Needle Stick injury

Specialties Management

Published

Need some help! I am a new nurse manager at an ambulatory surgery center. I was given no formal training for this position so I've been learning as I go, & using some prior knowledge I gained while working on a med/tele floor & as an assistant manager in a LTC. So I need any advice I can get!

I have an employee who experienced a needle stick injury and was exposed to pt blood. The employee informed me of this incident 3months after it happened and can't remember who the pt was. I've followed every step we have to do when a needle stick injury occurs. This employee stated they did not want to tell me because they didn't "feel like going through all the testing & have to write an incident report." Well my problem is now that employee wants to go through testing (5 months post needle stick). I've tried to look into this issue (even asked other nurse managers I know) but each has told me different. I need some advice on what my next steps should be?

GrumpyRN, NP

1,280 Posts

Specializes in Emergency Department.

In my opinion - for what it is worth considering I am in the UK - you need to discipline the employee. THEY did not follow procedures and are now expecting you to cover their back. In UK I would be looking to give a formal warning and also ensuring that they are following protocols on everything else. The protocols are in place for a reason and people do not get to choose which ones they follow.

What would be the point of testing now? It tells you nothing useful. If they have Hepatitis or HIV did they get it from the patient or some random time in the past 5 months or even prior to the needlestick? They can't even remember which patient so obviously nothing written at the time and you are unable to risk assess the patient.

In my opinion - for what it is worth considering I am in the UK - you need to discipline the employee. THEY did not follow procedures and are now expecting you to cover their back. In UK I would be looking to give a formal warning and also ensuring that they are following protocols on everything else. The protocols are in place for a reason and people do not get to choose which ones they follow.

What would be the point of testing now? It tells you nothing useful. If they have Hepatitis or HIV did they get it from the patient or some random time in the past 5 months or even prior to the needlestick? They can't even remember which patient so obviously nothing written at the time and you are unable to risk assess the patient.

Thanks for replying :)

The employee did receive a warning & I made her review & re-sign our policy for needle inj. I also had an outside speaker come in (from the health department) to do a BBP review & I changed the device to a safer one (despite hesitation from staff including that employee). I agree, there'd be no point now for testing, but now she's insisting on getting tested. This employee is well aware of timelines on testing, since they've been a RN for over 25yrs.

enuf_already

789 Posts

Suddenly after 3 months, the employee wants tested? Did she become scared, symptomatic, or have a community exposure (you will likely never know the real answer).

Since she can't remember the patient, there would be no proof if she tested positive for anything, that it was work related. She is insisting on testing and she's going to make your life miserable until she gets what she wants.

Do you have a risk management department who can guide you? With no incident report within the required time and no patient to link to the needle stick, it doesn't sound like your employee has any grounds to insist on testing at her employer's expense, but legal/risk management may say otherwise.

I'd involve risk management/legal on this one so you have backing and a solid answer. Good luck.

edmia, BSN, RN

827 Posts

Specializes in Emergency, ICU.
Suddenly after 3 months, the employee wants tested? Did she become scared, symptomatic, or have a community exposure (you will likely never know the real answer).

Since she can't remember the patient, there would be no proof if she tested positive for anything, that it was work related. She is insisting on testing and she's going to make your life miserable until she gets what she wants.

Do you have a risk management department who can guide you? With no incident report within the required time and no patient to link to the needle stick, it doesn't sound like your employee has any grounds to insist on testing at her employer's expense, but legal/risk management may say otherwise.

I'd involve risk management/legal on this one so you have backing and a solid answer. Good luck.

Completely agree! My first impression is that she was exposed elsewhere and is trying to get treatment covered by workman's comp. I'm cynical that way.

If she wants testing, tell her to go to her regular physician. It's not a work issue because she did not report it and can't prove the exposure happened at work. Run it by risk management, but that's my instinct here.

Sent from my iPhone -- blame all errors on spellcheck

psychnursie

28 Posts

I agree, I think she was exposed elsewhere.

Thanks for replying :)

The employee did receive a warning & I made her review & re-sign our policy for needle inj. I also had an outside speaker come in (from the health department) to do a BBP review & I changed the device to a safer one (despite hesitation from staff including that employee). I agree, there'd be no point now for testing, but now she's insisting on getting tested. This employee is well aware of timelines on testing, since they've been a RN for over 25yrs.

Testing is definitely worthwhile now. HIV can take 6 months or longer to show up. Educate and test.

I understand s/s of HIV can take months to yrs to show, but I don't understand how this employee would be able to prove that that needle stick was the source of infection. I mean this employee can't remember who the pt was, let alone the exact date it happened (can only give me an approx week it happened). I agree testing would not be a bad idea, but would it not be all on her effort?

Thank you for replying! :)

This employee states she is not symptomatic but feels that testing is now necessary & is insisting on it. This person can't provide me with the exact date of the injury either (just the month & approx. week it may have happened). Employee also states they questioned pt (@ time of stick) & pt states clean hx. Unfortunately I don't have a RM department (small surgery center) I can turn to.

GrumpyRN, NP

1,280 Posts

Specializes in Emergency Department.
Testing is definitely worthwhile now. HIV can take 6 months or longer to show up. Educate and test.

I understand that it takes time to sero-convert for HIV I used that as an example. It is less for Hepatitis though and that may be what the test is being asked for. I repeat, what is the point in testing someone for something that may have been caused by somebody but they don't know who, they don't know when and they did not document it at the time. It is surely now up to the employee to prove that they WERE stuck. Having read the comment about workers comp - which does not exist in the UK - it does sound as if this person has been up to some risky behaviours and wants to be tested so that they can blame their employer.

This person can't provide me with the exact date of the injury either (just the month & approx. week it may have happened).

She is blaming a patient, therefore the employer would now have to go to every patient that that person has had contact with in those weeks and question them and test them as they may have hepatitis/HIV. Every patient that that employee has been in contact with in the past 5 months would also have to be contacted to offer testing as they may have been looked after by an infected nurse.

edmia, BSN, RN

827 Posts

Specializes in Emergency, ICU.
Thank you for replying! :)

This employee states she is not symptomatic but feels that testing is now necessary & is insisting on it. This person can't provide me with the exact date of the injury either (just the month & approx. week it may have happened). Employee also states they questioned pt (@ time of stick) & pt states clean hx. Unfortunately I don't have a RM department (small surgery center) I can turn to.

Too bad! Then go to the owners and ask them to provide you with legal guidance.

Why isn't the employee just going to their doctor and getting tested? Or your local department of health? If paying for testing is the issue, there are plenty of free options.

Sent from my iPhone -- blame all errors on spellcheck

I understand s/s of HIV can take months to yrs to show, but I don't understand how this employee would be able to prove that that needle stick was the source of infection. I mean this employee can't remember who the pt was, let alone the exact date it happened (can only give me an approx week it happened). I agree testing would not be a bad idea, but would it not be all on her effort?

I think you've handled it very well, by the way. Warning the employee, re-signing the policy, & educating staff were needed steps. I just think, even though you have limited information, it would still be wise to at least offer testing for HBV, HCV, & HIV to the employee. Refusing to offer testing to an employee reporting a sharps injury, no matter how delayed, would make the employer look pretty bad, if you ask me. I would also consider evaluating the safety of the medical device used and ensuring the employee is using it properly.

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