Mail & Guardian, ARV treatment 'too late', 20 August 2004

Anti-retroviral (ARV) treatment given to 61 patients, some HIV-positive, at Sterkfontein psychiatric hospital in Johannesburg after an assistant nurse allegedly used the same needle on all of them, is likely to be ineffective, because the treatment was provided too late.

Nongezo Makgwe, the West Rand regional director of the Department of Health, confirmed the incident with the Mail & Guardian on Tuesday. The Gauteng department of health then released a statement saying the assistant nurse had been suspended for administering glucose tests to patients without changing the needle.

“The affected patients were tested for HIV and provided with anti-retroviral drugs as a precaution to protect them from getting the Aids virus.”

However, the statement failed to mention the time lapse between the incident and the administration of the ARV drugs.

ARV treatment is likely to be ineffective because it was not administered within the ideal window period of 72 hours, said Dr Des Martin, president of the HIV/Aids Clinicians Society. “In cases of sexual violence when a person presents later than 72 hours we do not administer the drugs.”

Popo Maja, spokesperson for the Gauteng department of health, confirmed on Thursday that there had been a four-day lapse, but said under the circumstances putting the patients on the drugs was the best response.

Makgwe said the testing took place on August 7. The assistant nurse took blood from 61 patients in the ward — six of whom are known to be HIV-positive. She apparently failed to change the needle with each new patient.

The device for testing glucose has a needle that pops out to pierce the finger, drawing a small amount of blood that is read into a machine and provides a patient’s glucose level.

A patient in the ward noticed that the nurse had not changed the needle, but only reported it the following Tuesday because Monday August 9 was a public holiday.

According to the statement given to Makgwe, the head psychiatrist made the decision to administer ARVs when she heard about the incident on Wednesday August 11, four days later.

“Family members have every right to be upset. We have taken this matter very seriously and will conduct HIV testing in six weeks’ time,” said Makgwe.

Martin said the type of needle used for glucose testing does not pose the same risk as the hollow-bore needle that penetrates tissue.

Makgwe said the extent to which the 61 patients understand the counselling will depend on their condition.

The assistant nurse will be investigated to establish her motives.

“We will have to investigate whether she was ignorant [of how to use the machine] and if it was part of her duty to do these tests or if she should have been supervised,” said Makgwe. “We also have to check her mental state.”

But making an assistant nurse “who has had one year of training” responsible for glucose testing of 61 patients is too much responsibility, said Thembi Mngomezulu, deputy director of the Democratic Nursing Organisation of South Africa. She said the incident is not an isolated case, but rather a reflection of the impact of the shortage of nurses on the country.

She said assistant nurses are trained in sterilisation of equipment, but suspects this nurse thought the needle was sterilised when it withdrew into the testing device.“She should have been supervised,” said Mngomezulu.




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