Needle prick injury

[Spodermin]

I recently got pricked and didn't notice until I took off my glove. I reported it, they drew my blood. The patient was being transferred to the ICU and they somehow "forgot" to draw her blood.
Long story short, I come back the next day and the patient had already expired, and was out of the hospital. Point is, no one drew her blood, and there's no record of any tests for HIV, HBV, HCV.

The OR and ICU nurses are playing the blame game, each saying it should have been done by the other team.
I still can't wrap my head around this clusterf*ck of a situation I'm in.

Whats the protocol on needle prick injuries where you're at?

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[neoevolution]

Did they offer you prophylactic meds when you reported it? I believe our school advice is that you wash the area, go to the ER + report to school, get offered meds, they'll test the patient, and you can d/c meds if they're negative. But without any tests, you're in a bit of a weird situation. Is their advice to keep taking meds until they can confirm your blood draws are negative?

 

[Man o War]

Only one needlestick in my long career, and it was with a bloody hollow needle that had just come out of a Hep C positive patient. Before my brain could even process what had happened, the OR nurses ripped my glove off, started milking it, and rushed me over to the wash station.
Went to employee health, I filled out some paperwork, and they told me to come back in 6 months to get a blood draw. Thankfully I'm fine.
Not knowing what this patient might have had, I'd do the HIV protocol.

 

[libertyyne]

Sorry to about this incident. I am sure it's not a pleasant experience. The answer is obviously institution dependent.but more often then not if you can't get a specimen from the source for testing you go down the hiv prophylaxis route with the appropriate follow-up testing. I would pull up the institutional policy and follow the algorithm that they have in place.

 

[OrthoTraumaMD]

what kind of needle was it? hollow or solid?
chances of hep C from a hollow bore needle is 3%, but hep c is curable now.
chances of HIV is 0.1%. the prophylactic meds make you very ill, one of my friends took it in residency and she said it was awful.

 

[Matthew9Thirtyfive]

I got stuck in the OR with a closed needle with a patient of unknown status. After the case was over, I went down to occ health. They drew blood, but the patient never got tested (refused, I think). I just got tested at six months and again at nine months. Thank God, I am okay. This was like 10 years ago almost. Scary stuff.

 

[IlDestriero]

They have a protocol for this. It’s essentially the same as a patient refusal.
You have to weigh the odds based on the patient and decided how to proceed.
Don’t waste any more time, if you’re going to start meds, you should do that ASAP.


--
Il Destriero

 

[allantois]

What’s the point of drawing blood immediately? Nothing is gonna show right away. You can get tested for HIV at 1 month (95%accuracy) and then again at 3 month (99% accuracy). But as has been mentioned the chance of transmitting of HIV through a needle stick is less than 1%. You should have been immunized against HAV and HBV.

You also cannot just draw someone’s blood without their consent.

 

[libertyyne]

What’s the point of drawing blood immediately? Nothing is gonna show right away. You can get tested for HIV at 1 month (95%accuracy) and then again at 3 month (99% accuracy). But as has been mentioned the chance of transmitting of HIV through a needle stick is less than 1%. You should have been immunized against HAV and HBV.

You also cannot just draw someone’s blood without their consent.

The point of drawing blood from the source immediately is to rule out some of the more serious stuff HIV, HB , hcv, so appropriate treatment can be started , HIV propholaxis etc. Sometimes the consent is provided in the general consent signed upon admission. Plus the uncertainty for three months is terrible.

 

[Spodermin]

They couldn't draw her blood because she was comatose and the family refused to give consent. That's the official explanation.
My tests came back negative, and occupational health told me that I don't need to be given any meds given the low risk that the patient had any of those diseases (they pulled out whatever history was available). I'm supposed to get tested at 12 weeks, 6 months and 9 months.
I think its bs to be honest, but there's nothing I can do I guess.
It was a solid needle btw

 

[Matthew9Thirtyfive]

The point of drawing blood from the source immediately is to rule out some of the more serious stuff HIV, HB , hcv, so appropriate treatment can be started , HIV propholaxis etc. Sometimes the consent is provided in the general consent signed upon admission. Plus the uncertainty for three months is terrible.

Maybe I misread, but I think he meant what is the point of drawing blood from the person who got stuck.

 

[Matthew9Thirtyfive]

They couldn't draw her blood because she was comatose and the family refused to give consent. That's the official explanation.
My tests came back negative, and occupational health told me that I don't need to be given any meds given the low risk that the patient had any of those diseases (they pulled out whatever history was available). I'm supposed to get tested at 12 weeks, 6 months and 9 months.
I think its bs to be honest, but there's nothing I can do I guess.
It was a solid needle btw

Your risk is pretty low, but it will never cease to amaze me how inconsiderate people can be. Family refuses a simple blood draw on a comatose patient, and now you have to worry for 9 months.

 

[OrthoTraumaMD]

Your risk is pretty low, but it will never cease to amaze me how inconsiderate people can be. Family refuses a simple blood draw on a comatose patient, and now you have to worry for 9 months.

Yes. I will never understand that either.


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[Psai]

Only one needlestick in my long career, and it was with a bloody hollow needle that had just come out of a Hep C positive patient. Before my brain could even process what had happened, the OR nurses ripped my glove off, started milking it, and rushed me over to the wash station.
Went to employee health, I filled out some paperwork, and they told me to come back in 6 months to get a blood draw. Thankfully I'm fine.
Not knowing what this patient might have had, I'd do the HIV protocol.

Apparently you're not supposed to milk it, just wash it with soap and water

 

[Smurfette]

What’s the point of drawing blood immediately? Nothing is gonna show right away. You can get tested for HIV at 1 month (95%accuracy) and then again at 3 month (99% accuracy). But as has been mentioned the chance of transmitting of HIV through a needle stick is less than 1%. You should have been immunized against HAV and HBV. You also cannot just draw someone’s blood without their consent.

They draw your blood immediately to make sure you're not already positive for what they're testing for (because if you have it at baseline, they don't have to cover it from a workman's comp perspective).

I've never been immunized for Hep A, and it's not standard for hospitals to require this.

Some hospitals have on their consent forms (when patients consent to be treated there) that blood will be drawn in case of staff exposure to blood. So those patients can and will have their blood drawn automatically in this type of situation.

 

[OrthoTraumaMD]

They draw your blood immediately to make sure you're not already positive for what they're testing for (because if you have it at baseline, they don't have to cover it from a workman's comp perspective).

This.
As someone who has had multiple trips to occ health, courtesy of our scrub Stabby McStabberson, I can state there's nothing they would like more than finding out you already have the disease they're testing for.


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[Microshaft]

Apparently you're not supposed to milk it, just wash it with soap and water

lol i feel like its more psychologically reassuring though

 

[pacman2018]

courtesy of our scrub Stabby McStabberson

 

[Man o War]

Apparently you're not supposed to milk it, just wash it with soap and water

Really? Hadn't heard that. This was a long time ago, back then that's what they told us to do.

 

[ezhik]

Not sure if this would work given refusal of consent or given the timeframe, but another thought would be to call lab and see if they could add on the labs to the previously drawn blood.