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

Nurses General Nursing

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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?

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? :lol2:;)

omg......i am so sorry.....i got you totally mixed up with another jedi here who is a she!!! i didn't pay attention to the differences in the names, i just paid attention to the "jedi"!

in my own experience, there may be more risk of sticks in the er when you think about the actual jobs, but i don't think i've seen more sticks suffered by er nurses than others. i have felt in the past that i was unlucky.....how many nurses have coding pts vomit into their faces when the chests are compressed by another person?....but that's all about the circumstances surrounding the exposures, not the exposures themselves.

and yes, you can have a hug!!! :icon_hug:

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Specializes in Emergency, Trauma.

Chance of contracting HIV is less than 1% even from a needlestick from a pt with known Hx of HIV...can't remember exact numbers for Hep C, but risk is much higher. Someone posted earlier about receiving some kind of vaccination 2 hours post exposure; that's not quite how it works...if it is recommended that you take PEP, then yes, it should be started within 2 hours, but you are put on a combination of meds for 28 days. These meds have some nasty side effects and our docs rarely recommend them, typically only for sticks with large hollow bore needles that have significantly penetrated...we always counsel pts on the side effects and offer them, but after hearing an in depth explanation of risks vs. benefits, few decide to take the meds. I work in ER, and the exposures I see are paramedics, firefighters, and occasionally home health care workers. I've never been stuck by a dirty needle in six years...and as far as my fellow employees, have seen one RT and one MD get stuck in that same time frame. Don't know about the rest of the hospital...if they get stuck, they go to employee health.

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Someone posted earlier about receiving some kind of vaccination 2 hours post exposure; that's not quite how it works...if it is recommended that you take PEP, then yes, it should be started within 2 hours, but you are put on a combination of meds for 28 days. These meds have some nasty side effects and our docs rarely recommend them, typically only for sticks with large hollow bore needles that have significantly penetrated...we always counsel pts on the side effects and offer them, but after hearing an in depth explanation of risks vs. benefits, few decide to take the meds.

Yes, that was me. I was referring to the policy/procedure that one of my school's clinical hospitals implements for exposure to blood or body fluids. I have the paperwork in front of me as I'm typing this, and it says that this policy is based on the CDC's guidelines for post exposure prophylaxis; also, that even if medication is not required for a given exposure, the incident itself still has to be reported within that 2 hour time frame. There is also a lot of detail about a Zidovudine + Lamivudine + Indinavir regimen. Again, it was my instructor at school that was very particular about the 2 hour time-frame. As I understood it, she emphasized that point not just because it is the facility's policy but also because, as she put it - the sooner treatment begins, the better your chances are of recovering. Maybe she is wrong or confused, but she is our instructor (this particular instructor is the nursing chairperson at my school actually), and that is just what she said.

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omg......i am so sorry.....i got you totally mixed up with another jedi here who is a she!!! i didn't pay attention to the differences in the names, i just paid attention to the "jedi"!

in my own experience, there may be more risk of sticks in the er when you think about the actual jobs, but i don't think i've seen more sticks suffered by er nurses than others. i have felt in the past that i was unlucky.....how many nurses have coding pts vomit into their faces when the chests are compressed by another person?....but that's all about the circumstances surrounding the exposures, not the exposures themselves.

and yes, you can have a hug!!! :icon_hug:

hey taz,

i think you were thinking of jediwitch. (she's just a jedi poser, unskilled in the true ways of the force ;) )

yeah...that vomiting during the code bit...wow. lol...

sounds like you've earned some battle scars over the years...(no pun intended)....

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yeah...that vomiting during the code bit...wow. lol...

sounds like you've earned some battle scars over the years...(no pun intended)....

that wasn't the worst i've seen......years ago a coworker was cathing a woman with explosive diarrhea.

need i say more?

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Specializes in ER.

Jedi,

March 2006, pt with internal defibillator in V-tach. Defibillator is firing every 30 seconds or so causing his body to jump off the stretcher. New lab tech in to draw blood. Absolutely TERRIFIED at the thought of touching pt because someone has told her she'll get shocked, but blood HAS to be drawn. Being the hero-complex sufferer that I am, I volunteered to hold pt's arm for her to draw blood. She drew the blood, defibillator fired, pt jumped, and a needle attached to a syringe full of freshly drawn blood went into my gloved hand right between my thumb and index finger. Pt was a known IV-drug user and a fairly frequent flyer whom we all knew was + for Hep C. As a matter of fact, when my nurse manager was told I had been stuck by his dirty needle, her first comment was, "Oh, God! Of all the people to get stuck by!". Thanks...that really helped my anxiety riddled @ss.

Fortunately, he was negative for HIV. But I spent the next few weeks nervous as Hell that I would get stuck again. I would break out in a cold sweat everytime I had to handle a needle. I would find myself thinking, "what if I get stuck again", "what if this one is HIV positive", etc. Being nervous and scared of the needles made me more clumsy with them. I realized I had to get over my fear or I was going to end up sticking myself. These days, I have a healthy respect for them and I am as careful as I can be, but I don't get scared at the thought of getting stuck everytime I pick one up. I guess what I'm saying, is that if you really want to be in the ER, don't let a fear of "what if" stop you. Use common sense and safety precautions and understand there is a risk of a needle stick no matter what area of the hospital you work, just like there is a chance of an accident everytime you walk out of your house. Its a chance. It is not a sure thing.

By the way, the pt survived only to die earlier this year from an OD. I had a year of labwork and every test came back negative. I figure if I didn't catch Hep C from that stick, the percentages really must be low.

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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.

not wearing gloves when starting iv's? that is just asking for trouble. i work in pediatrics, and i always wear gloves when starting or removing an i.v. i see many nurses on my floor who practice just as you do(guess they think little kiddos don't have hep and hiv) anyway, my point is, when starting an i.v. without gloves on, what if blood spills everywhere all over your fingers. you may have a cut you don't know you have. if you ended up with a disease, i wouldn't have any sympathy, because you yourself didn't take proper measures to protect yourself. take the 2 seconds and put on gloves. do you realize how unprofessional you look if family is in the room and they see you start an i.v. without gloves on.:nono:

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not wearing gloves when starting iv's? that is just asking for trouble. i work in pediatrics, and i always wear gloves when starting or removing an i.v. i see many nurses on my floor who practice just as you do(guess they think little kiddos don't have hep and hiv) anyway, my point is, when starting an i.v. without gloves on, what if blood spills everywhere all over your fingers. you may have a cut you don't know you have. if you ended up with a disease, i wouldn't have any sympathy, because you yourself didn't take proper measures to protect yourself. take the 2 seconds and put on gloves. do you realize how unprofessional you look if family is in the room and they see you start an i.v. without gloves on.:nono:

and when did i ever suggest that i would ask for/expect sympathy???? this thread is about needlesticks.....the point of my comment was that wearing gloves will not protect me from a needlestick.

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Specializes in IM/Critical Care/Cardiology.

So well said. I learned this subject as not only mandatory but called universal precautions. Doesn't mean an accident can be prevented, but what I hear you saying is that you thought more about what you were doing (even in the rush setting) and it helped you. I agree with you and your practice!!!

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Specializes in Emergency, Trauma.
Yes, that was me. I was referring to the policy/procedure that one of my school's clinical hospitals implements for exposure to blood or body fluids. I have the paperwork in front of me as I'm typing this, and it says that this policy is based on the CDC's guidelines for post exposure prophylaxis; also, that even if medication is not required for a given exposure, the incident itself still has to be reported within that 2 hour time frame. There is also a lot of detail about a Zidovudine + Lamivudine + Indinavir regimen. Again, it was my instructor at school that was very particular about the 2 hour time-frame. As I understood it, she emphasized that point not just because it is the facility's policy but also because, as she put it - the sooner treatment begins, the better your chances are of recovering. Maybe she is wrong or confused, but she is our instructor (this particular instructor is the nursing chairperson at my school actually), and that is just what she said.

I think you mistook my post; I'm not disagreeing about the 2 hour window...I just didn't want someone reading this to think that it was as simple as that first dose of meds...that you truly have to take the entire 28 day course of meds for it to be fully effective.

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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.

oy. talk about "ah, poop!" moments.

we had a guy on lovenox. no one knew how to work the safety on the needle. (of course, none of us read the box, either. :rolleyes: at myself)

i recapped after injecting. (i know, i know!) the needle pierced the cap and stuck me.

the next day i asked my charge nurse if she knew how to use the safety feature on the lovenox.

well.

to the er, reports to our workmen's comp carrier, testing the resident....

i wasn't remotely worried that i caught anything nor was the doc in the er. the population we serve isn't likely to have the fearsome diseases.

but don't recap needles after injecting someone!

yes, i was taught that in nursing school.

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Jedi,

March 2006, pt with internal defibillator in V-tach. Defibillator is firing every 30 seconds or so causing his body to jump off the stretcher. New lab tech in to draw blood. Absolutely TERRIFIED at the thought of touching pt because someone has told her she'll get shocked, but blood HAS to be drawn. Being the hero-complex sufferer that I am, I volunteered to hold pt's arm for her to draw blood. She drew the blood, defibillator fired, pt jumped, and a needle attached to a syringe full of freshly drawn blood went into my gloved hand right between my thumb and index finger. Pt was a known IV-drug user and a fairly frequent flyer whom we all knew was + for Hep C. As a matter of fact, when my nurse manager was told I had been stuck by his dirty needle, her first comment was, "Oh, God! Of all the people to get stuck by!". Thanks...that really helped my anxiety riddled @ss.

Fortunately, he was negative for HIV. But I spent the next few weeks nervous as Hell that I would get stuck again. I would break out in a cold sweat everytime I had to handle a needle. I would find myself thinking, "what if I get stuck again", "what if this one is HIV positive", etc. Being nervous and scared of the needles made me more clumsy with them. I realized I had to get over my fear or I was going to end up sticking myself. These days, I have a healthy respect for them and I am as careful as I can be, but I don't get scared at the thought of getting stuck everytime I pick one up. I guess what I'm saying, is that if you really want to be in the ER, don't let a fear of "what if" stop you. Use common sense and safety precautions and understand there is a risk of a needle stick no matter what area of the hospital you work, just like there is a chance of an accident everytime you walk out of your house. Its a chance. It is not a sure thing.

By the way, the pt survived only to die earlier this year from an OD. I had a year of labwork and every test came back negative. I figure if I didn't catch Hep C from that stick, the percentages really must be low.

Thank you for sharing that. I will definitely take your advice into consideration. That sounds like quite an experience you had.

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