Needle Stick Protocol - Antiretroviral?

Specialties Disease

Published

Greetings!

Like many of the nurses who have posted here, I'm the luck recipient of a needle stick. Our "safety needles" aren't so safe and the sheath didn't click, allowing the needle to protrude.

I immediately reported it to my supervisor, filled out an incident report and was told that employee health would contact me to set up lab work. I got a doctors order for labs on the patient and thought nothing more about it.

Today I was confronted by a member of management who found out about the stick and initially thought I had not reported it. When I assured her that I followed procedure, she asked me if I had been offered an antiretroviral. I had not.

It was then revealed to me that the patient has a history of sexual abuse and possibly prostitution in a foreign country and no medical records.

My question is this - Are antiretrovirals the gold standard for needle sticks from high risk patients? Since it's been more than a week, is there any use in starting them now?

Thanks for your input.

Specializes in Emergency Nursing..

The patient should have been tested. The gold standard of care is a rapid HIV test and you should have results in less than 12 hours, usually with in an hour. If the source patient is HIV positive then starting on the anitretrovirals is extremely important. There has actually been no documented case of HIV transmission to a health care worker who started on meds right away. One week out is a little late I would think. I would attempt to find out what the source patient's results were and if they were negative I would just continue to with the labs. You should have labs at exposure, one month, three months, six months, and one year.

I took a needle stick in the back of the knee. My dumb*** boss at the time left an IV stylette sitting on the bench of our ambulance. I knew instantly what that prick was. I was ****** more than anything else. Tests came back all negative. Fortunately for me, the patient was an old pentacostal lady who claimed to have never had sex with anybody but her long dead husband nor having ever received any blood products.

Specializes in Adult primary care, college health.

Ideally PEP is started within 1-2 hrs of exposure, and at least within 24-36hrs. I'm not sure how effective it would be 1 wk after exposure, if at all; at this point it's probably more worthwhile to track down the pt's results than to worry about - likely unnecessarily - exposing yourself to the drug toxicity of ARVs (as spoken by someone who was on a 3-drug regimen for a month after a stick from a known HIV/HCV+ pt).

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