Needle Sticks: how common? When doing rotations has it happened to you?

[midoritori2013]

Hi

 

So I'm really accident prone. I got my finger caught in a handheld blender once. Yeah. So I've read on some Doctor forums about all these people in residency that have been stuck accidentally with a needle. Either they did it themselves, another student did it, or even a doctor (cutting one with a scalpel in surgery).

 

So two questions

 

How common is this?

 

And during rotations, will they stick you with higher risk patients that have HIV etc?

 

Thanks for any insight here?

[Reality Check 2]

25 yrs - been stuck twice - once by an ortho surgeon with a CTX needle through the tip of my long finger on an 89 year old female with a hip fracture. Went through all the testing - nothing.

 

Next stick was actually a slice and I did it myself with a 10 blade on donor bone trying to remove a chunk of tendon. The bone was fully tested and nothing was contaminated - so basically a giant nothing.

 

The protocols and exposures for needle sticks are easily found on several websites.

 

Getting stuck on rotations has a lot to do with what rotation you are on and what your role and position is. As a trauma student in a level one trauma center - I had a lot of exposure years ago.

 

Hepatitis B is a bigger risk than HIV.

 

I would strongly recommend looking up the workplace needle stick exposure statistics - really not that impressive anymore.

 

Learn proper technique and USE IT FOREVER. A lot of not getting stuck is your job and being aware of your surroundings.

 

In 25 yrs I have assisted on many Hep C and HIV patients - never treated them much differently than anyone else and in trauma - your patients are a complete unknown - literally - might not even know their name at first but they are trying to die and I was part of the team trying to save them.

 

Be smart, be safe, be aware.

[NYCPAC]

Never happened to me personally but happened to my best friend in PA school on an ER rotation. Patient was HIV+ and Hep C+ ....she had to follow with an ID doc for an entire year essentially. Had to take a few meds and I know one of them made her so sick that she couldn't finish the remainder of her ER rotation and had to repeat it. Word of advice- treat every procedure with the same amount of care and caution. Protect yourself with proper technique and always pay careful attention to what you're doing

 

 

Sent from my iPhone using Tapatalk

[jlumsden]

Needle sticks are uncommon, but happen.  Fortunately, post exposure prophylaxis for HIV and Hep C have gotten much, much better in the past few years.  Just be careful, use universal precautions, and don't treat patients any differently just because they have certain blood borne illnesses.  You'll be fine.

[rev ronin]

Learn proper technique and USE IT FOREVER. A lot of not getting stuck is your job and being aware of your surroundings.

This.  Never two-handed re-cap anything.

[EMEDPA]

2 needle sticks in 30 years. once stuck by a surgeon on trauma surgery rotation, once stuck myself with IV needle. neither resulted in a poor outcome.

[FrankB]

ICU nurse for 9+ yrs.

One needle stick from a lady so thin the heparin needle went through her skin then into me.  

Then one glucose check that squirted from the guy's finger into my eye...of course he had hep C.  6 months of labs, but in the clear.

 

Don't recap, don't cut or poke anyone who is moving too much. 

 

Use PPE like everyone has gonoherpasyphilaids with Hep C and you will most likely avoid getting stuck. PPE protocols typically fail when people don't follow them.

 

I don't think they will "stick you with HIV patients" most medical professionals know the risks are low and take precautions.  A person with HIV, Hep C shouldn't be treated any differently.

[Poetsiren]

My school had a specific set of procedures for students with needle sticks in addition to the hospital/site protocols - be sure to check up with your school, too!
 
But yes, practice and keep those techniques!! Pay attention to everything when you are handling needles or someone around you is. Be AWARE of your surroundings and people in it.
 
As a non-certified CNA in surgery LOOONG before PA school, I was kind of accident prone. For instance - while I was knelt in the surgical suite picking up a piece of equipment during a procedure, someone kicked a nasty "kick bucket" (they are on rollers) in my direction and didn't say anything and I cut my arm on it when I turned (Yes, I was pretty PO'ed). The hospital workers' health office was like "oh, you can get worse things on a shopping cart at Walmart" and they didn't want to do the full procedure and series of tests. I said, "I don't care - test me." I had to make them do it and keep up with all of the protocols, dates, and the exposure timeline "windows" on my own. I was 19. Know the hospital protocols!
 
That said, during my PA rotations I didn't get stuck at all. However, I came CLOSE to getting stuck once in surgery when the first assist and I were closing and I grazed and snagged my outer glove on my hand with the needle I was using in the opposite hand. Of course, that needle wasn't used on the patient after that, and I stopped and the first assist finished closing that case without me.
But I know plenty of others who got stuck while on rotations! Again, Pay attention to technique, your placement of all of your appendages, and where everyone else is in the room and what they are doing if there is a needle or scalpel in use!

 
Also, on rotations I was placed with Hep C patients and HIV patients before I knew they had it...... you still have to do your job.

So, anticipate it and THIS: 

Use PPE like everyone has gonoherpasyphilaids with Hep C and you will most likely avoid getting stuck. PPE protocols typically fail when people don't follow them.

[DogLovingPA]

16 years in medicine, only one stick and that was as a medic trying to draw up meds in the back of a bumpy ambulance so needle was clean.

 

You're much more likely to be exposed to urine, stool, vomit.....

 

As a PA student I volunteered to scrub in on the surgery cases of HIV patients because the med students all refused. Everyone deserves good care.

 

Like all have said above, be careful and follow protocols. Most of the students I have seen have the most trouble with needles when they are suturing.... don't grab the suture needle with your fingers :-)

[GetMeOuttaThisMess]

I must be a klutz. Wasn't uncommon to stick myself with a suture need while I was in ED. Never mentioned it, all subsequent tests have been negative, and I've had all the available series. Usually a jerking kid with improper immobilization from co-worker while trying to sew somewhere on head. I'd ask family if any pre-existing health issues. We're talking 90's-early 00's.

[mmiller3]

I had a surgeon stick me while in my surgery rotation in school. It was a *&%$* mess. My school told me I was covered under the hospital I was rotating with, and the hospital told me the school was covering me. I spent about 6 hours in 3 different clinics before finally having an HIV test drawn at the very location I sustained the stick at. None of the clinics that turned me away had any problem charging me to tell me they wouldn't treat me. After I received the bill, no one would cover it, so I was stuck (again) with a $400 bill.

 

Just typing this out reminds me how salty I still am, almost 10 years later...

[Reality Check 2]

From my work in Occupational Medicine - I wrote the bloodborne pathogen protocol for companies, employers, hospitals, police departments, etc.

 

Getting the ER or anyone to actually FOLLOW THE PROTOCOL has proven profoundly difficult.

 

There is risk stratification based on the source person - route of transmission and method of exposure. 

 

Nursing, med and PA students that I dealt with were covered by their educational entity in conjunction with the hospital/clinic etc and there should never be a cost to the stickee (for lack of better word). 

 

It is an area that no one wants to deal with and everyone freaks out about and, in reality, the risk factors and actual conversion rates for those exposed is very very low.

 

So, prevention is still the key!! 

[Febrifuge]

 

>> How common is this?

 

As above, it seems to vary a bit but in general, pretty uncommon. To the extent you have control, just be sure to do everything right, and you should be able to protect yourself. If you're not naturally good at being careful, then it's an opportunity to develop a skill. I'm not naturally organized or great at time-management, but I've put in the effort and gained some skills because of the need to pay extra attention, and those skills have served me.

 

>> And during rotations, will they stick you with higher risk patients that have HIV etc?

 

You probably didn't mean any offense, but you should probably plan on being "stuck with" patients of all kinds, with all kinds of diseases and risk factors. And you'll do better and be happier if you think of it as being given the chance to learn, not as something that's being done to you.

[Guest UVAPAC]

From my work in Occupational Medicine - I wrote the bloodborne pathogen protocol for companies, employers, hospitals, police departments, etc.

 

Getting the ER or anyone to actually FOLLOW THE PROTOCOL has proven profoundly difficult.

 

There is risk stratification based on the source person - route of transmission and method of exposure. 

 

Nursing, med and PA students that I dealt with were covered by their educational entity in conjunction with the hospital/clinic etc and there should never be a cost to the stickee (for lack of better word). 

 

It is an area that no one wants to deal with and everyone freaks out about and, in reality, the risk factors and actual conversion rates for those exposed is very very low.

 

So, prevention is still the key!! 

Any chance you are willing to post this protocol?  I would be curious to see how it compares to our hospital.  Thanks.

[Reality Check 2]

Any chance you are willing to post this protocol?  I would be curious to see how it compares to our hospital.  Thanks.

 

The corporate behemoth that I worked for told me it was THEIRS because I worked there when I wrote it. Let me clean it up a bit and I can put out a copy.

 

Another ding for corporate medicine.......................... jerks

[loliz]

Be careful with EVERY patient!! You are at as much a risk with the middle aged housewife as you are the homeless guy that looks like he's had better days. Learn proper technique and if you know you are a klutz, then get over it and pay attention to what you are doing. 

 

That being said, as a student, you will come across all kinds of cases, however the student is often protected. My school had a policy that we were not to touch a patient in OR, procedures or phlebotomy that had known HIV, HBV, or HCV. I'm not sure that all schools did this, but at multiple sites, this policy was known, accepted and mostly followed (ie. how often will you get to do an LVP on a cirrhotic as a student if you can't touch hepatitis?).

[GetMeOuttaThisMess]

Be careful with EVERY patient!! You are at as much a risk with the middle aged housewife as you are the homeless guy that looks like he's had better days. Learn proper technique and if you know you are a klutz, then get over it and pay attention to what you are doing.

 

That being said, as a student, you will come across all kinds of cases, however the student is often protected. My school had a policy that we were not to touch a patient in OR, procedures or phlebotomy that had known HIV, HBV, or HCV. I'm not sure that all schools did this, but at multiple sites, this policy was known, accepted and mostly followed (ie. how often will you get to do an LVP on a cirrhotic as a student if you can't touch hepatitis?).

I wish I had known then how simple it was to rectify the problem. Kid swiveling his head like The Exorcist had no culpability.

[cbrsmurf]

Three times, with dirty needles, in 5 years or so.  Once as student, preceptor stuck me in ED with suturing needle.  Twice by the surgeon I work with.  Guess I'm a pincushion compared to everyone here.  

[ventana]

two exposures for me

 

one - in IR, tried to suture my finger tip to a patients chest....  didn't work..... ;-) - v- - hours and hours in ER - all testing negative in long run

second, guy with massive 4+ kissing tonsils who coughed and blew phlem all over my face and eyes on oral exam... normally who cares, but in 2-3 weeks I was scheduled to go to honduras for relief mission for 3 weeks - off label valtrex and was fine

 

biggest teaching points

1-NEVER used two handed recap (I did not count the time I jammed a new clean needle into my hand doing a two handed recap)

2-PPE helps - PUT ON A FLUID SHIELD MASK for just about any procedure.....  oh yeah I forgot one exposure, injecting an abscess - darn thing blew up and chunks of pus and goo right into my mouth - that stuff tastes nasty....... massive mouthwash with water and what every else I could jam in my mouth - this is the last time I ever did not put on a fluid shield face mask for I&D

 

 

 

 

Recently this was a bit of a push in the literature (admittedly this is no longer my field) saying that we are not prophylaxing people enough...... 

[rpackelly]

So the bottom line is not so common on a day to day basis, but over a whole career, you will almost always have one or two incidents if you do any procedures at all. I have had maybe three or four "real" sticks over 40 years. No adverse effects. More likely you will have an accident on your way home from work after call when sleep deprived