Hep C exposure?

  1. I'm currently just finishing my first year of nursing school. A couple of weeks ago at clinicals my patient (known Hep C), pulled out her IV as she was getting dressed and then stuck her bleeding hand in mine before I realized what was happening. So I washed my hands really good and checked for any open places on my hands, which there were not. I told my teacher who said don't worry about it. So I didn't worry. Then today, another teacher overheard me talking about it and freaked that protocol had not been followed and that something more should have been done. I had to go talk to the director of the program about what happened. And she basically has me so stressed and worried. I'm 4 months pregnant, and she just kept saying "we're even more worried because you're pregnant. So I called my doctor and got tests started, but I guess my questions are how likely is it that I could have contracted hep c with no needlestick, and how long could it be before a test could show up positive. Being pregnant is just not making things better, I'm so darned emotional right now!
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    About bandas

    Joined: Oct '05; Posts: 76; Likes: 43
    Pulmonary RN; from US
    Specialty: Pulmonary


  3. by   Lacie
    I agree it should still have followed protocol but dont let them freak you out. If they are so worried then they should be concerned with emotional stressing you out during pregnancy also. Remember Hep C is very short lived once out of the body unlike Hep B which can hang on for quite awhile. Also you immediately washed and had no cuts or open areas on your hands. I would still get the routine test done but dont over concern yourself at this point. I was exposed back in the day to Hep B and fortunately developed a natural immunity rather than developing the disease or being a carrier. I have no clue of how or where but when I started in nursing we didnt wear gloves for much other than cleaning poo or trach care. So potential exposure back then just wasnt a thought. Just be more cautious in the future and next time insist that policy and procedure be followed in cases of potential exposure.
  4. by   VegRN
    What is your facility policy?
    According to the CDC (Center for disease control), you were NOT exposed. Hospitals should be following these guidelines. CDC define exposure as:

    "An exposure that might place HCP (health care personnel) at risk for HBV, HCV, or HIV infection is defined as a percutaneous injury (e.g., a needlestick or cut with a sharp object) or contact of mucous membrane or nonintact skin (e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other body fluids that are potentially infectious (16,17)."

    The entire document is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm

    and is titled
    "Updated U.S. public health service guidelines for the management of occupational exposure to HBV, HCV and HIV and recommendations for postexposure prophylaxis."

    Also, Hepatitis C does not die immediately as Lacie suggested. According to the CDC, the virus can live outside the body for at least 16 hours but not greater than 4 days if the temperature is at least 25 degrees C.

    To sum it up, you were not exposed to Hep C. Your skin was intact and there was no stick. I am wondering why the second teacher is "freaking out". Honestly, I would bring the CDC report to the instuctor that is freaking out and hand it to her. She isn't up to date with her facts and she should be basing her recommendations on evidenced based medicine which she is not. She is also needlessly scaring you.

    What does your doctor say about this? I am sorry that others are implying that this is an exposure which, it isn't. I highly recommend that you read the full CDC report above, I think it would help you ease your mind.

    Take Care
  5. by   bandas
    Thanks for directing me to the CDC guidelines. I tried to call my ob today but he and his staff were not in the office so I was planning on calling back on monday. I call my general practitioner's office and talked to his nurse. She gave me basically no info, just said she got an order for a test and that I could come into the lab. When I asked her the about how soon it would show up on a test she said she didn't know. (It has been 2 1/2 weeks). And then when I was trying to explain what happened she cut me off and said "just come into the lab" and that was it.
  6. by   TazziRN
    A pox on your GP's nurse!!!

    Depending on how freaked out I was, I would request a callback from my OB and apologize for bugging him after hours. Explain what happened and ask what the risks are. If he/she is compassionate he/she would forgive you for the call and understand your fears.
  7. by   RNfromMN
    Quote from VegRN
    I am wondering why the second teacher is "freaking out".
    I'm gonna go out on a limb here & say the 2nd instructor is playing a little game knows as "Covering Your Posterior." And that is absolutely, without a doubt what I think the program director is doing.

    I'm not that cynical of a person, but even before I got done reading the original post, I was thinking, "They're thinking lawsuits, newspaper headlines, student buzz, the whole nine yards." Not that I can really blame them, I suppose - it's gotta be tough work being an instructor & a program director. Definitely entails some responsibilities that I don't think I'd ever want to handle. Kudos to your clinical instructor for not trying to freak you out.

    This is what Teacher #2 & the Program Director are envisioning:

    "Well, did you hear about what happened to Bandas? Well, I'm not really sure exactly what happened, but I heard she contracted Hep C at clinical...& her instructor didn't even do anything about it!"

    "Yeah, I would have gone to that school, but I heard a girl who was nine months pregnant - with twins - got stuck by a dirty needle & contracted Hep C...& after she told her instructor she got stuck, the instructor didn't even do anything."

    "Good morning. The reason I requested this meeting is because I have a client that claims she was exposed to Hepatitis C while practicing as a student during one of her clinicals. My client claims she informed her instructor of the exposure & no precautions were taken afterward. My client is asking for this dollar amount as compensation...or would you rather settle this in court?"

    See what I'm saying? Rumors & lawsuits. It's their job to get freaked out about stuff like that. Too bad they had to freak you out in the process. I agree with VegRN - try not to totally lose your cool about this. Hey, here's a positive - you'll probably never get a test question wrong regarding Hepatitis C ever again!
  8. by   meownsmile
    If they were so worried, why didnt THEY get your bloodwork done etc. Why is it that it is on your nickle that you get tests done? Maybe take them the bill and have them pay it for not following protocol. I know you are worried because of your pregnancy not because of a bill, but they are more worried about the bill.
  9. by   ElvishDNP
    Veg is right, this is technically not an exposure, but if it were me and I were pregnant, I would still want labs drawn, even if it were on my nickel.

    I had a similar incident as a newbie nurse; known HIV pt had an AV access rupture and instinct kicked in, I went flying into his room & slammed my bare hand down on it to apply pressure. I was trying to stop the bleeding and not at all thinking of his status. Of course there is blood everywhere and it was actually the patient who hollered at me to go get some gloves on. I rinsed my hands (not washed) in hot water at the time (STUPID!), & put some gloves on as I didn't want this guy to bleed out on me....

    End of the story...I called it to OH (happened on a WE night) and to my mgr, neither of whom flipped out, no labs done, so I just went on. Were it to happen again, I would probably insist on labs at least for me. But fortunately everything came back neg when I did get tested. I know the feeling...best of luck. Please let us know what happens.
  10. by   VegRN
    Quote from meownsmile
    If they were so worried, why didnt THEY get your bloodwork done etc. Why is it that it is on your nickle that you get tests done? Maybe take them the bill and have them pay it for not following protocol. I know you are worried because of your pregnancy not because of a bill, but they are more worried about the bill.
    Exactly, if there is a policy "that wasn't being followed" why aren't they covering themselves by bending over backward?

    Although, I believe at many nursing schools, you have to sign a waiver saying if you get injured in clinical, you have to use your own insurance to pay costs associated with it. Students are not considered employees and therefore are not covered under a hospitals employee health coverage in the same way paid employees are.

    Also, our hospital, like many hospitals, has a very strict policy where employees must report all exposures i.e needle sticks, splashes to non intact skin or mucous membranes. If they do not and then contract hep c or hiv and try to pin it on the hospital, their requests for compensation are denied. It then seems that the hospital may have some leverage to call out "slander" if you then say that you "contracted it at work" if there is no report filed. I do believe that if you get exposed to intact skin, i.e. not a true exposure, they will still test you at your request, for free.

    Our hospital is somewhat proud of the fact that no employees have contracted HIV in the line of duty. However, they don't come right out and say it but, employees have contracted hep c from exposures in the workplace. In addition, at least one surgeon has contracted hep c from needle sticks obtained while suturing up pts however, he never reported any exposures and apparently had many. So that isn't even considered "contracted at work", only "possibly contracted it at work". You must, must, must report your exposures.

    Of the two needle sticks on my unit, from hep c/hiv positive pts (one stick had both), neither nurse has converted. One stick happened while the nurse was in a hurry (one of that nurses chronic characteristics) and the other because the safety device was not activated.

    I agree with the previous poster, I bet you will be very careful in the future.

    And yes, if I was worried, I would get tested but, understand that your risk in your situation is extremely low. And remember this.....

    Transmission is affected by the length of the needle, depth of the inoculation and size of the inoculation (how deep and how much).
    Just remember the rule of 3's:
    • For Hepatitis B the risk is 30%.
    • For Hepatitis C the risk is 3%.
    • For HIV the risk is 0.3%.
    In actuality, the recent CDC report says the chance of contracting hep c is 1.8% after a needle stick but I guess the rule of 3's is so much easier to remember