Needlestick?

[al9900]

Today got stuck with a STERILE needle at work (right out of the package). It was the needle on the side of a butterfly that attaches to the hub. Only concern is I may have had a little patient blood on my gloves. What is the risk of transmission of a blood borne pathogen?

Freaking out a little bit, first needle stick!!

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[ScepticSkeksis]

If that's something you are anxious about, then EM is likely not for you.

 

[RustedFox]

DID YOU HAVE PATIENT BLOOD ON YOUR GLOVES?

 

[s/p epilepticus]

If that's something you are anxious about, then EM is likely not for you.

Ridiculous. For EM to be "for you" you have to have no anxiety about your FIRST needle stick that may have caused exposure to patient blood? Insane.
OP just talk to your hospital employee health and ask about their protocol if you're worried about it.

 

[ScepticSkeksis]

Ridiculous. For EM to be "for you" you have to have no anxiety about your FIRST needle stick that may have caused exposure to patient blood? Insane.
OP just talk to your hospital employee health and ask about their protocol if you're worried about it.

Gotta disagree. Sterile needle through a glove that likely had no blood on it. Not even something to spend 5 seconds thinking about.

 

[cyanide12345678]

Yeah don’t worry about it. Your needle stick is pretty much no risk

 

[TooMuchResearch]

DID YOU HAVE PATIENT BLOOD ON YOUR GLOVES?

This is an important part of the puzzle here, OP.

Also what type of needle?

 

[JacobMcCandles]

Your risk is essentially 0% in this situation. The risk of a needlestick with known infected blood is like 1% for Hep. C and 0.3% for HIV.

 

[Janders]

HIV Needle Stick Risk Assessment Stratification Protocol (RASP)

The HIV Needle Stick Risk Assessment Stratification Protocol (RASP) Quantifies HIV exposure risk by source and exposure type and need for prophylaxis.

www.mdcalc.com

small needle through glove (maybe with minimal blood somewhere on it?) with a "deep transcutaneous" poke from an unknown population is roughly...

<<0.001 %​

Or, 1 in 10000000

 

[s/p epilepticus]

So there you go. The risk is extremely, unfathomably low. But to say that EM is not for him because he thought about it is ridiculous.

 

[Janders]

So there you go. The risk is extremely, unfathomably low. But to say that EM is not for him because he thought about it is ridiculous.

Agreed. Needlesticks suck, especially for students / junior staff that haven't been taught the data... but even then they suck.

 

[Mount Asclepius]

I think it’s a little harsh to criticize someone for being concerned, especially if they don’t know the low risk.

That said, being comfortable with risk is a huge component of working as an EP. It’s hard to be productive and maintain a career in EM if you are overly risk adverse. You have to be willing to stick a needle about anywhere, make big decisions with limited data points and discharge people frequently who are walking time bombs.

 

[Dred Pirate]

even if a clean needle I would still report it - my case in point.
I stuck myself with a clean needle drawing meds up in a code - got myself good (damn magnesium backorder and drawing dose out of a 50ml bag to push) - I pushed the big 16 gauge needle through the side of the bag and bled quite a bit- I have literally drawn up thousands of meds in codes over the years, but got going to fast. Put a couple of bandaids on and thought nothing of it.
Months later I got a large cyst/bump on my thumb. Ended up requiring surgery (inclusion cyst) - I completely forgot about the needle stick until the doc said it likely comes from a penetrating wound. Bingo! well, since I didn't report it, it wasn't covered under workman's comp and had to pay out of pocket.

 

[ScepticSkeksis]

even if a clean needle I would still report it - my case in point.
I stuck myself with a clean needle drawing meds up in a code - got myself good (damn magnesium backorder and drawing dose out of a 50ml bag to push) - I pushed the big 16 gauge needle through the side of the bag and bled quite a bit- I have literally drawn up thousands of meds in codes over the years, but got going to fast. Put a couple of bandaids on and thought nothing of it.
Months later I got a large cyst/bump on my thumb. Ended up requiring surgery (inclusion cyst) - I completely forgot about the needle stick until the doc said it likely comes from a penetrating wound. Bingo! well, since I didn't report it, it wasn't covered under workman's comp and had to pay out of pocket.

I would never report a minor needle stick. The paperwork, and time suck involved would literally destroy my day.

 

[Siggy]

My first needle stick was a suture needle after putting in an A-line on a patient with a history of treated hep C.

The worst part was going to the hospital's contracted urgent care and waiting an hour to get blood draws at the designated times for follow up.

It sucks, but realize that the 3 major ones (HIV, hep B, hep C) either have great post exposure prophylaxis (HIV) or great treatments now (hep B and C).

 

[DocEspana]

DID YOU HAVE PATIENT BLOOD ON YOUR GLOVES?

It was the blood of my enemies.

so, yes. Patient's.

 

[RustedFox]

My first needle stick was a suture needle after putting in an A-line on a patient with a history of treated hep C.

The worst part was going to the hospital's contracted urgent care and waiting an hour to get blood draws at the designated times for follow up.

It sucks, but realize that the 3 major ones (HIV, hep B, hep C) either have great post exposure prophylaxis (HIV) or great treatments now (hep B and C).

Didn't we all get Hep B vaccinated a long time ago?

 

[NITRAS]

When I read about it after my needle stick while in med school, there has never been a reported case of HIV transmission with a solid needle like a suture needle. It made me feel better at the time. But unless you went through patient’s blood on your glove, the risk is basically zero.

Now it was kinda funny looking back. I was in ortho, sewing up at the end with the fellow. The attending has specifically asked I NOT suture up, but the fellow insisted I should. Good times.

 

[ScepticSkeksis]

I wouldn’t bother reporting needle sticks unless it was a used angiocath. At some places they’ll make a huge deal about it and drug test you.

Exactly the correct response. This also is useful for those of us who want to "Do the Bare Minimum". For something with a <1:1000 chance, it's not worth the time and effort to report. Agree about used angiocath, though if it was a healthy, normal patient with clear medical history I probably wouldn't worry.

 

[Siggy]

Didn't we all get Hep B vaccinated a long time ago?

I did. Regardless, hep B (and C) went from being a long term death sentence where the cure (interferon/peg-interferon) was almost as bad as the disease and only worked 50% of the time to good oral treatments with minimal side effects in the time it took me to go through medical school and residency.

 

[RustedFox]

I did. Regardless, hep B (and C) went from being a long term death sentence where the cure (interferon/peg-interferon) was almost as bad as the disease and only worked 50% of the time to good oral treatments with minimal side effects in the time it took me to go through medical school and residency.

I remember having to get vaccinated an unusual number of times because my titers kept coming back negative.

 

[pkwraith]

I get annoyed by the needlestick policy at a lot of places.
When I was a resident, I got a needle stick. I filled out a form, a nurse drew gold top while I was working. Our work doctor calls me the next day. The end. I thought this was normal.

Now, where I work. If I get a needle stick. I have to ****ing check in as an ED patient, waste another doctor's time. Fill out the same form. Now, I have to deal with Worker's compensation crap. Make an appointment with a Worker Health clinic. More worker's compensation bills. Talk to our group's insurance carrier. Complete waste of time, forms, and thousands of money funneled from one entity to another for unnecessary ED visit.

 

[ScepticSkeksis]

I get annoyed by the needlestick policy at a lot of places.
When I was a resident, I got a needle stick. I filled out a form, a nurse drew gold top while I was working. Our work doctor calls me the next day. The end. I thought this was normal.

Now, where I work. If I get a needle stick. I have to ****ing check in as an ED patient, waste another doctor's time. Fill out the same form. Now, I have to deal with Worker's compensation crap. Make an appointment with a Worker Health clinic. More worker's compensation bills. Talk to our group's insurance carrier. Complete waste of time, forms, and thousands of money funneled from one entity to another for unnecessary ED visit.

Exactly. Colossal waste of time for most likely infinitesimal risk.

 

[TooMuchResearch]

I wouldn’t bother reporting needle sticks unless it was a used angiocath. At some places they’ll make a huge deal about it and drug test you.

A drug test for a needle stick? Hard pass on that place.

 

[90sportsfan]

Didn't we all get Hep B vaccinated a long time ago?

Yup. We all should have Hep B vac.

 

[prolene60]

Why does it have to be a report versus no-report situation? I was stuck not too long ago and just went to my PCP who ordered some initial and then later some window titers and that was it. I avoided the workman's comp, paperwork, ER visit etc. all together.

 

[wholeheartedly]

Why does it have to be a report versus no-report situation? I was stuck not too long ago and just went to my PCP who ordered some initial and then later some window titers and that was it. I avoided the workman's comp, paperwork, ER visit etc. all together.

because if you report it, we get the proper baseline testing on you and properly document it to cover you for workers comp in the event the unthinkable does happen, all at no cost to you AND we can test the patient at no cost to them to see if there’s even any risk. then we can do followup at no cost to you if needed.

its a pain in the butt for sure but better to have your bases covered.