How do you deal with Hep C risk?

[Foxxy Cleopatra]

For those of you out there that are going through this, you know that a Hep C + patient isn't exactly hard to find. Needle sticks/ scalpel stabs/ splashes are a part of the job, and the risk of converting + really does scare me. I was just wondering how other people deal with it- do you get tested routinely? If you know someone that has converted + could they identify the exact mechanism (splash, hollow bore needle, etc)? Though I realize this is pure speculation, how common is it to convert from a needle stick or a cut from a scalpel?

Thanks for any insight; I'm pretty interested in this.

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[mpp]

article link
pubmed link

 

[Blade28]

I'd always heard the conversion rates after needlestick were approximately 0.3% for HIV, 3% for Hep B, 30% for Hep C. Scary.

Lots of hep C patients where I've worked. Been lucky so far. *knock on wood* Don't know what I'd do if I got stuck. Maybe I should ask my insurance carrier what plans they have for this situation?

 

[FliteSurgn]

In our VA population, it's estimated that almost 50% of the patients are anti-HCV positive. I've had one needlestick from a known HCV positive patient and thankfully didn't convert. (There was a hectic call to my favorite ID doc though) The incidence of seroconversion seems to be lower than was originally feared. The numbers I always heard were 0.3% for HIV, 3% for Hep B, and 30% for Hep C. The data seem to suggest that the seroconversion rate is actually closer to 1-3% for HCV as well, but some of that data is pooled from all types of exposures...needlesticks (both hollow and smooth) and mucous membrane exposures from splashes. Lower risk is good, but it's still a nerve-wracking experience.

 

[vent]

the same happened to me . One of my attendings splashed my hand with a blade while doing a surgery on both HIV and Hep C positive patient. Fortunately, did not get anything. There is an hotline in in SF for helath care providers who got exposure to HepC or HIV blood. I heard that HIV .3%, HepC (not Hep B) 3 % and Hep B 30%, in case of bore neddle use to venipuncture. so far in 5 nmonths of residency I got exposed 3 times with pt blood, even though I am extremely careful, however I bilieve it is inevitable.
I spoke to one ID physician recently who is doing research recent 5 years about needle stick infectio, he told me he ahs seen a lot of people peole with needle stick, but no one who got an actual infection, so I also beleive that there is an speculationa about this.

 

[njbmd]

Hi Folks,
I treat all of my patients the same with Universal Precautions. I am very cautious about needles (holster them at all times) and I double glove while operating. I use very good hand-washing between patients and I swipe my stethoscope with an anti-bacterial towelett between patients. I also do not touch my face. So far, I have been able to avoid colds, flu and needle sticks to myself and others. I also operate in loupes most of the time or guards to avoid eye splashes. My attendings have adopted my double-gloving techniques too.
njbmd 🙂

 

[avgjoe]

we all double glove but how does that really help? does that extra layer really prevent a needle from going all the way through?

 

[surggal]

I think that double gloving does help.
When I scrub out, I always take off my outer gloves first, so that i can de-gown and then clean up the patient with clean gloves underneath. At least a few times per month, I notice blood on an inner glove without having felt a stick or nick. I can only imagine how many exposures this has protected me from.

In my experience, getting stuck with a blade or solid needle is much more likely for a surgeon than getting stuck with a hollow bore needle. I think that by penetrating an extra layer of glove, more blood gets rubbed off of the solid needle before it enters your skin. Perhaps not scientifically proven, but it makes sense to me and certainly can't hurt.

 

[FliteSurgn]

Double gloving has been shown to decrease the risk of transmitting infectious pathogens. Here's a quick link to a journal article by the JCAHO.

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12856559

If you've ever tried the BioGel indicator gloves, it will make you a believer. The inner gloves are green and the outer gloves are the normal color. When you have an outer glove breach, you'll see bright green. There are a lot of times that your outer glove will fail and the hole is tiny. You just switch out the gloves and go on. If you were wearing a single pair, not only would you miss those small holes but those glove failures would put the patient's fluids on your skin instead of on our second pair of gloves.

Older surgeons have a problem with it because they're used to single gloving, but I find it odd that anyone would not double glove these days. Double gloving should be your standard.

 

[Paulista]

This same questions popped up before...
I was PGY-2 got stucked with a needle during surgery.
The ancient attending was not concerned...he said" I got stucked many many times...you don't have to worry!"

But, the other attending who just started to practice told me...don't listen to
this old fart...Go to ER and get triaged..and see an infectious disease guy at least to cover yourself...

Lastly, I was placed on HIV med and all other meds for good six weeks until we found out the serostatus of the source...What a scary thought...

My DME and Program Director pretty much did not care.....

My point is if you are at risk minimize it as much as you can..
Some attending I know always double glove himself..he said that would decrease contamination...but who knows...

They say there are hundreds of surgeons in our country infected not only with hep C but with HIV as well.......

I guess you should take precautions but if you are really concerned you should reconsider your career choice...since that is something you would face on a daily basis...you can't discriminate patients based on their disease...specially if you are their physician....

Oh well I let you decide..