Co-worker stabbed in surgery

Pediatric Critical Care Columnist · Mar 6, 2008

I would have done just what you did. I think the physician was very cavalier about the risks and the psychological effects of potential exposure to this young woman and that if the state college of physicians knew about this incident there would be a censure issued. I agree that the likelihood of your coworker having caught anything is quite low, but the blood and body fluid exposure protocol is in place to protect everyone. With all the emphasis on privacy laws these days, she will have no access to information about that patient and can only be absolutely certain she's in the clear by being tested herself. As for whether you should send her flowers... what would you want your coworkers to do if you were the one exposed? I'd rather have a hug and a cup of coffee.

ScaredNewNurse · Mar 6, 2008

I apologize, but what I meant to imply was what about the employer sending flowers to the injured employee due to his partner's negligence.

Munchkin315 · Mar 6, 2008

What a scary situation!

I, personally, would not want to work with that particular phys. But, alas, want is not something that happens often in the real world.

Sometimes it amazes me how people just blindly agree with things. I almost always ask for a second opinion when it comes to ANYTHING. I would have done the same thing if I was in your shoes.

**canoehead, BSN, RN** · Mar 7, 2008

She needs to be tested now, to prove she was negative before the accidental stick. If she converts without proof, she will be out of luck as far as claiming medical expenses. They did a nice end run around her to save themselves millions if there is an issue down the road.

ebear, BSN, RN · Mar 7, 2008

:yeahthat: EXACTLY

core0 · Mar 7, 2008

Hi all! I'm obviously a new nurse. I recently received my first RN nursing job at a private practice office. I have been on the job three full weeks.
Yesturday, one of the CMA's assisted a physician with an excision. During the surgery, the physician struck the coworker's hand with a pair of pointed, small surgical scissors. The incident broke the skin and resulting in some bleeding.
Afterwards, the concensus was that the patient would go for a HepC,B panel and HIV test. The doctor who owns the practice said that given the patient profile, the CMA was at low risk, and if the patient came back negative, she would be OK. He told the patient to have the bill sent to the office and told the office manager to send the patient flowers. He also told the CMA that it was unlikely for her to contract any illness. Basically, that the patient was getting tested and the necessity for her to be tested was not that large. Also, the chances of her "catching something" was so slim it was not worth the side effects from the AZT prophylatics.
I told the girl today that I would go get tested now, six weeks and three months out. She should not really rely on the patient as NO ONE really knows what goes on in someone's private life. In my education, I was told that there was a three month window. So that patient could have a had a one night stand last night, the night before or two weeks ago. Also, the patient's husband may have had an indiscretion.
For my own piece of mind, I would get tested. I would start AZT prophylatics. I called CDC and Univ. of CA exposure hotline today. According to UCA, someone would typically seroconvert in 25 days and with near 100% certainity know in three months that they would remain negative. Did I do the wrong thing in telling my coworker my opinion?
I don't want her to be upset, but I don't want her to blindly believe that if the patient tests negative now, she will be OK. She doesn't want to work with that doctor anymore and rightfully so. Today, I was the unlucky one who had to take over and assist with this physician's surgeries.
I'm afraid I'll get stuck working with her for the remainder of my employment. I was in an incident with this same physician previously when she nearly poked me with a suture needle.
I am appalled at the way the primary physician handled the whole incident. They didn't even give the poor girl the rest of the day off paid!:angryfire I would have been livid. I didn't want to be put in this situation. I didn't want to have to assist this physician. What about sending flowers to the employee that was exposed? :angryfire
What would you guys do?

Here's the CDC fact sheet for bloodborne exposure.

http://www.cdc.gov/ncidod/dhqp/pdf/bbp/Exp_to_Blood.pdf

It really depends on whether this is a high risk individual or not. There are a number of guidelines, I don't see a CDC one but here is a definition of high risk that I have:

Such "high-risk" behaviors, according to the guidelines, include:

men who have had sex with men after 1975
men and women having unprotected sex with multiple partners
past or present injection drug users
persons being treated for sexually transmitted diseases; and
persons with a history of blood transfusion between 1978 and 1985.

Of course people usually don't admit to high risk behavior. While the danger of bloodborne pathogens is real it is also very small in general population. If the person was know to be HIV positive post exposure prophylaxis is generally recommended. I am not as involved as I was in this but the rules generally were not to start PEP unless HIV was documented. The side effects from the drugs are pretty severe (two drug combo now). Here is the fact sheet from aids.org:

http://www.aids.org/factSheets/156-Treatment-After-Exposure-to-HIV-PEP.html

You should get the HIV status back within 24 hours. If it was me I would have drawn it there and sent it stat. Hopefully the CMA has their HBV vaccination done. HCV has more infectious potential. Generally if we had a needlestick we would check HIV, HCV and HBV antibody. Then HCV RNA every month x 6 and HIV ab every month x 6. From my understanding if you get past six months you are usually in the clear. Other than that be supportive and give the physician some blunt scissors until they learn to play well;).

David Carpenter, PA-C

fins · Mar 7, 2008

She should definitely get tested, but the prophylactic meds are a different issue. The side effects are not trivial. When I had my needlestick (by a doc), I absolutely got tested, but the patient was low risk, so I didn't take the meds. It's not like taking a course of antibiotics or something.

TiredMD · Mar 8, 2008

. . . if the state college of physicians knew about this incident there would be a censure issued.

For what exactly?

Pediatric Critical Care Columnist · Mar 8, 2008

For attempting to minimize the potential risk of harm to the nurse. For attempting to conceal the surgeon's role in exposing the nurse to those risks.

core0 · Mar 9, 2008

For attempting to minimize the potential risk of harm to the nurse. For attempting to conceal the surgeon's role in exposing the nurse to those risks.

The Board of Medicine's job is to protect the public from poor physicians. Unless you can show that the physician did this deliberately then there isn't much there. It would be hard to punish a clumsy physician unless there was injury to the patient.

Not sure why attempting to minimize the potential risk for harm to the nurse would be a bad thing. I'm assuming that you mean that the did not attempt to minimize the potential for risk for harm to the nurse (sounds like a nursing diagnosis). General blood borne contact rules cover this. The problem is enforcing compliance with the person that owns the business.

As far as attempting to conceal the surgeons role (pretty broad definition of surgeon here), I don't see this either. Its not like the OP said the physician told the MA to hide anything or document anything that was untrue.

Unfortunately this is pretty standard in small physician practices. Larger practices will have policy and procedure to address these (you can buy a policy handbook from a number of places) as well as professional management that is informed about risk. In smaller practices (like most small business) it falls back onto the physician who may or may not have up to date knowledge. Bad form by the physician? Sure. Trying to actively conceal something, not from what we heard.

She needs to be tested now, to prove she was negative before the accidental stick. If she converts without proof, she will be out of luck as far as claiming medical expenses. They did a nice end run around her to save themselves millions if there is an issue down the road.

Actually the practice put themselves at tremendous risk. You can't test an employee before employment but the reason that employers test employees for viral hepatitis and HIV after a needlestick is to document whether it was a pre existing condition or not. If it is a pre existing condition then they are not liable for treatment. If it was not present but then the employee develops HIV, HBV or HCV then the practice is liable. If they didn't document then their workmen's comp also might refuse to cover sticking the employer with the bill. Once again this is indicative of a small business that does not understand risk and good employment policy.

David Carpenter, PA-C