Thinking of Marrying A Surgeon??

[NYRN]

Well, if you took a moment to calm down, take a deep breath, and stop crapping your pants long enough to do a search, you could find a few answers. To answer your question, yes, there have been cases where healthcare workers most likely were infected by HIV after getting stuck by a dirty needle. It's not that common anymore, but there are reports where it has happened.

Secondly, you don't get AIDS from patients, you get HIV.

Finally, needlesticks are less of a big deal, in terms of HIV, because there's post exposure prophylaxis, the rate of transmission isn't necessarily all that high on its own, etc. Hepatitis B is also not a big deal, since you should be vaccinated against that. The REALLY scary one is Hepatitis C, which does have a high rate of transmission, does not have a vaccine, does not have any form of post-exposure prophylaxis, and has a good chance of becoming chronic and possibly evolving into liver cancer. Premeds always get in a tizzy about HIV, but that's not the scariest possibility.

Just as an FYI, if any of you are ever exposed to Hep C via a needle stick or other exposure, there is some hope. Although it's not really prophylaxis, there is treatment available. In a nutshell it works like this.

If you are exposed to Hep C, you are tested at that time to determine if you already have Hep C. If not, than you are tested over a period of 6 months or so.

If you convert, then you are treated for Hep C right away using the drug combo Pegasys and Copegas. From what I have been told by a doc who specializes in Hepatitis and liver disease, the cure rate is pretty close to 100% when treated in this manner.

Even then, everyone please be careful. Don't rush during invasive procedures, or when suturing and for god sakes, NEVER leave needles in the patient's bed!! I can't tell you how many people have been stuck because people don't clean up their sharps or they stick the needles in the mattress and forget about them.

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[Winged Scapula]

Just as an FYI, if any of you are ever exposed to Hep C via a needle stick or other exposure, there is some hope. Although it's not really prophylaxis, there is treatment available. In a nutshell it works like this.

If you are exposed to Hep C, you are tested at that time to determine if you already have Hep C. If not, than you are tested over a period of 6 months or so.

If you convert, then you are treated for Hep C right away using the drug combo Pegasys and Copegas. From what I have been told by a doc who specializes in Hepatitis and liver disease, the cure rate is pretty close to 100% when treated in this manner.

Even then, everyone please be careful. Don't rush during invasive procedures, or when suturing and for god sakes, NEVER leave needles in the patient's bed!! I can't tell you how many people have been stuck because people don't clean up their sharps or they stick the needles in the mattress and forget about them.

Hmmm....I've never heard of, seen,or thought about doing this, even when placing lines during arrests. Are you sure these are surgeons doing this?

 

[Rabbit Hole]

Just as an FYI, if any of you are ever exposed to Hep C via a needle stick or other exposure, there is some hope. Although it's not really prophylaxis, there is treatment available. In a nutshell it works like this.

If you are exposed to Hep C, you are tested at that time to determine if you already have Hep C. If not, than you are tested over a period of 6 months or so.

If you convert, then you are treated for Hep C right away using the drug combo Pegasys and Copegas. From what I have been told by a doc who specializes in Hepatitis and liver disease, the cure rate is pretty close to 100% when treated in this manner.

Even then, everyone please be careful. Don't rush during invasive procedures, or when suturing and for god sakes, NEVER leave needles in the patient's bed!! I can't tell you how many people have been stuck because people don't clean up their sharps or they stick the needles in the mattress and forget about them.

Leaving needles in the bed or sticking it in the mattress. Totally healthy.. completely normal.

 

[NYRN]

Hmmm....I've never heard of, seen,or thought about doing this, even when placing lines during arrests. Are you sure these are surgeons doing this?

Usually inexperienced residents either don't realize that they haven't cleaned up all their sharps or they leave a mess for others to clean up and then someone gets stuck with a needle that was hidden in paper or the linen. I wouldn't say only surgeons do this, EM physicians and nurses do it too although I think that for the most part, people are being careful not to leave sharps in the bed.

If I'm assisting an MD with a procedure, I'll clean up papers and such as we go along if I can. I don't mind one bit. However, I think that the risk of a needlestick goes up if u have one person passing sharps to another rather than the doc disposing of them herself.

 

[Arcan57]

Hmmm....I've never heard of, seen,or thought about doing this, even when placing lines during arrests. Are you sure these are surgeons doing this?

Probably not, but IM residents do relatively few procedures these days. A large percentage of the PGY2s I've supervised do not have the concept of sharps safety ingrained into them. It's one of the few times I'll sit back and watch a nurse light up a resident.

 

[Winged Scapula]

Probably not, but IM residents do relatively few procedures these days. A large percentage of the PGY2s I've supervised do not have the concept of sharps safety ingrained into them. It's one of the few times I'll sit back and watch a nurse light up a resident.

Perhaps.

But I've used a knife to cut food since I was a child and would know better than to leave something sharp lying around where others can be hurt by it. Whether you do a lot of procedures or not, sounds more like either lacking in common sense or basic principles of procedures.

Why are IM residents doing so few procedures "these days"? Our IM residents did their own lines (of course the use of PICC lines has increased substantially), thora/paracentesis, chest tubes, etc. Only at the VA and a local Catholic hospital (without residents) did we do all of them.

 

[Ronin2258]

Even then, everyone please be careful. Don't rush during invasive procedures, or when suturing and for god sakes, NEVER leave needles in the patient's bed!! I can't tell you how many people have been stuck because people don't clean up their sharps or they stick the needles in the mattress and forget about them.

Not rushing is key.

If it is emergent, most of the kits have single shot staple appliers in the kit, which I have had to use. It was a Hep C, IVDA patient that was bucking and fighting that they needed an emergent central line in. Perfect subclavian hit, and once the line was in, instead of sewing it in (no drivers, and only a Keith needle in the kit,) and risk her bucking the needle through my hand after it has been through her and her blood on my gloves, I grabbed the staples and snapped them in to hold the line. Held long enough to get her through the night and they secured it with stitch once she calmed down the next day.

Probably not, but IM residents do relatively few procedures these days. A large percentage of the PGY2s I've supervised do not have the concept of sharps safety ingrained into them. It's one of the few times I'll sit back and watch a nurse light up a resident.

The old scrub tech in me would be ripping said resident a new part in their anatomy if they dropped or misplaced a needle. Pretty hard-wired into me. It still irritates me when I drop a needle doing clothing repairs.

Why are IM residents doing so few procedures "these days"? Our IM residents did their own lines (of course the use of PICC lines has increased substantially), thora/paracentesis, chest tubes, etc. Only at the VA and a local Catholic hospital (without residents) did we do all of them.

You would be surprised how scared witless some of them are now a days over placing a peripheral IV. I was consulted on quite a few line placements by my IM colleagues (one of the top 5 reasons surgery was consulted during this time of the year.) I would try to get the IM interns to do them with my guidance to sign them off to do them, as the program required them to certify. They would try to dodge, some succeeded, but they knew I would teach them if they called.

Our PD talked to their PD regarding the central line "dump" on us, and it got better as time progressed.

Medicine is practiced with your mind, heart, and hands. Some of my IM colleagues at my old hospital forgot that last part.

 

[Arcan57]

Perhaps.

But I've used a knife to cut food since I was a child and would know better than to leave something sharp lying around where others can be hurt by it. Whether you do a lot of procedures or not, sounds more like either lacking in common sense or basic principles of procedures.

Why are IM residents doing so few procedures "these days"? Our IM residents did their own lines (of course the use of PICC lines has increased substantially), thora/paracentesis, chest tubes, etc. Only at the VA and a local Catholic hospital (without residents) did we do all of them.

I'm sure there is a broad range of procedural experience across programs, but I have seen from medical school to being an attending a decrease in the procedural skills of the IM residents I've worked with. I admit this could be more a trend of the institutions rather than one of time. However, it seems like more procedures that used to be done by residents are now done by the fellows. As a result fewer IM attendings are comfortable with performing these procedures. This in turn meant that they were uncomfortable with supervising their residents during these procedures. Or at least that was an excuse I heard often.

Even uncomplicated paracenteses/thoracenteses are increasingly IR procedures (the necessity of that is debatable) and more hospitals have line teams: either PICC or a pulmonary run CVC service that collects revenue that lost when unsupervised residents perform a procedure. Increasing the prevalence of U/S, especially for IJs and taps, may return some of these procedures back to being a standard IM practice.

 

[NYRN]

Probably not, but IM residents do relatively few procedures these days. A large percentage of the PGY2s I've supervised do not have the concept of sharps safety ingrained into them. It's one of the few times I'll sit back and watch a nurse light up a resident.

I don't think I have ever seen an IM resident place a central line. Surgery does it if the patient is on the floor and EM does it in the ER obviously.

I have never seen an attending leave sharps around, they are very good at making sure everything is cleaned up. The times where ER staff have been stuck by a needle 9 times out of 10 were surgery residents doing procedures for patients boarding in the ED without a supervising attending present. They leave a mess to clean up, and several PCT's and nurses have been stuck. One housekeeper was also stuck (with a needle + syringe full of blood ) because the resident threw the whole central line tray in the garbage without taking the sharps out. I felt so sorry for him because we could not determine who the blood was from to even test a source patient.

One thing that I see all the time that is a hazard is when the docs put the guidewire into the sharps container with the ends of the guidewire sticking up and out of the container. Instead, they should bend it in half from the middle and then put the ends into the container facing down so that nobody gets stuck.