Needlesticks

[deleted836128]

Ever had a needlestick injury at work? Have you reported one? Or have you sheepishly shrugged, knowing your odds are low of contracting anything?

Just curious to see what you guys are actually doing.

I’ve stuck myself a couple times through a glove. Once was when I was trying to tap a shoulder joint and stupidly tapped my finger instead with the 18 gauge when I removed it. It’s an embarrassing process to go through, even more so when you sheepishly report it to the charge nurse who has better things to do. Patient is notified and tested, charge nurse is notified, a giant packet is given to fill out, and employee health harasses you until you do various steps for follow up. Today I was suturing with Ethilon (f-ing Ethilon! I like Prolene for a reason) and when tying a knot, the suture string snapped, and somehow the suture needle flew up into my glove, pricking my finger enough to make it bleed. I had a fleeting thought of reporting it but the patient was a healthy military kid and I figured it was low risk so I got a new suture and moved on. I know that the PEP available for HIV but I remember reading somewhere that the chances of getting HIV from a needlestick even from a known source is 1/300. I admit that not reporting it is not the sharpest thing but here I am...

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[SamtheWise]

I stuck myself once with a clean needle and didn't report it, but that was only because I was 100% sure it was clean, as in I had just opened a sterile triple lumen kit and was rushing so I grabbed the finder needle the wrong way and jammed it into my thumb. I'd report it though if dirty, sure the chances of infection are low, but if it somehow it affects your ability to work I don't think your disability insurance will pay out if you don't go through official channels. An irritated charge nurse and some paperwork is better than lost earnings in my opinion.

 

[BoardingDoc]

Ever had a needlestick injury at work? Have you reported one? Or have you sheepishly shrugged, knowing your odds are low of contracting anything?

Just curious to see what you guys are actually doing.

I’ve stuck myself a couple times through a glove. Once was when I was trying to tap a shoulder joint and stupidly tapped my finger instead with the 18 gauge when I removed it. It’s an embarrassing process to go through, even more so when you sheepishly report it to the charge nurse who has better things to do. Patient is notified and tested, charge nurse is notified, a giant packet is given to fill out, and employee health harasses you until you do various steps for follow up. Today I was suturing with Ethilon (f-ing Ethilon! I like Prolene for a reason) and when tying a knot, the suture string snapped, and somehow the suture needle flew up into my glove, pricking my finger enough to make it bleed. I had a fleeting thought of reporting it but the patient was a healthy military kid and I figured it was low risk so I got a new suture and moved on. I know that the PEP available for HIV but I remember reading somewhere that the chances of getting HIV from a needlestick even from a known source is 1/300. I admit that not reporting it is not the sharpest thing but here I am...

I've had 2 needlesticks. Once was with a solid bore suture needle while working abroad where they didn't have the capability to test the source patient for anything. I didn't freak out too much given that it was solid bore, so I just waited 6 months and got tested to see if I seroconverted. All good.

The other one was as I was disposing of a sharp after doing a CVL in the ICU as a resident. The guy was 80 or so and there for CHF or something. I didn't get evaluated by anyone, but I did get consent from his wife to test him for Hep and HIV which were both negative.

As an aside about your suturing needlestick: as noted above, I did the same thing. My research at the time indicated that there have been ZERO reported cases of HIV transmission from a solid bore needlestick.

 

[d2305]

I got rather anxious suturing know hiv positive patients. I wore 2 pair of gloves.

 

[TooMuchResearch]

Always report it.

 

[MedicineZ0Z]

If the patient is infected then a single exposure poses a risk of:

HIV: 0.3%
HepC: 3%
HepB: 30-50% (assuming you arent immune)

HIV will vary widely depending on the viral load which varies based on whether the patient recently got infected and/or if they're on meds. AKA, patient who doesn't know they have it and hence isn't on meds - poses a much higher risk than 0.3% than someone who is on meds and treated (probably well below 0.3%). Even more so if they just got it, as the viral load will be sky high during the acute phase and really first few months.

Remember, open air immediately "kills" HIV. It's the exposure to blood that hasn't been exposed to air that is dangerous.

 

[deleted836128]

Thanks for the feedback, guys. I do know the risk of HIV is exceedingly low so I don’t worry about that so much as hepatitis C. I guess so I don’t have to worry about this as much, I need to examine my processes more and double glove... and I will definitely be reporting needlesticks in the future.

 

[cyanide12345678]

It's not hiv that's the scary one.

Hep C is the scary one. 1-2 percent transmission rates, can't do crap about it if your person is positive for hepatitis, no prophylactic medications you can take.

Always report. Always.

 

[deleted836128]

I've had 2 needlesticks. Once was with a solid bore suture needle while working abroad where they didn't have the capability to test the source patient for anything. I didn't freak out too much given that it was solid bore, so I just waited 6 months and got tested to see if I seroconverted. All good.

The other one was as I was disposing of a sharp after doing a CVL in the ICU as a resident. The guy was 80 or so and there for CHF or something. I didn't get evaluated by anyone, but I did get consent from his wife to test him for Hep and HIV which were both negative.

As an aside about your suturing needlestick: as noted above, I did the same thing. My research at the time indicated that there have been ZERO reported cases of HIV transmission from a solid bore needlestick.

How does this work? A physician told me to do this once. He said he doesn’t often report it to HR; he just asks the source patient if they will be tested and gets the tests, checks the results himself and moves on. If there’s no documentation of an injury through HR how can you justify ordering labs that are not immediately medically necessary for a patient who will be later be billed for for them (or their insurance will be paying for them)? This is something I don’t get. I feel like you could get into hot water with the hospital for this if all the sudden someone is billed for labs and they’re like “why am I paying for these?” And it’s discovered you didn’t report it.

 

[FiremedicMike]

If the patient is infected then a single exposure poses a risk of:

HIV: 0.3%
HepC: 3%
HepB: 30-50% (assuming you arent immune)

HIV will vary widely depending on the viral load which varies based on whether the patient recently got infected and/or if they're on meds. AKA, patient who doesn't know they have it and hence isn't on meds - poses a much higher risk than 0.3% than someone who is on meds and treated (probably well below 0.3%). Even more so if they just got it, as the viral load will be sky high during the acute phase and really first few months.

Remember, open air immediately "kills" HIV. It's the exposure to blood that hasn't been exposed to air that is dangerous.

I worked as the department infection control officer for several years and it cannot be overstated how low the transmission risk really is. That's not to say it shouldn't be reported, but it does offer a lot of piece of mind to know that it's highly unlikely that you'll contract anything.

 

[RoyBasch]

I'll confirm what the other docs are saying. You need to report, unless you are 100% sure the needle is uncontaminated i.e. fresh out of the pack not used yet. On the off chance you ever seroconvert, your healthcare expenses related to treatment of the disease (possibly life long with HIV or short but expensive like 80-120k for a course of antivirals for HCV) WILL NOT be covered whatsoever. This is an on-the-job-injury and should be completely covered, so there is no excuse for not going through proper channels. There is no PEP for HCV but people who seroconvert from needle sticks are excellent candidates for antiviral treatment and likely to have a sustained viral response with functional cure.

 

[The Knife & Gun Club]

Got splashed in the eyes with pus from an I&D on an HIV+ homeless dudes who was not on antivirals. Took the PEP and prayed. Luckily the treatment was not not that bad.

 

[TheSingularity]

Question. How is this handled for independent contractors? Are you entitled to the same compensation for meds in the off chance you convert?

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[wholeheartedly]

I'm the infection preventionist at my facility and handle all the needlestick workups. While the risk is low, always report it. There are a few reasons for this.

Biggest reason, as noted above, is that if you are infected with something, you'll have all the necessary documentation to get it covered under workers comp, etc. If you try do the workup yourself, you're likely to miss something and could be shooting yourself in the foot. There is a lot of documentation that needs to happen beyond source testing and deadlines for workers comp notification. These people are just like insurance companies that try to avoid paying for things whenever possible.

The second is that we have all the paperwork and processes in place to get/document informed consent from the source patient and ensure they aren't billed for the testing (which could bite you in the butt later ie, "well yes I consented cuz the doc stuck himself, but I shouldn't be billed for that" then you're in hot water for that and not reporting). We also know the laws, which in some states allow us to use an existing specimen for testing even if they don't consent. Then if anyone is positive for anything, it's also reportable to the health department which opens a whole other can of worms if testing is done outside official channels.

It's also a pretty emotionally jarring thing, especially if it's a high risk situation. I think it's better not to try to go it alone.

On a couple occasions in my facility, the incident involved an unsafe version of a device and reporting it got the device changed to a newer safer version in less than a day with very happy staff as a result. Reporting it allows us to identify issues and improve safety.

In some facilities they take extra steps to protect source patient and employee anonymity with testing and record keeping. So tests get ordered with a de-identified number instead of your name and results might get stored in an employee medical record (which is separated from your HR record) instead of the facility EMR. OSHA mandates records are kept for the duration of employment plus like 30 years.

Yeah, it's a pain in the ass and a ton of paperwork, but I'll still glady do them every time. There really isn't a good reason not to report it (outside above mentioned resource limited setting).

The independent contractor situation is tricky. When we have docs from a staffing company OSHA says both the staffing company and the hospital share joint responsibility for educating staff on safety and providing them a safe environment. But in the event of a needlestick, the employer covers the costs and that winds up being the staffing company in those cases. I'm not sure how an IC would work.

 

[wholeheartedly]

@ERCAT it isn't too late to report it. you'll probably take a little heat for the delay, but they can still do the baseline testing on you which would be needed to support a future claim and they might still have usable sample on the source patient.

 

[thegenius]

Ever had a needlestick injury at work? Have you reported one? Or have you sheepishly shrugged, knowing your odds are low of contracting anything?

Just curious to see what you guys are actually doing.

I’ve stuck myself a couple times through a glove. Once was when I was trying to tap a shoulder joint and stupidly tapped my finger instead with the 18 gauge when I removed it. It’s an embarrassing process to go through, even more so when you sheepishly report it to the charge nurse who has better things to do. Patient is notified and tested, charge nurse is notified, a giant packet is given to fill out, and employee health harasses you until you do various steps for follow up. Today I was suturing with Ethilon (f-ing Ethilon! I like Prolene for a reason) and when tying a knot, the suture string snapped, and somehow the suture needle flew up into my glove, pricking my finger enough to make it bleed. I had a fleeting thought of reporting it but the patient was a healthy military kid and I figured it was low risk so I got a new suture and moved on. I know that the PEP available for HIV but I remember reading somewhere that the chances of getting HIV from a needlestick even from a known source is 1/300. I admit that not reporting it is not the sharpest thing but here I am...

I would never report what happened to you above.

You will be fine! No PEP necessary

Some people don't realize it, but HIV dies within about 10 seconds of being exposed to air. I know that's not applicable to you above, but I'm just sayin

 

[thegenius]

It's not hiv that's the scary one.

Hep C is the scary one. 1-2 percent transmission rates, can't do crap about it if your person is positive for hepatitis, no prophylactic medications you can take.

Always report. Always.

now we have meds to get rid of Hep C. Like Epclusa. That's good.

But correct no prophy meds for Hep C

 

[sylvanthus]

Question. How is this handled for independent contractors? Are you entitled to the same compensation for meds in the off chance you convert?

Sent from my Pixel 3 using SDN mobile

Going through this now as an IC, getting the runaround from everyone, the state, the hospital, teamhealth. Likely gonna have to pay the bloody ED bill myself. Awesomesauce.

 

[Brigade4Radiant]

IC you are on your own you don’t have employee health. College got needle stick just registered her as a patient and she had to pay for everything that is the hospital protocol you. None of these meds will be covered for you if you are an IC.

 

[TheSingularity]

Fantastic. Add this to the list of reasons CMGs suck and why I'm so happy to be free of them.

 

[cyanide12345678]

now we have meds to get rid of Hep C. Like Epclusa. That's good.

But correct no prophy meds for Hep C

Yeah and those meds treat only a type 1 infection, 60 percent or so of all hep C infections. Plus they cost 100k. So yeah... If there's an off hand chance that i could be paying 100k or 3k monthly for hiv meds, then yes i will swallow my ego and report things. What if i end up with any of those diseases? At least workman's comp covers those expenses then.

 

[deleted497653]

Yeah and those meds treat only a type 1 infection, 60 percent or so of all hep C infections. Plus they cost 100k. So yeah... If there's an off hand chance that i could be paying 100k or 3k monthly for hiv meds, then yes i will swallow my ego and report things. What if i end up with any of those diseases? At least workman's comp covers those expenses then.

You should definitely report work related injuries and not worry about how it will make you look. Even as independent practitioners you can report these and get appropriate documentation. There is usually a time limit. Not sure if it’s 24 hours to report.

your cmg doesn’t care that you’re trying to save them the trouble of having to deal with an employee injury. Think of yourself and your family and report injuries.