I've been a nurse for almost a year and a half, and this is the first time anything serious has happened to me. Last Tuesday I was giving an insulin shot to a patient with known Hep C. The shot part went fine, but when I went to push the safety up, it got stuck and my thumb slipped over the bar that sticks out and I felt a tiny poke. (We use the kind that has a "barrel" that pushes up over the needle, I hate them because some are difficult to push and they get stuck.) I'm not sure if it even went through the glove, I couldn't see a hole and there was no damage to the skin on my thumb and no blood when I pushed on it. At the time I blew it off thinking that it didn't pierce through.
However, I worked last night and did a couple of experiments with some of the insulin needles and now I feel the poke may have actually gone superficially into my skin, but I might not have bled from it. I couldn't see any holes in the glove, either. At the time I was going to "test" the glove for holes, but stupid me threw it away. I notified the house supervisor on duty and she told me that she was going to put in some labs for him to be tested for HIV. Hopefully they also check his viral load. I have to go to employee health this morning.
I can't stop thinking about it now. I'm pregnant with my 4th baby, and she's due in 3 months, around the time when I would be tested for the 3 month Hep C test. I don't want to pass this on to her or my family! I'm scared to tell my OB, too.
Do you think I'm just being paranoid? Do you think I actually stuck myself? Any input/advice is welcome.
i am a firm believer that it is not necessary to disclose if a patient is hepatitis positive or not.
i assume that every patiet could possibly be hepatitis or hiv positive whenever i work with them...because they very well could be unknowingly infected.
why would you not want that disclosed?? not having that piece of information just delays care. for a suspected needle stick, it's a good piece of information to have - of course, obtaining labs on that source patient could answer the question of hep or not just as easily.
of course universal precautions are in place for that very reason, to assume each and every patient is infected w/ everything we can (and should) imagine.
A big part of me agrees with you; however, I wonder how many needle sticks go unreported because a nurse does not know of a patient's status? I may be going out on a limb there but it's a possible issue. Then that nurse, who's now not been tested herself, could pass it on to others...and so on and so on...
I don't believe everyone needs to know of a patient's status...but if you're going to be handling the infectious material (even with proper protection) and the status is known, then I believe you have a right to it as a healthcare provider. Not because you'll be "more careful," but because you may be more likely to seek testing, treatment, counseling, etc. in the event of an exposure (not how I would feel but in the real world I think a lot of people feel this way). And I know and firmly believe in patients' rights...but I believe in healthcare providers' rights as well.
I would always report a needlestick regardless of the patient's status, and here is why.
1. Unless there is a medical reason for it, routine testing of Hepatitis and HIV does not occur in the hospital...so if the patient was admitted for an unrelated medical condition, they may be positive and not know it.
2. Workman's Comp. If you do not report the needlestick and get appropriate tests, you cannot claim later that it was from a work-related injury.
I used to wonder why employee health would test an employee for HIV and Hepatitis the DAY OF the needlestick because it is medically impossible for a positive result to show up that fast.
Then I found out that the real reason? Was because if you test positive for either Hepatitis or HIV...then they know you had it prior to the needlestick and thus, a workmans comp claim would be denied.
Why would you not want that disclosed?? Not having that piece of information just delays care. For a suspected needle stick, it's a good piece of information to have - of course, obtaining labs on that source patient could answer the question of Hep or not just as easily.
Of course universal precautions are in place for that very reason, to assume each and every patient is infected w/ everything we can (and should) imagine.
...and how would that delay care?
You are supposed to use universal precautions.
You are supposed to report a needlestick when it happens.
If you CHOOSE not to do these things, knowing the patient's status has nothing to do with either.
MassED, BSN, RN
2,636 Posts
is that 0.5% or 5%? Big difference - your decimal placement makes all the difference.