needle prick AGAIN

[NewlyGradBSN]

this is so frustrating. after being careful all these months, i've been stuck with a needle yet again.

it was the 11th hour and so this was what happened. after consuming a sidedrip for an antibiotic, i was being careful and when I removed it, and prepared to dispose of it, something was painful. Then, I realized that it pricked my the gauge 18 needle that was just in the y-port earlier. I checked back at the y-port to check for blood exposure of the needle, there was none. I interviewed the patient and there was little chance that she contracted hep b or hiv in the past 3 years, because he spent time at home and wasnt going to work or school.

the policy of our institution regarding needle pricks are not nurse-protective. I dont trust our infection control officer and I think she is divulging unnecessary information. and when we report these cases, the expense will be shouldered by the nurse and we will write a report and we will be reprimanded for not being too careful. please I need your input.

[Esme12, ASN, BSN, RN]

First of all you need to examine why you are getting stuck so much. I have been a nurse a really LONG Time and I can count on one hand the times I've been stuck. Slow down. Breathe.

Your facility doesn't use a needless system?

As for the nurse being responsible...that is crazy it is a work related injury and covered by workman's comp. I have never heard of such a thing. These are OSHA regulated. They are using intimidation to prevent reports so they look good under reporting guidelines. https://www.osha.gov/OSHA_FAQs.html

What state do you live in. Many states have passed laws about needless systems....check to see if your is one..... for example my state

MASSACHUSETTS

(1999 MASS HB 5394)(Signed into law 8/00)

Provisions:

1. Requires the Department of Public Health to develop regulations requiring hospitals to use "only such devices which minimize the risk of injury to health care workers from needlesticks and sharps" except in certain circumstances approved by the state (including where the hospital can prove that use of the safety device would interfere with a medical procedure or patient/employee safety issues exist or alternative equally effective measures are in place);
   
2. Requires the Department to develop and to maintain a list of safety devices for employers' use;
   
3. Requires hospitals to develop written exposure control plans, include a procedure for selecting safety devices, include safety devices as engineering controls, maintain a confidential sharps injury log (to be used for continuous quality improvement activities and to be reported to the Department annually), and
   
4. Requires the appointment of an advisory committee to assist in developing the regulation and list of safety devices.
   

Unique:

1. Mandated use of sharps injury log for continuous quality improvement activities;
   
2. Sharps injury log confidentiality provision, and
   
3. Specific limited application to hospitals.
   

http://www.cdc.gov/niosh/topics/bbp/ndl-law-1.html

This was a y port for a med.....little if any exposure....most facilities would not even consider testing or treatment. That being said all sticks should be reported

Workers are entitled to working conditions that do not pose a risk of serious harm. To help assure a safe and healthful workplace, OSHA also provides workers with the right to:

• Receive information and training about hazards, methods to prevent harm, and the OSHA standards that apply to their workplace. The training must be in a language that workers can understand;
  
• Receive copies of the results from tests and monitoring done to find and measure hazards in their workplace;
  
• Review copies of records of work-related injuries and illnesses that occur in their workplace;
  
• Receive copies of their workplace medical records;
  
• File a confidential complaint with OSHA to have their workplace inspected;
  
• Participate in an OSHA inspection and speak in private with the inspector;
  
• File a complaint with OSHA if they have been retaliated or discriminated against by their employer as the result of requesting an inspection or using any of their other rights under the OSH Act; and
  
• File a complaint if punished or discriminated against for acting as a "whistleblower" under the 21 additional federal laws for which OSHA has jurisdiction.
  

See OSHA's Workers' Rights page for more information.

[Esme12, ASN, BSN, RN]

I'm sorry I just noticed that you are not in the US....I have no idea what the regulations are in the Philippines.

We cannot offer medical advice as per the Terms of Service.

[NewlyGradBSN]

Esme, you are the sweet. I wasn't seeking medical advice though. I'll be leaving this hospital soon. I was just paranoid and I wanted reassurance that there is little to no exposure which is what you've said. thank you.

[Esme12, ASN, BSN, RN]

I know honey....you deal with a different regulating body and clientele and you should talk with your doctor..... From medscape...Needle-stick Guideline Treatment & Management it requires registration but it is free

The need for HIV or chemoprophylaxis (antiretrovirals) is based on an assessment of the risk by using the 3-step process developed by the Centers for Disease Control and Prevention (CDC).^[6]

• Step 1: Determine exposure code.
  
  • Is the source material blood, bloody fluid, other potentially infectious material, or an instrument contaminated with one of these substances? If not, there is no risk of HIV transmission? If yes, what type of exposure occurred?
    
  • If the exposure was to intact skin only, there is no risk of HIV transmission.
    
  • If the exposure was to mucous membrane or integrity-compromised skin, was the volume of fluid small (ie, few drops, short duration) or large (ie, several drops or major splash, long duration)? If small, the category is exposure code 1. If large, the category is exposure code 2.
    
  • If the exposure was percutaneous, was it a solid needle or a superficial scratch (ie, less severe)? If yes, the category is exposure code 2.
    
  • Was it from a large-bore hollow needle, a device with visible blood, or a needle used in a source patient's artery or vein (ie, more severe)? If yes, the category is exposure code 3.
    

  [*]Step 2: Determine HIV status code.

  • What is the HIV status of the exposure source? If HIV negative, no postexposure prophylaxis is needed. If HIV positive, was the exposure low titer or high titer? Low-titer exposures are asymptomatic patients with high CD4 counts: These are HIV status code 1. High-titer exposures are patients with primary HIV infection, high or increasing viral load or low CD4 counts, or advanced acquired immunodeficiency syndrome (AIDS): These are HIV status code 2. If HIV status is unknown or the source is unknown, the HIV status code is unknown.
    

  [*]Step 3: Match exposure code with HIV status code to determine if any postexposure prophylaxis is indicated.

  • Postexposure prophylaxis recommendation
    
    • Exposure code 1 and HIV status code 1: Postexposure prophylaxis may not be warranted. Exposure type does not pose a known risk. The exposed health care worker and the treating clinician should decide whether the risk for drug toxicity outweighs the benefit of postexposure prophylaxis.
      
    • Exposure code 1 and HIV status code 2: Consider the basic regimen. Exposure type poses a negligible risk for HIV transmission. A high HIV titer in the source may justify consideration of postexposure prophylaxis. The exposed health care worker and the treating clinician should decide whether the risk for drug toxicity outweighs the benefit of postexposure prophylaxis.
      
    • Exposure code 2 and HIV status code 1: Recommend the basic regimen. Most HIV exposures are in this category. No increased risk for HIV transmission has been observed, but use of postexposure prophylaxis is appropriate.
      
    • Exposure code 2 and HIV status code 2: Recommend expanded regimen. Exposure type represents an increased HIV transmission risk.
      
    • Exposure code 3 and HIV status code 1 or 2: Recommend expanded regimen. Exposure type represents an increased HIV transmission risk.
      
    • HIV status code unknown: If the source or, in the case of an unknown source, the setting where the exposure occurred suggests possible risk for HIV exposure and the exposure code is 2 or 3, consider the postexposure prophylaxis basic regimen.
      

  [*]Basic regimen: 4 weeks of zidovudine (600 mg/d in 2-3 divided doses) and lamivudine (150 mg twice daily)

  [*]Expanded regimen: Basic regimen plus either indinavir (800 mg q8h) or nelfinavir (750 mg 3 times/d).

  [*]Interferon ribavirin prophylaxis decreases risk by 40%. Exposed workers should be counseled on the risks of disease transmission based upon their specific exposure.

[NewlyGradBSN]

Esme, thank you for your last post. In my nursing experiencce, i have been pricked about 3 times, the 3 traumatic times I wwas worried.and now this third time. I really sae no blood on the needle. I somehow know the history of the patient. Im just scared and im thinking that maybe i shouldnt be a bedside nurse:( i dont know