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Needle sticks (Question for all nurses, esp those in ER)

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Anyone ever had a needle stick?

I am a first year student, and one of our instructors in school yesterday was telling us about a new grad who had only been out of school for 6 months when she got a needle stick. Apparently she had been following all proper procedures, was not doing anything wrong or taking any "shortcuts" or anything like that - but what happened is that immediately after she had removed the needle from the patient, the patient jerked out of pain and caused her to accidentally stick herself. Turns out she later tested positive for HIV.

This sounded kinda scary to me - particularly because it happened in the ER. I myself have always kind of been leaning towards wanting to work in the ER, but hearing this story concerns me - because I would imagine that the ER would be perhaps the most high-risk area for needle sticks. The reason I say this is because I would think that the ER would have a much higher percentage of patients who are either intravenous drug users and/or mentally or physically unstable (shaking or unable to stay still and thus causing a needle stick/accident) and/or patients who have uncertain or questionable health histories.

Do you think that needle sticks are more common and/or present a greater risk in the ER?

DutchgirlRN, ASN, RN

Specializes in OB, M/S, HH, Medical Imaging RN. Has 33 years experience.

immediately after she had removed the needle from the patient, the patient jerked out of pain and caused her to accidentally stick herself. Turns out she later tested positive for HIV.

99.7% of needlestick exposures do not lead to infection.

Do you think that needle sticks are more common and/or present a greater risk in the ER?

I would think that the ER would have a much higher percentage of patients who are either intravenous drug users and/or mentally or physically unstable (shaking or unable to stay still and thus causing a needle stick/accident) and/or patients who have uncertain or questionable health histories.

It depends on which type of hospital you work in and where that hospital is located. Your average hospital has no more IV drug users, mentally unstable or patients with questionable health histories in the ER than they do on the floors.

I don't work in ER but I've had a needle stick. I was cleaning a IV pump and the nurse had left a needle dangling from tubing (why I don't know). As I attempted to remove the needle (it screwed off) the cap came off and stuck me. I tested negative for HIV and hepatitis.

I know the risk is really low of contracting HIV from a needle stick. I work in a small hospital and we do get lots of drug users and such. I think I'm the only one that has had a stick in the past 2 years.

Here's a link to the CDC website: http://www.cdc.gov/hiv/resources/qa/qa28.htm

Scientists estimate that the risk of infection from a needle-stick is less than 1 percent, a figure based on the findings of several studies of health care workers who received punctures from HIV-contaminated needles or were otherwise exposed to HIV-contaminated blood.

I think that you are at risk for a stick in any department. Just remember that safety is first. Always expect the patient to jerk away from you. That way if they do, you'll be prepared.

Thanks to all so far for the responses....

99.7% of needlestick exposures do not lead to infection.

Where do you get that statistic from? And are you referring to HIV or any kind of infection? Just curious. Thanks!

DRBear432

Specializes in Adult Critical Care and Emergency. Has 20 years experience.

Thanks to all so far for the responses....

Jedi:

When you are placing or removing a needle from a patient best practice and your full attention to that proceedure need to supercede everything but a pre-code situation. I try to review the proceedure in my head then make sure I have the tools needed and finally secure the sharp rapidly and appropriatly.

Safety first. We cannot practice effectively in fear, so confidence and skill are next. And all this is gained through experience. If this is a proceedure that is new to you it is certainly reasonable to ask a more experienced nurse to mentor you throught the process. Discuss any new proceedure with yor peers and glean experience from their experiences.

Almost 20 years in nursing and starting IV's since 1975 without a needle stick, knock on wood. [insert banging on my head here]

Dutchgirl is right, very few sticks lead to infection, and the most common infection contracted this way is hepatitis. If that student converted to HIV+, was the source pt positive? I'm finding it hard to believe that the stick was responsible.

I have had so many sticks in 19 years of working ER that I lost count and don't even blink anymore.

Dutchgirl is right, very few sticks lead to infection, and the most common infection contracted this way is hepatitis. If that student converted to HIV+, was the source pt positive? I'm finding it hard to believe that the stick was responsible.

I have had so many sticks in 19 years of working ER that I lost count and don't even blink anymore.

Wow. Those are interesting comments you make.

The instructor who was telling us this story did not elaborate, but she did definitely imply that yes, the patient was the source of the infection. I think that was the whole point of her telling the story. This story was also told to our class after having shown us a video with interviews of nurses who had gotten Hepatitis B from needle sticks (the nurses had never recieved the Hep-B vaccine, obviously).

So Tazzi - as a strictly hypothetical question - are you saying that you would allow a needle that had been used on an HIV+ patient (or any patient, for that matter) to be poked into your skin?

Also, you say that you've had several needle sticks and "don't even blink anymore". I'm curious - when you get a needle stick, do you simply do nothing and continue about your day? The reason I ask is because part of the video also included discussion on very crucial follow-up procedures, such as making sure that an RN who experiences a needle stick from an HIV+ patient recieve an accelerated vaccine within 2 hours of the incident.

Wow. Those are interesting comments you make.

The instructor who was telling us this story did not elaborate, but she did definitely imply that yes, the patient was the source of the infection. I think that was the whole point of her telling the story. This story was also told to our class after having shown us a video with interviews of nurses who had gotten Hepatitis B from needle sticks (the nurses had never recieved the Hep-B vaccine, obviously).

So Tazzi - as a strictly hypothetical question - are you saying that you would allow a needle that had been used on an HIV+ patient (or any patient, for that matter) to be poked into your skin?

Also, you say that you've had several needle sticks and "don't even blink anymore". I'm curious - when you get a needle stick, do you simply do nothing and continue about your day? The reason I ask is because part of the video also included discussion on very crucial follow-up procedures, such as making sure that an RN who experiences a needle stick from an HIV+ patient recieve an accelerated vaccine within 2 hours of the incident.

Yes, it happens but it is extremely rare. I believe the 99.7% that Dutchgirl mentioned comes from the CDC.

I'm not going to answer for Tazzi, but I know that we are required to report needle sticks even if it is a clean stick. I was told the CDC and health depts use this data to determine percentages. Also, it's pretty darn hard to dodge the infection control nurse after you report a needle stick. With me, she came up to me at work and reminded me to get blood drawn for my follow ups. I'm told not all those who experience a needle stick receive the HIV cocktail. Certain risks are assessed. In my case, OR had pt's blood left over from surgery and that was tested. I worked with a pregnant RN who received a needle stick. She was offered the cocktail but it was up to her whether or not to risk her life or the baby's. She chose not to take the cocktail.

RNDude

Specializes in Critical Care.

...Here's a link to the CDC website: http://www.cdc.gov/hiv/resources/qa/qa28.htm

I happen to have had had a discussion with an infectious disease doc about these statistics in my last semester of nursing school. I came away from that conversation with the understanding that these results are interpreted as meaning that if you get a needle stick injury, AND the needle is contaminated with blood from a patient KNOWN to be HIV+, then your chances of seroconverting to HIV+ yourself are actually less than 1%.

I think this may have been pretty much said already, more or less, but I just want to be clear the statistic doesn't seem to be for needle stick injuries overall, but rather for the needles from known HIV+ patients.

And yes, hepatitis is by far easier to transmit. Get those hep-B vaccines!

wow. those are interesting comments you make.

the instructor who was telling us this story did not elaborate, but she did definitely imply that yes, the patient was the source of the infection. i think that was the whole point of her telling the story. this story was also told to our class after having shown us a video with interviews of nurses who had gotten hepatitis b from needle sticks (the nurses had never recieved the hep-b vaccine, obviously).

so tazzi - as a strictly hypothetical question - are you saying that you would allow a needle that had been used on an hiv+ patient (or any patient, for that matter) to be poked into your skin?

also, you say that you've had several needle sticks and "don't even blink anymore". i'm curious - when you get a needle stick, do you simply do nothing and continue about your day? the reason i ask is because part of the video also included discussion on very crucial follow-up procedures, such as making sure that an rn who experiences a needle stick from an hiv+ patient recieve an accelerated vaccine within 2 hours of the incident.

wow.....you read a lot into what i said........

let's forget about hypothesis......no one allows him/herself to be stuck with a contaminated needle. it happens. oftentimes it's because of someone's carelessness, but ya know what? sometimes it happens no matter how careful one is.

no, i do not allow a contaminated needle to poke my skin and then just go on my merry way. i follow all procedures.....cleaning, reporting, submitting to labs, prophylaxis if indicated, etc. i do everything by policy.

by "i don't even blink anymore" i mean that i do not let the fear of "what if?" take control over my life. i do not let the incident terrify me, and i do not spend my time worrying everytime i have a needle in my hand, wondering if i'm going to get stuck again. this does not mean i don't care, nor does it mean i'm not scared. i just don't let the fear control my life, because until the lab results come back and unless something comes up positive, there isn't a darn thing i can do about it.

and here's some information about needlestick exposures that corroborates what dutch said.

http://www.emedicine.com/emerg/topic333.htm

now i'm really gonna stir the pot: i very rarely wear gloves when giving injections or even starting ivs. i can start almost all my lines without any blood leaking out. if i poke myself, wearing gloves isn't gonna do squat.

BillEDRN

Specializes in ED, critical care, flight nursing, legal.

Besides treatment to prevent infection, it is extremely important to document ANY needle stick for purposes of any future claim that may arise out of a subsequent infection. What happens if you do get HIV or hepatitis? Do you think your facility is going to pay for the associated costs for treatment or care without something to document it happened at work? Not likely. Just think about how your facility handles your "routine" illnesses that are very likely from occupational exposures....

NursingAgainstdaOdds

Specializes in Med-Surg/Tele, ER. Has 2 years experience.

When I was in nursing school, I was terrified of needlestick injury. Not just because of what it could mean for me, but also because I was (and am) nursing a toddler. A needlestick would = instant traumatic weaning (where I'm all about child-led weaning, my kiddo's still nursing at 2.5 yrs :D).

Yeah, it's a scary thought. However, fear will only get you so far. It's all about safe practice and doing what you can to avoid a needlestick injury. Take precautions and follow protocol.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

Safe practices are what is important. Always wear gloves, use the protective equipment and:

"Public health recommendations during the 6 months following exposure to blood, include:

. NO sharing of personal items, such as needles, toothbrushes and razors;

. NO unprotected sexual intercourse;

. NO breast-feeding; and,

. NO blood, semen, or organ donations"

This is from the Indiana.gov site:

http://www.in.gov/isdh/healthinfo/needle%20sticks.htm

WakeUpRN

Specializes in PACU, Med/Surg.

And yes, hepatitis is by far easier to transmit. Get those hep-B vaccines!

I am in my first semester of nursing school, and already the classroom instructor has gone over needlestick infection statistics.

Not sure if this is accurate, but it is what we are being taught and tested on.

She said the risk of contracting HBV after a needle stick is close to 30% and the risk of contracting HIV is under 2%.

sharona97, BSN, RN

Specializes in IM/Critical Care/Cardiology.

I was stuck by a needle when a doc left the needle and syringe in the glove paper as I was cleaning a Mayo Stand. This was before Work Comp and Osha regs got it together and made the stiched up pt get a blood draw (as well as nurses) and got a name and etc etc. I think the regulatory rules have helped towards this problem today. But I will never know the pt name of who I helped the doc stitch up. Scary!

sharona97, BSN, RN

Specializes in IM/Critical Care/Cardiology.

:uhoh21:DON'T FORGET TO CHECK UP ON HEP C AS WELL!

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