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?

[NHavenRN]

Having never worked in an ER, I can't speak to the comparative risks, but I can speak to the fact that a dirty stick can happen anywhere. My first (and only so far - knock on wood!!) stick - as a student nurse, no less - was on a med/surg unit, in a situation pretty similar to a previous poster's story. She was an unresponsive patient, and I was stabilizing her arm for another nurse to get a stat blood draw while the rest of the rapid response team made it up to the floor. When her muscle contracted, even though the arm itself didn't move, the needle flew out of her arm and into my hand. Since she's a known HIV/HCV patient at least I didn't have to hesitate about the cost/benefit of heading to the ER (since it was after hours) and starting PEP. I thought I had been doing all I could to avoid a stick - following all the precautions - and yet I was stuck.

I felt pretty paralyzed for a couple weeks - and the s/e of the meds were definitely unpleasant - but I actually think it's been a good thing for me; strangely, it ultimately bolstered my confidence to continue what I was doing, since I had made it through the thing that I had been fearing so much with my determination to become a nurse intact.

[lpnstudentin2010, LPN]

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.

Ya one time one of my OR nurses got stuck and they asked for permission from my parents (since i was a small child at the time) to test me. it came back neg and the nurse was thankful to my parents since she knew there was nothing to worry about at all.