Some questions about needlestick injuries

[mar1981]

I have been seriously considering going into nursing after taking a EMT class first. But to be honest now am starting to question if this would be the right decision on my part. I have been helping to take care of my grandmother who has recieved many blood transfusions in her lifetime. She is diabetic and as such I give her the insulin shots. I usually keep my eye on the needle at all times after I give the injections of insulin but I lost the cap on the needle, could not find it and as such tried wrapping it in a paper towel.

I took the needle bent it back on the barrel of the syringe and rewrapped it real good using tape. Later on I began to question if I was careful enough wrapping the syringe to ensure I was not stuck because I lost site of it and my fingers were in the area of the needle. So here are my questions.

1) Can you be stuck in the hand-fingers with a syringe and not know it? Would you usually always feel it and would there usually always be blood when stuck in the fingers?

2) On a needlestick injury does the skin have to be cut all the way to the point of bleeding to allow for transmission of HCV, HBV, HIV?

3) Even being careful, do most nurses get a needlestick injury at some point in their careers?

[NO50FRANNY]

Hi there,

Two needlesticks in 14 years. One was nothing, but the other was a different story. I was looking after a trauma patient who was hep C +ve and a junkie. At some point during his care I noticed blood on the inside of my glove, and it was a bloody trauma as well, I broke the skin through a glove and didn't feel it. The patient and co-worker in the room told me to run, which I did. Have never scrubbed my hands like that before or since. The policy in our hospital dictates that regardless of hour, the Infectious diseases consultant is contacted in high risk cases. My registrar at the time was fairly convinced that I would need post exposure prophylaxis and phoned the ID consultant at home at 3am. Interestingly the glove is key. The patient consented to all the blood tests and serology spun off the HIV in less than an hour. Because the HIV came back negative and the injury was through a glove, the chances of transmission were so tiny that PEP was not thought to be useful. It is fairly complicated but it has a lot to do with viral load of the patient at the time and whether you are wearing gloves. Hope this is helpful. I would imagine that transmission via a wound that wasn't bleeding would be miniscule.

[canesdukegirl, BSN, RN]

You wrapped that sucker tightly, didn't you?!? Good job. A word of caution-it isn't the safest thing to bend back a used needle. You probably already know that, but if you find yourself in this situation again, clip off the top of a pencil eraser and embed the needle in it. Or you can use a wine cork.

I work in the OR, so the risk for needlestick injuries is high. I got my first needlestick when I was scrubbed in for a Vag Hyst. The pt was in lithotomy and the surgeon was to my left. The back table was behind the surgeon about 2 ft away. I had to stand sideways so that I didn't contaminate the back table with the back of my gown. The surgeon reached back and put a used 2-0 Vicryl on the back table and asked for 3-0 Monocryl. As I was reaching for the needledriver on the back table to change out suture, she changed her mind and without looking at me, she grabbed the driver back, sticking me in the process. She cursed me out for not being careful with sharps. She never apologized. So much for the hands-free zone, eh?

Another time, I was holding retractors for another vag hyst. My back was facing the pt's head and I was leaning over the pt's left leg. He was using the pt's belly as a mayo stand (I know, real nice, huh?) and threw a big honking 2-0 Nylon up, tearing my glove and grazing the back of my hand. It didn't bleed, but the skin was broken. The surgeon was very apologetic, and I gave him a piece of my mind for being careless AND for using the pt's belly as a mayo stand. I filled out an incident report, did the whole needlestick protocol, etc. So my nurse manager calls me into her office the next day and demands to know why I wasn't more careful. HUH? I felt like I just entered Crazytown.

Thank goodness neither of these pt's had anything dirty in their blood. I have known other nurses to be on the unfortunate side of dirty needlesticks. It is always a very scary ordeal.

To answer your questions, yes-you can be stuck and not know it, especially during a trauma case. If any sharps break the skin, it is considered a needlestick injury.

[diva rn, BSN, RN]

Hi, first of all, in the hospital you don't generally ever recap a used needle. (or any open needle for that matter)

There are sharps containers all over the place, you merely take the entire used needle to the container and drop it in.

As one poster said before, it's not a good idea to bend the needle back...it seems like it would be safer but it really isn't.

I have had only 1 needlestick in 19 years that really was nothing and it was with a clean needle.

HOWEVER....before I became a RN I was a Registered Dental Hygienist who worked at an HIV clinic...this was back in the late 1980's....were were extremely vigilent and double gloved and draped, gowned, masked and visored and wrapped everything.

One day I was reaching for another instrument and my assistant was reaching for the same one...and I accidently impaled the palm of my hand on one of my scalers............!!!!! I think my entire life flashed before my eyes....I ripped off both of my gloves and it did bleed. Scrubbed it like crazy and of course called the Medical Officer in charge of the Health dept (who I worked for)...obviously my pt was HIV+ we knew that already...so, I was tested and given anti-virals....and tested at I think 6 weeks, 3 months, 6 months and 1 year...and all was fine!!!!

But that was scary! Far scarier than ever working as a nurse and I have since taken care of hundreds of HIV, AIDS and HepC and HepB patients....and other scary things.....

Just be careful....you will be fine..and don't let the fear of a needlestick keep you from becoming a nurse if that's what you want to do.

[JZ_RN]

You might not feel it, and it doesn't have to bleed to transmit whatever, still risks are low.

I don't suggest working with the elderly/dementia patients if you fear needlesticks though. They are almost all diabetics and flail, roll, grab at you, etc when you stick them for insulins. scariest part of my job besides the violent ones...

[mar1981]

Thanks everyone for the replies...althought I must admit I am still confused. I talked with my mom's friend who is a nurse and has been for 18 years. She stated that with a insulin syringe in the hand that I would feel it for sure. She said "its happened to me several times and unless you have a medical condition such as neuropathy you would have felt the needle in your finger." She went on to remind me that the fingers are one of the most sensitive parts of the body and that if still in doubt I should take a sterile needle, alcohol swab and try it in my finger. It makes sense but now I am reading that some of you have been stuck and not felt it. That is scary.

[mar1981]

Can anyone tell me if you get stuck in the fingers with a insulin syringe (that was the only place possible for me with my grandmother) if you would usually always feel the stick and/or bleed in that area?

[MPKH, BSN, RN]

Sure you'd feel it if you prick yourself with the needle...but you might not always bleed tho. I accidentally pricked my index finger with a clean needle ( thank goodness) and while I felt the prick I didn't bleed.

[NeedleTape]

Hoping you come out clean on this one! It must be scary not knowing. What I find troubling in a few of these posts is that a surgeon and nurse manager were blaming a nurse for being careless! This is crazy making. Needlestick safety is EVERYONE's responsibility in the OR suite. You could be the most careful nurse ever but not everything is in the nurses control.

Nurses are an integral part of the healthcare continuum of care and should be treated with more respect.

[Double-Helix, BSN, RN]

I'm just curious- are you disposing of the sharps properly at home? Recapping the needle, or bending it back and then wrapping it in a paper towel might be enough to keep you from getting stuck- but what about the people who are taking out the trash?

Sharps should never be thrown in the regular trash- recapped or not. You should be using a hard plastic container (clearly labeled as Needles or Sharps)- such as an empty laundry detergent bottle- and putting the needles in there after they are used. You don't need to recap them if they are going straight into the sharps container- and that's the best way to avoid sticking yourself. Keep the container by the bed and go straight from giving the injection to throwing it away. Call your local sanitary department to find out how to safely dispose of your needle container once it's filled.

[Cathylady]

What about those 'safe' needles that some hospitals use. Do they prevent needle sticks?

[Stephalump]

My friend is in an MA program at a CC (trying to get experience for PA schools). The program director was an MA for a plastic surgeon, but can no longer practice because she contracted hepatitis.

When the students asked how, she said she didn't know, but it was probably a dirty needle at work. I had no idea you could be stuck and not know it!