminated with bodily fluids should be disposed of safely. Use the red bloodborne pathogen bags when available. Otherwise, use a garbage bag and keep it sealed, isolated, and under your control until you can dispose of the contaminated items in a proper (legal) manner. LEOs, Fire Depts & EMS can help you - so can hospitals.

Take care of yourselves. This is no joke. This summer at San Antonio College (in my EMT recertification class), I was told 200 or so EMS people die each year from diseases contracted from their on-duty patients. Don't be paranoid about this - just be careful.

It's great to be a hero. It's not so great to bring home some horrible disease that also can infect your loved ones.

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Svoboda ne bezplatnoe



[This message has been edited by Dennis (edited 01-11-99).]

[olazul]

The decision to help an individual in need is a highly personal one-

Unless you are being paid for your lifesaving skills(at that moment), you are not legally obligated to perform CPR/help. Furthermore as long as you are trying to help you are a good samaritan and the likelihood of being successfully sued is miniscule. I think the fear of being sued do to bad outcome of CPR is not based on reality. In order to prove negligence you must do something wrong that then worsens a patients condition. If you are doing CPR the individual is already dead. It is hard to hurt someone without a pulse.

Since the disease has been documented by the CDC, there have been no documented and only 12 possible cases of trasmission of HIV to EMT/paramedics. To be "documented" the individual must have had a previous negative test as a baseline(maybe not explained in a CPR pamphlet but not hidden either). How many police officers get killed every year?

There is quite a bit of paranoia about HIV. As long as the patients mouth is not covered with large open sores or covered with blood the risk of Getting HIV by performing CPR is incredibly small(see previous post on open mouth kissing). I could not find any cases of transmission through CPR.

Dennis- This is not meant to be a flame but I find it distressing that you are "preaching" your biased views during a CPR class. You should be teaching facts and the facts do not support with holding CPR due to fear of catching a terrible bug.
The example of monica lewinsky is entertaining, but not really pertinent. The human mouth is one of the dirtiest organic holes in nature. The normal flora consists of all kinds of nasty bugs. The last date you guys went on, did you kiss? What are the chances she has engaged in oral sex with another individual in the past?, that she has a history of IV drug use?("I did it just that once!"), TB exposure?, chronic hepatitis B?, or herpes?(you did know people shed the virus without having sores didn't you?). The point? You always need to take REASONABLE precautions- socially and professionally. Reasonable being a key word.

By the way the CDC has not stated that you could not contract HIV from saliva, just that it is very, very unlikely.

Think about this. The individual who is lying there has about 5 minutes. Less time than it takes to get to a phone and the medics to arrive. You are their chance for survival. If CPR is not started by a bystander the chance for survival is negligible. Your chance for contracting a terrible disease from helping them is also so small as to be negligible(insert common sense here). Hey, it may be as easy as opening their airway.
Make a decision but let it be an informed decision, not one based on paranoia or fear. To save a life- it is a beautiful thing(IMHO).

Of course, it is your decision.

[Spectre]

Dennis and olazul, thanks for the posts. I appreciated them both.

In regards to my personal situation on the job: if I was in a position to decide whether or not to do CPR, the possible recipient will likely be a homosexual man with a history of at least some drug use. I love my fellow man (well, not in a Greek way :)), but I am not going to administer more than rudimentary aid to such high-risk individuals. I will help them off the floor. I will bring them a charcoal pill to combat the #$%^ they put in their system. I will carry them out. CPR? I don't think so. This may be callous in the eyes of some, and if that is the feeling you get of me, I am sorry.

...regardless of my personal choices, it is always good to have the information. Thanks.

[GLV]

Dennis, don't know if state law governs or not. I do know part of what you said is correct, if you start CPR, there are rules as to when you can cease. I am a 10 year EMT/AHA CPR instructor. If I am working, yes I am obligated to perform CPR. If I am not working, I am not obligated, but If I thought the person down had a chance, I would start CPR.
Dennis, I think this 200 number you were given, is phony. Neither I nor any I know have ever heard of that kind of number. GLV

[olazul]

Spectre-
I do not think you are callous. The situation you describe is higher risk than usual. At least you are making a well informed decision. BTW, a good "trick" is to ask if anyone knows CPR and direct the action. Many times people just need someone to take the lead.

I didn't mean to come off too strong. My appologies.

Olazul

[Spectre]

Not at all. There was no offense taken. It's often hard to express oneself over the internet without seeming either pedantic or rude. It's hard to see or hear me smile over the web. Wait, I never smile... :)

I was honestly just attempting to forestall any thoughts that I don't *care*. I do. I have no problem with helping someone who's taken too much drugs, and is dazed and needs to be kept awake until I can get some charcoal and sugar into his system. (Even if I think they're a @#$%ing idiot for doing this to their body.) I'll do what I can for them, help them outside, look for any friends they may have, call a cab, etc. I am an atheist, but try to live my life with honor and guided by the "golden rule", which is a universal principle. I am just not going to put myself into a lot of risk for someone who has chosen to take multiple actions with known destructive effects.

[Cheapo]

The shortest answer:

Touch nothing moist.

Perform only 2-person CPR. YOU do the chest compressions. The lover/date/closest admirer does the airway thing.

If all else fails, one of my own golden rules is that it is better to err on the side of _doing_ something than to err by inaction. Even if it turns out badly--you will have acted with honor.

Cheapo.

[Douglas in CT]

Gentlemen,
While we all agree to the answer to original question, my real for anyone in this environment is their exposure to people with tuberculosis!!
Given: The homosexual life style is fraught with irrespsonsible behaviour.
Reports from my medical contacts indicate that those so inclined rarely finish their prescibed drug programmes. Thus a drug resistant strain has appeared.
This is why I never take the subway or bus system in NYC - too much exposure.

Suggestion: Get out of there and find different clientel.

Thoughtfully yours,
Douglas in CT

[This message has been edited by Douglas in CT (edited 01-13-99).]

[Dennis]

Hi Guys. Sorry to take so long getting back to you. Especially glad to see so many weighing in on this one.

Olazul,
No flame perceived here! I believe we agree more than shows here.

We agree:
- Appropriate bystander care is critical to patient survival. A heart attack patient in full arrest has, AT BEST a 43% chance of survival. No bystander care = 19%. (NSC figures.)

- The decision to help is very personal. Greater bystander expertise and performance means better chance of survival for both the patient and the rescuer.

- Good Samaritan Laws, in those states that have them, greatly reduce the threat of being sued (and further reduce the threat of losing such a suit). In my classes, everyone gets a copy of the Texas Good Samaritan Act and we discuss the first two paragraphs in depth. We also discuss: Duty to Act; Abandonment; DNR orders; Rescuer/Bystander safety, control, and assistance; Patient Confidentiality; and much more. I give a legal disclaimer, recommend seeing an attorney for "... advice you can rely on". I have had at least a dozen attorneys in my class (almost ten years) and EVERY one said I did a good job.

- It is difficult to prove negligence when the patient is dead to begin with. We discuss clinical v. biological death. I state that I never worry about being sued (for doing CPR) because I perform "by the book" - just as we all do together in class.

- Saving a life is a beautiful thing. That's why I rode the ambulance in my community for six years. (Took my own daughter to the hospital twice.) There were times, after turning my patient over to hospital personnel, I then have had to wash blood, vomit, broken glass, mud, even horse manure out of my hair, clothing, etc. (I have learned to really HATE fire ants!) I spent money, effort, and time away from my family to go to meetings, teach EMS classes, make runs all hours of the day and night (and go to work thereafter, etc.). I had 7 or 8 homes in my subdivision where I was their first level of medical care, working directly with their doctors. I also am partially disabled because of my EMS duty. I never received or asked for a single penny for this community service. Yes, I understand the value of saving a life.

- About the CDC risk assessment - I agree. I should have said, "... too little to be contagious in practical terms" - or something to that effect. Same with the AHA info.

- MOST importantly, we agree that Spectre is at low risk checking IDs or escorting folks from the bar (per his example)

Sorry you're distressed with my "preaching... biased views". ( :) I appreciate your gentleness.) Please relax. I use nationally-approved tapes, texts, tests, & brochures. We discuss in great depth the extremes in willingness to provide medical care (Never? Always? Where in between?). I fully explain the views of fine Paramedics who land everywhere along that continuum. Re-reading my post, I see it implies "bias". However, I was trying to preach the use of gloves and barrier devices - not the withholding of medical care.

-------
We disagree not so much in facts as in choices:

1. My example of Monica Lewinsky is a better example for my point (concerning strangers) that your example of a date. If I were still dating, I would know enough about the lady to somewhat evaluate the risk of her general health and lifestyle. With complete strangers, in the heat of an emergency, such evaluation is MUCH more difficult. While nothing is certain, we can (and do) evaluate such risks all the time.

2. Apparently we evaluate the risks of communicable diseases differently. that's OK. If you have little or no fear of communicable diseases, I commend you for your bravery - for you know the risks. You're listed as a "medical professional" so I must believe you have seen patients die in agony from pneumonia. According to Carol Kahn (Parade Magazine, 12/20/98 pp 12-13), "Up to 3 million cases of infectious pneumonia occur annually, resulting in about 75,000 deaths." Note other communicable diseases are not included in those figures. I'm not preaching "withhold care". I'm preaching, "Use gloves & barrier devices."

3. You refer to 12 cases of HIV transmittal from patient to EMT. Again, I was discussing ALL communicable diseases. I stated my source for the 200 EMT annual deaths hoping someone could shoot it down! But as one instructor put it, "It doesn't matter how many (EMT deaths) there are. You don't need to be one of them." Food for thought...

4. We both skipped some of the obvious advice to Spectre. Such things as frequent hand-washing, don't touch your eyes, use a towel on the restroom door when you leave, etc.

5. "Reasonable is a key word." We agree 100%. I have never refused to treat a patient I thought I could help, including CPR. However, I personally consider it unreasonable NOT to use a barrier device when doing CPR on a stranger. I am being sincere when I again commend you for your bravery, but the "beautiful" lives I want to save first are my wife, my children, their children, and my mother.

Spectre,
If I had a part in convincing you NOT to do CPR on anyone, I did you, myself, and your potential patient a great harm. At the time, I thought my meaning was clear that I was advising you to use a barrier device. Upon re-reading my post I see Olazul's point - it seems I was trying to "scare you off". My mistake and I apologize.

As we speak, I have a small pouch on my belt with a barrier device and four gloves. The pouch is 3"x4"x1" - smaller than my handcuff case. If you have Gall's "Holiday '98" catalog, see examples on pp 151 & 160. Please contact some of your local EMS field personnel to see what they use and advocate. Ask those who serve IN THE FIELD, TODAY - their advice should be current and practical.
Stay safe. I'm sure we're with you whatever personal decision you make.

[Spectre]

Dennis:

Thanks- and kudos- for a long and caring post. I have decided I need to update my Red Cross training to be better prepared to help anyone in need. I can always make a choice on the spot if there are special circumstances.

The Galls' kit is a primo idea. I will order one soonest.

The interaction in threads like this is why I love the The Firing Line. My thanks to our hosts, you really do have the best online forum.

[olazul]

Dennis-
Thanks for the clarification. You will be happy to know that, yes indeed, I have taken a chill pill.

Perhaps we are mincing words, but there is little room for disagreement in the evaluation of risk. There is however much room for discussion on an individuals tolerance to the risk. It is my objective to bring enlightenment and perspective to the risk involved and dissolve some of the disinformation, fear, and paranoia.

You stated that you would only go mouth to mouth with 6 people with very rare exceptions. To believe that is fine. To say that in a class you are teaching shows an extreme bias, which is not based on the facts presented. The reason I wrote the post was to counter that thought.

First let me say that I am purposefully vague about my profession on line. However if any of the regulars here at TFL would like specifics, I would be happy to email you and give the "ad nauseum". I generally like my ideas to be judged on content and not percieved expertise due to my background.

My point in bringing up kissing on a first date is that as well as you think you know someone- you don't. That girl your kissing is a representation of the general public- like it or not. Therefore mouth to mouth with the general public, with some exceptions(see individual described below, hooker, person with track marks or needle sticking out of arm, pulled out of a crack house, etc...), has minimal/negligible risk and even in above settings is smaller than most would think.

I believe I have a very real & experienced perception of the risk of infectious disease. I am neither "brave" or foolhardy(in this case anyway- more often foolhardy than brave). I would be very reticent about a liplock on a dishelved, stinky, yellow(from disease), blood splattered, suppurating ulcer laden individual. In fact, that person is probably not going to recieve a liplock from me, flimsy barrier or not. However given someone who does not have obvious extreme disease(or above circumstances) will recieve my help, flimsy barrier or no, because the risk is low. By the way I would not place much confidence in the barriers, as you know things get pretty sloppy and wet when it gets going- CPR that is. Better than nothing though.

I cannot refute your statistics about the # of EMS dying from disease contracted on the job(nor would I want to- true or not, it serves to remind us to be carefull) because I have no source, you have given none. But regardless, health professionals daily perform invasive procedures and are exposed to splurting fluids which skew the risk from a single mouth to mouth exposure by a good samaritan.

Point taken about the pnuemonia, i.e. be carefull! But poor example. The most common route of transmission of pnuemonia in a healthy individual is your own mouth/nose. Pnuemonia is not typically transmitted people to people. It is caused by viruses and bacteria which colonize your mouth and nose intermittently. Then if there is a breakdown of defenses, it infects you. That is why people in hospitals are not quarantined with pnuemonia(a very few bugs excepted). The vast majority are not "contagious" person to person(for reference- Robbins pathologic basis of disease, Cecils or Harrison's internal medicine texts are a good start). On top of this it is usually the very old and those with other major illness that die of pnuemonia.

Please do not misunderstand, there are bugs you can theoretically catch which have been pointed out previously(HIV, hep B,hep C), from CPR - but risk is very small. TB may be transmissable by CPR(I do not know) but I feel the risk would be small. I base this on the fact TB is not appreciably present in saliva, just sputum from deep within the lungs- in some people. If the TB is dormant(usually the case) the organism is "walled off" and more difficult to transmit. Usually you need to be in close & intimate quarters for a prolonged period of time to get TB. Given all of this I would never perform mouth to mouth on a person I knew for a fact had any of the above diseases. But when you multiply the odds of a person having these diseases with their tranmisabillity- well, you get the idea.

enjoy,

Olazul

[olazul]

BTW all-
I have always had the utmost respect for those who are in the business of helping and protecting. Be it military, LEO's, or EMS(any others?). There is something about choosing a profession to help others in need that is special. We may not always agree on the little details, but this does nothing to take away from the difficult jobs you have chosen. Even though this should go without saying, sometimes it is nice to say it anyway :).

Olazul

[Dennis]

All,
Olazul is giving us more reliable, detailed, and SUBSTANTIATED information than I have heard in my eleven years in the field.

Olazul,
Thanks for sharing this information. It could save many rescuer and/or patient lives.

To the discussion:

1. Saying that a lady I would date and liplock is as great a medical risk as liplocking any stranger with no external signs of illness requires a leap of faith I can not make. Let us agree to disagree agreeably on that point.

2. Again, the thorough explanation I give in my class offsets the impression of bias you perceive here. I fully explain the range of opinions and express my viewpoint as just one among those of more experienced medical professionals. Suggesting that I should tout strictly and only the "party line" without sharing clearly identified opinions of experienced personnel will have to be our second point of agreeable disagreement. You have concentrated my attention on the possiblity of bias. I will strive to prevent it.

3. Separating Evaluation v. Tolerance of risk is worthy of much examination! As Holmes might say, "I perceive you have considerable expertise in this area." Perhaps I'm mincing words, but to say there is little room for disagreement in the evaluation of risk requires me to blindly trust the condescending opinion of those whose government job too frequently involves duplicity and "calming the masses".

(Please don't call me paranoid. I watched the government lie for twenty years in military intelligence. Later they lied about Agent Orange, "mystery" illnesses from the Gulf War, the stealing of most of my promised benefits, etc... We can e-mail the rest if you doubt the justifications of my distrust.)

4. MY problem? I just don't trust the CDC! Can you please evaluate for us, or at least comment on, these common stories?

4a. Years ago, CDC said our blood supply was safe and free from HIV/AIDS. The great tennis star Arthur Ashe (sp?) had heart surgery, received HIV-contaminated blood, contracted AIDS, put his loved ones at risk, and died through NO fault of his own. CDC lied about the efficacy of the early AIDS tests.
-- I've been told that more effective tests have virtually eliminated this risk.
-- Many healthcare professionals still recommend the patient donate his own blood, well before surgery, to eliminate this risk entirely. How common is this suggestion? Why?

4b. CDC's heavy-handed blundering into the political maelstrom of gun control really blew their credibility with me. They lied! Sweet & simple. They did not follow scientific methods here, they followed the "party line".

4c. CDC is funded with tax dollars. I truly fear their "fundings" may affect their "findings". (You don't get ahead proving the boss or funding authority is mistaken or telling lies.)

4d. Dr. Fasci of CDC (God, I hope that isn't YOU!) has put out tapes that seemed just a bit devious to me. I do not doubt his expertise, I am uneasey about his motives and worry about a possible hidden agenda.

4e. Too many times, when we discuss communicable diseases, the conversation swerves to the low risk of HIV/AIDS and never addresses the risks of the broad spectrum of communicable diseases!
-- I have been told in EMS over and over that TB is "an aerosol disease" that is "highly contagious". Now you ref heavy sources explaining EMS training was wrong.
-- Hepatitis: One PM said, "Don't worry about AIDS. Worry about hepatitis. That's what will end up killing you." That's verbatim.

5. Again, about the 200 EMTs who die from diseases they caught on duty. Jeez, I sure was hoping someone could prove that included both on and off duty: Motor Vehicle Accidents, falls, heart attacks, etc. etc. I still find "200" hard to believe...

Greatly appreciate the time and effort you're putting in here, Olazul. I also appreciate TFL understanding that appropriate evaluation of these risks is pertinent to many TFL readers.

Spectre,
Bet you never guessed what a can of worms this could be.
Great idea getting the training. First Aid works off duty too. Could save a loved one's life. Could also be good protection in court.

Stay safe, all.
----------
Unite!

[Spectre]

Dennis,

It is my understanding that the HIV virus is not what is detected in AIDS testing. What is detected are the body's antibodies attempting to fight the virus. This would be why it would be possible to have the virus-for some amount of time, at least- without it being detected in the tests.

[Dennis]

The ten o'clock news just came on. One of the top stories is about "an outbreak of bacterial meningitis" at our local high school. The news lady said at least four times that this meningitis can kill a patient and it is very contagious!
Turns out it is ONE case. Olazul is right about sensationalism, disinformation, etc.
The shool sent home a notice with each student telling the parents to have their children screened by a doctor for meningitis.
Sure it's better to be safe, but the news lady leaned forward, her eyes got big, her voice was super-expressive. :( A bit overdone, methinks.
---------
Unite!

[olazul]

Dennis,
I am happy to say that I am in no way connected to the CDC. I am in fact a simple "foot soldier" hoping to clarify an area where I have something to give.

Let me also say that I never want to be in the position of defending a government agency.

Now lets talk about HIV testing and the blood supply. Most stats are based on a population of 271 million in the U.S..

TESTING- Before being diagnosed with HIV you must have a positive EIA test(which tests for your antibodies to the disease) and a positive western blot. The accuracy of these tests combined is greater than 99%. There is a window where current tests cannot detect the virus. This is because sufficient antibodies do not yet exist. This window is generally 3mos. but can be up to 6. In certain very rare cases this window can last 2yrs or more.
If you are HIV+ and develop certain clinical conditions you are diagnosed with AIDS.

BLOOD SUPPLY- The blood supply is currently tested for HIV1, HIV2, HTLV-1, HepB, HepC, and Syphilllis. There is a window with HIV where the person is infected, and also infectious, where someone could give blood and not have it detected by the screening tests(see above). They do attempt to weed these cases out by denying people who even have risk factors for HIV. At the end of 1992 there were 4,959 cases of transmission by recieving blood/tissue products. All but 21 of those occured before screening started in 1985. To give you an idea of safety, there are around 17 million units of blood products used every year. Studies have shown blood product trasmission rates of HIV between 1/38,000 and 1/300,000. There was a study in 1990 by the CDC and American Red Cross that showed a rate of 1/225,000.

As to other infectious diseases and CPR. Some facts may have been posted already. Those diseases listed are the ones you should be most worried about.

HIV- Roughly .4% of the population in the U.S. is HIV+(.13% is documented HIV+). There have been no reported cases of transmission via CPR. There has only been one case of transmission via french kissing- I think this is believed to be a blood exposure in reality. There is a 1/250(4%) chance of contracting it through a needlestick. There have only been 54 documented and 133 possible cases of transmission of HIV to a U.S. healthcare worker since the inception of testing the disease(84-85?).

TB- I do not know if this has ever been spread by CPR. 10-15 million people are infected in the U.S.(vast majority is pulmonary). On average, only 10% will ever have the active/contagious form of the disease in their lifetime. If the disese is not active, it is not contagious. I have not seen numbers about the # of active cases currently in U.S, but this would be much less than 1-1.5 million( .4-.6% of population) because it would be spread over their lifetime. To spread pulmonary TB one must cough deeply and aerosalize the germ. I do not know if CPR mimics this cough, I doubt it does- really efficiently anyway(it is very difficult sometimes to get a good sputum from patients, even when they try hard). "Really contagious" is relative. If someone had active TB and I was in an ambulance I would treat it as such. But, in the realm of infectius disease, it generally takes a prolonged encounter- like living with someone. The odds of catching the disease from someone with ACTIVE TB, in this circumstance, is 23%. Of course just like the girl at the prom, you might get "lucky" the first time. Plus if you sum up the time you spend with these people as an EMT over 20 years it adds up to a prolonged exposure. The vast majority of TB is treatable with medication. There is a small percentage of drug resistant strains which is on the rise(did not look up the #, but again only 10% of these will ever have active disease)

Hep B- Occurance of less than 2% in population with ~1 million chronic carriers(.4% of pop). You can get this by a person with an acute infection or chronic infection. 6-10% go on to chronic infection, .5-2% go on to liver failure. Transmission has not been documented by kissing although it is present in saliva(you generally get this by sharing needles or sex). There are some cases of infection by bites. I do not know if any cases have been transmitted by CPR. You can get vaccinated against this disease. If you are an LEO, medical personel, still dating, or other dealing with the public in an intimate manner- vaccination is HIGHLY recommended. Make sure you get tested for seroconversion("immunity") after the series. You may have to have another round of shots.

HepC- I screwed up here before, I misread the stats. This is more common than I previously thought, with a prevalence of 1.8%(majority are carriers) in our society. If you get a needlestick there is a 5-10% chance of getting it. Routes of transmission are not well understood at this time other than it is definitely spread by blood contact. It is very bad though as most cases(70%) go on to liver failure and ~85%(or more) will develop carrier status. Treatment is available and is effective 15-30% of the time. No vaccine is available. Good news is that in recent years the incidence of new cases is down 75% due to screening the blood supply.

There are a myriad of other diseases including meningitis which can ruin your day. I would caution against dwelling on diseases too much. There is a saying that 2nd year medical students are all hypochondriacs, as they have learned alot of what can go wrong but have no clinical framework to put it in perspective. One can go mad thinking about germs.

To summarize the encouraging news:

HIV- no known cases of transmission by CPR.
Only 1 case of transmission by kissing.

TB- usually takes a prolonged encounter and really good coughing. BTW don't inhale the patients breath while giving mouth to mouth, turn face away etc.... Majority of cases treatable.

HepB- get vaccinated. No known transmission by kissing. Only .5-2% of infected go on to have liver failure.

HepC- This is bad. lets do the math though. Assume transmission rate of 5%(very high as this is low end for a needlestick). What are the odds that you will perform CPR in general public on a HepC+ person AND that you will contract this disease? .018 X .05 X 100%= .09% = 1/1,000 (we can probably add at least another zero or two here for mouth to mouth which would make it 1/10,000-1/100,000).

Again we are talking about one exposure of mouth to mouth with a person who is not blatently disgusting health/bloody wise. I would caution against placing your mouth on blood- this will increase your risk significantly. While I cannot give you one number, I think you can see that to get a bad disease from this type of exposure would be rare(my opinion, do with the information as you will). There are risks, minimize them when you can.

BTW- I have several messages out to the CDC and elsewhere as to whether there have been reported cases of hepatitis or TB (now HepC also)through giving CPR. Don't hold your breath. If I get it, so will you. Dennis, I will also attempt to get the # of healthcare workers who contract potentially terminal bugs/year.
Also- my #'s and information were derived from a large number of references, some up to 3-5 yrs old. They are very good approximations. I am not publishing, so I have not included the numerous citations. If anyone has a question about a particular fact or # I will tell you where I got it.

I really appologize for the length of the post. You won't have to suffer another long one from me for awhile :)- promise.

Olazul

This post was revised due to faulty information on Hep C(a little crow, on occaision, is good for the soul) and addition of a couple of clarifying stats elsewhere. No other changes in numbers were made.

[This message has been edited by olazul (edited 01-16-99).]

[Dennis]

Olazul,
Thank you so very much for the time, effort, research, and patience you've exercised here.

I'm going to get around your charge of "bias" by continuing to present (in my classes) the entire spectrum of "willingness to help" options. I will not identify my personal decisions but I will state that I have information "independent" of what I (in TFL) call the "party line" which negates many of the arguments we have heard in the past. (If I may, I'll e-mail later this week for some other info.)

I am astounded at the extreme differences between the material you have presented here on TFL and the information I have heard presented as facts here in the San Antonio/Austin area. (That's not a challenge for God's sake! :) :) All I've been given was word of mouth and contradictory. Rest assured I accept your research.)

Whether or not you have proven me "biased" or "wrong" is not the point. You have illuminated a flaw in my attempts to get as many people as possible ready, willing, and able to provide First Aid (including CPR). For that I thank you and assure you I will make changes which I believe you would find suitable.

Hmm, I guess we ought to give the TFL back to everybody else now, huh?

Spectre,
I don't know where you will ever see the subject of "Bloodborne Pathogens" expanded to "Communicable Diseases" as thoroughly as Olazul's last post. I don't know who Olazul is, but I will guarantee you "This ain't no First Aid Instructor!" Best of luck.

[olazul]

Dennis,

Thank you for the repartee'. I learned alot by trying to prove my point :)(this certainly was not on the top of my head). Good and fervent discussion is one of the spices of life!

The CDC and "powers to be" publish certain guidlines and statistics that are passed on to EMS, LEO's, RN's etc... and these folks are then expected to train the public. Their goal is to sell medical personal, and the public, on the dangers of diseases. Certain statistics are emphasized that will "sensationalize" their cause- IMHO. Paranoia, to a certain extent, is probably healthy in order to keep health professionals alert and minimize the exposure & personal risk. To lose a single EMT or LEO in the line of duty is always tragic. Therefore we all have been trained to view every contact as extremely dangerous(rightfully so?). This keeps the professinals using universal precautions and joe public using rubbers- this saves alot of lives.

In defense of this training is that medicine is complicated and at times the experts don't agree, so the message is generally simplified. Also the CDC does publish pretty complete statistics, just that at times you have to look for them and have the background to put it in perspective. Also keep in mind that people acquire, and die from, disease every day. I hope my post will not relax your guard. There is danger. Make an informed decision.

This training can be counterproductive in the case of CPR and the general public. You have been taught a certain way to keep you "safe". Again the professionals risk and exposure over a career is significant, much different from a single contact by joe public. Therefore all of those hours spent training you to be carefull(plus your considerable experience), greatly outweigh one sentence in the instructors manual about there being a "small risk by CPR"- and usually they only talk about HIV. Any rational person would view this with a certain amount of skepticism.

I am sure you do an admirable job of teaching, and you are to be commended for your effort and time. You are performing as any rational being(sounds like much better actually) in your position would. IMHO- the "powers that be" have brought this on themselves. It is no wonder that only ~50%(I think) of the time does a bystander perform CPR to help.

I would enjoy an email, and your right we should return TFL to others :). This entire post is obviously only my personal opinion.

Best regards,

Olazul

[olazul]

All,
Sorry if I am beating a dead horse but I just ran across a recent review of all reported cases of transmission of infectious disease through CPR. The entire article can be found at www.acponline.org/journals/annals/15nov98/infeccpr.htm (http://www.acponline.org/journals/annals/15nov98/infeccpr.htm)

The bottom line only 15 cases of transmission of disease by CPR in the last 30yrs. Only a couple of cases were fatal.

Only exception is if you are pregnant you should not perform mouth to mouth because you could contract a normally benign virus(CMV) which is really bad for the fetus.

Olazul

[This message has been edited by olazul (edited 01-25-99).]

[Dennis]

Olazul,

Many thanks. It is printing as I speak (?type?). I will read & heed.


[This message has been edited by Dennis (edited 01-26-99).]