It is more like a shock than a stick.
Another Saturday night, another rather intoxicated and uncooperative assault *victim*.
You have just completed a venipuncture and as you begin to withdraw metal from flesh the patient executes a flailing crocodile roll. His arm slaps against yours and the needle slices through latex and deep into your finger.
The sharp sting of the needle is accompanied by the sensation of your bowel squirting out your rectum like silly-string. Yes, it is definitely an awful moment for any nurse or doctor.
At some stage in our career many of us will receive a needle-stick injury. Over the twenty years that I have been working in the emergency department, I have had eight. Incredibly, three of those were during the resuscitation of a single patient. Thank-you very much Dr Zhivago*.
(*not his real name.)
These days needle-stick injuries are much more easily preventable. Many needle-less systems have been developed to eliminate the need for sharps in activities such as drawing up antibiotics and administering IV medications. Sharps bins should be in abundance in the work environment ensuring rapid and safe disposal of contaminated equipment.
Unfortunately, we still need to puncture our way through the skin to take blood, insert cannulas, deliver intramuscular injections and access a multitude of bodily cavities.
risk of infection.
In most cases the actual risk of transmission of a blood borne pathogen following a needle-stick is extremely low. The most commonly transmissible diseases of concern to nurses are the human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV).
Hepatitis B: Of these HBV is the most transmissible, with a risk of infection following exposure of around 6-30%. (Staff that have achieved immunity after being covered with the hepatitis B vaccine are practically immune.)
Hepatitis C: Infection from HCV following a needle-stick is around 1.8%.
HIV: Risk of becoming infected with HIV is a mere 0.3%.
Of course the chance of transmission occurring is dependent of several factors including:
The viral load of the source person at the time of transmission.
The volume of infected blood transferred.
Always observe universal precautions. If you practice nothing else, practice this: every single patient you look after is HIV positive, is oozing with Hepatitis, Syphilis, and crawling with MRSA.
Got that? Now protect yourself accordingly:
- Wash your hands. Before and after any intervention.
- Gloves, and eye protection, without exception.
- Use safety needles and cannulas. If your hospital is not using some form of safety cannula, you should definitely throw a big tantrum.
- Needles should go directly from patient into sharps bin in one motion. Never leave a sharp laying around to take care of *in just a second*.
- Never, ever try to re-sheath or re-cap a needle.
- 100% attention when handling sharps.
- 200% attention when handling butterfly needles. They are springy little buggers and will flick around and bite you given half a chance.
If you do experience a needle stick injury, immediately wash the site well with water. Squeezing or milking the site is of little benefit.
You should then activate your own hospitals policy for post occupational exposure management.
Remember, the risk of transmission is determined by the type of exposure rather than the patients risk factors.
You and your patient will probably both need blood taken for serological testing for hepatitis B surface antigen (HBsAg), and HIV as soon as possible.
Depending on your immunization status you may need to have a course of HBV vaccine and a dose of hep B immunoglobulin.
If a significant exposure to HIV has occurred, retroviral drug prophylaxis should be offered promptly. Use of such post exposure prophylaxis is not to be treated lightly and expert guidance should be sought. Read up on your own hospitals policy.
needle and the damage done:
Having the statistics on your side does not lessen the anguish of sustaining a needle-stick injury.
I remember several years ago (before we had safety cannula’s) a member of our staff was stabbed in the palm with a large trocar needle as she was collecting up a pile of rubbish left on an IV trolley. At that time we had an HIV positive patient on the ward who had recently been cannulated. No one knew if this was the needle used on him.
Everything turned out OK, but the mental stress placed on this nurse was significant.
No matter how low-risk the needle stick injury may have been it may still cause you significant distress. If this is the case you should seek professional counselling.