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

[Jedi of Zen]

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?

[BillEDRN]

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]

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 ).

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]

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]

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]

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]

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

[sharona97, BSN, RN]

Well said.

[Jedi of Zen]

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

well, like i said - your comments were interesting.

i guess i also found it interesting that drbear, who responded right before you did, said that she had worked for almost 20 years and never had a single stick; you then said that you'd worked about the same number of years and had had so many that you lost count.

[TazziRN, RN]

A) I still find it hard to believe that the stick was responsible because the stats are SO LOW for HIV transmission from needlesticks.

B) "I guess I also found it interesting that DRBear, who responded right before you did, said that she had worked for almost 20 years and never had a single stick; you then said that you'd worked about the same number of years and had had so many that you lost count."

And your point is? That is my experience, no one else's. Sometimes it was my fault. Once I was poked by a phleb when I held a newborn for her to draw. Another time I was involved in a code with a non-intubated pt; when the doc pushed on the pt's chest vomitus came flying out of his mouth and into my face. Another time I helped a doc with an I&D....he had the scalpel in his hand and turned around, didn't realize I was standing right next to him and he cut my arm.

Dr. Bear has been very lucky. S/he is also in the MINORITY for never having suffered a needle stick.

[DRBear432]

TazziRN:

I did not research this carefully but our Infection Control gang agrees that hepatitis A, B, C are a more likely than HIV transmission. This seems consistent with the CEU stuff I do every year for FL. But it does not mean I want to risk a dirty needle stick!

I suspect the instructor was using expert experience and fear to instill the vigilance needed into her novice students. That fear may be counter-productive in some cases and the novice nurse may opt out of direct patient care as a result. This instructor might include some of the follow-up information to mitigate that fear, using the risk of needle sticks as a positive teaching opportunity.

Additionally, I am a paramedic, ED nurse, and critical care nurse. I have had numerous needle sticks in the past 20 years but no used needle sticks. Every time I kick myself for putting speed ahead of safety,or for my own complacency, and thank God the needle was clean. I have witnessed numerous needle sticks and in almost every case I have learned something new and this improves my prearedness and vigalance. But this does not stop me from performing my duties rather it reinforces the need for care and vigilance among all members of the health care team.

DRBear, RN, CCRN, NRP

PS: Your anecdotal report of numerous needle sticks might identify another issue: under reporting of needle sticks. We as nurses cannot fix a problem if we do not have a good idea of the scope of the problem. I hope you work in a non-punitive envronment where reporting and followup is prompt and medicallly appropriate.

A) I still find it hard to believe that the stick was responsible because the stats are SO LOW for HIV transmission from needlesticks.

B) "I guess I also found it interesting that DRBear, who responded right before you did, said that she had worked for almost 20 years and never had a single stick; you then said that you'd worked about the same number of years and had had so many that you lost count."

And your point is? That is my experience, no one else's. Sometimes it was my fault. Once I was poked by a phleb when I held a newborn for her to draw. Another time I was involved in a code with a non-intubated pt; when the doc pushed on the pt's chest vomitus came flying out of his mouth and into my face. Another time I helped a doc with an I&D....he had the scalpel in his hand and turned around, didn't realize I was standing right next to him and he cut my arm.

Dr. Bear has been very lucky. S/he is also in the MINORITY for never having suffered a needle stick.

[TazziRN, RN]

TazziRN:

I did not research this carefully but our Infection Control gang agrees that hepatitis A, B, C are a more likely than HIV transmission. This seems consistent with the CEU stuff I do every year for FL. But it does not mean I want to risk a dirty needle stick!

PS: Your anecdotal report of numerous needle sticks might identify another issue: under reporting of needle sticks. We as nurses cannot fix a problem if we do not have a good idea of the scope of the problem. I hope you work in a non-punitive envronment where reporting and followup is prompt and medicallly appropriate.

When did I say I wanted to risk it?? I just said that it's more likely to contract Hep than HIV through a needle stick.

I have never been treated punitively because of exposures. The sticks that were my fault were clean sticks also. The dirty ones were either pure accidents, failure of the safety devices, or I was poked by someone else.

I hope the OP sees your clarification about your needle sticks, she's under the impression (as was I) that you had never had one.

I must be tired. I seem to be the only one that makes any sense of what I said.

[Jedi of Zen]

When did I say I wanted to risk it?? I just said that it's more likely to contract Hep than HIV through a needle stick.

I have never been treated punitively because of exposures. The sticks that were my fault were clean sticks also. The dirty ones were either pure accidents, failure of the safety devices, or I was poked by someone else.

I hope the OP sees your clarification about your needle sticks, she's under the impression (as was I) that you had never had one.

I must be tired. I seem to be the only one that makes any sense of what I said.

The OP happens to be a "he" - not "she" :) but yes, I was under the impression that she had never had a needle stick of any kind. However, as DBear said, she's had needle sticks before but never dirty needle sticks - and that's basically what I had in mind when I composed the OP.

btw, Tazzi - I'm not criticizing you or knocking you for where you stand on needle sticks, or your experience, or anything like that. I am only 4 days in to my first year of nursing school, so believe me, I'm not out to grind any axes. The only reason I brought the topic up is because our instructor gave us a lengthy talk about needle sticks this week, and we also watched a video about needle sticks. It was a very interesting topic and it did seem rather sobering. I have long considered working in the ER, and the story that my instructor told us about the new-grad ER nurse who got HIV via needle stick just made me think twice about whether or not the ER is a more high-risk area for needle sticks. And, if so, I was just thinking about how that might influence my own decision of whether or not to pursue emergency nursing. You said that you'd gotten several sticks (clean & dirty, as I understand you), and that you're an ER nurse; Dbear has had no dirty sticks, and she's not an ER nurse - so that again made me wonder about ER work. I was not trying to call you out, I was really just wondering more about how the ER compares to other nursing disciplines as a whole, in terms of overall needle-stick risk. So, I'm sorry if that came across the wrong way.

And now that I've gotten that off my chest....can I have a hug?