Needle sticks

[MoosePilot]

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Can anyone tell me how common needle sticks are in surgery and surgical subspecialties? FoxxyCleopatra mentioned it several times and now I'm curious how often you can expect to get stuck.

Does anyone have links to stats on docs contracting Hep C or HIV in the course of their work?

Thanks.

 

[Vukken99]

I got stucked twice...during my junior year.

Both were with suture needles.....
Patient got tested for hepatitis and HIV but until then I had to take antivirals for like good four weeks.....

What you need to do if that occurs is:

Notify your Occupational medicine nurse or physician of the hospital where you are working or rotating.

Don't listen to some stupid attendings one time some old timer saw that happened to me and he said not to worry about....

When something like that happens take care of it...
Go to Emergency room speak with the ER doc and then get them help you expedite testing...and treatment if youneed it. Plus get the name of the patients and how it occurred if the needle had blood or not and the depth of injury.

Thank God, my sources were non infectious...but I knew a vascular attending got stucked with a huge needle while he was doing a CVP line or central line and the source was Hepatitis C and HIV positive patient.

And, whenever you are trying to do phlebotomy or IV or any other procedure even handling sharp scissors be very careful...have full control of patient..
If you have a patient who is not cooperative you can't skip that patient unless he or she can be sedated or some assistance with other guys...

I am dead serious about injuries in training cuz if you do get infected your career will be over truly.......One Im resident in a teaching hospital in NYC like two years ago ended up returning to his country after seroconverting to HIV positive after two years.......sad case indeed.

Also be aware of people around you who are practicing in a unsafe manner like handling blood sampling tubes with bare hands and stuff...You dont want to be around or be trained with people who are negligent in their own safety these are the same people who neglect or fail to practice safe medicine and surgery...

 

[rotty1021]

I've seen many residents get stuck by Hep C positive needles on TV--luckily, they never caught it.

 

[Leforte]

Seroconversion for an open bore needle stick with someone who is Hep C positive is ~3%. Considering that ~1-2% of Americans are Hep C positive, this translates to seroconverting for 1 in every 1,500 to 3,000 open bore needle sticks. The numbers are less for suture needles.

Seroconversion for an open bore needle stick with someone who is HIV positive is ~0.3%. Considering that, again, ~1-2% of Americans are HIV positive, this translates to seroconverting for 1 in every 15,000 to 30,000 open bore needle sticks. Again, the numbers are less for suture needles.

Ensure you are Hep B vaccinated (I can't imagine anyone who is not in the health care field). Seroconversion is ~30%.

 

[tlew12778]

BF has been stuck once in our entire 6 year relationship. The patient was tested for HIV and Hep C and a myriad of other diseases. No meds were given to BF bc all the surgeons just brushed off the incident saying it happens a lot when one choses a career in surgery.

Re: the HIV... at BF's hospital all surgical patients have routine bloodwork including an HIV test. If a patient is positive, the surgical team is made aware so that they can take the necessary precautions. I have never heard of anyone contracting HIV here due to a needle prick in the OR.

 

[MoosePilot]

I appreciate the info so far, thanks! If anyone else has anything to contribute, I'm still following the conversation.

 

[flighterdoc]

I appreciate the info so far, thanks! If anyone else has anything to contribute, I'm still following the conversation.

I never got a needle stick but I did get Hep-C (called non-A/non-B back then) crawling over broken and bloody glass at an auto accident. I got a very small cut from the safety glass, and a few weeks later developed jaundice. Whoops!

This was in the early 80's, before universal precautions were universal. Kicked me off flight status for more than 6 months. Fortunately, I continue to remain fairly healthy.

Now days I keep PPE in the car.

 

[LaCirujana]

If a patient is positive, the surgical team is made aware so that they can take the necessary precautions.

This is just stupid. UNIVERSAL PRECAUTIONS mean just that: precautions are to be implemented universally--all patients and their body fluids should be treated as if they are potentially infectious. You double-glove (or not, if that's your choice, stupid as it may be) for every patient, not just the ones that you know are HepC or HIV positive. You're careful w/sharps for every patient, wear eye protection for every case, etc., etc.

That being said, I've been stuck 4 times, all w/suture needles, 3 of them by my attendings, plus a couple of splash exposures. Our pre-op consent allows us to send blood immediately from the OR on the patient and we usually have the results before we're done w/the case or shortly thereafter. So far, all sources have been negative, but you should also be tested yourself, to establish a baseline negative, as well as a 6 month follow-up to confirm seronegativity for HIV, although most seroconversions take place within 6 weeks of infection.

 

[Mirror Form]

I never got a needle stick but I did get Hep-C (called non-A/non-B back then) crawling over broken and bloody glass at an auto accident. I got a very small cut from the safety glass, and a few weeks later developed jaundice. Whoops!

This was in the early 80's, before universal precautions were universal. Kicked me off flight status for more than 6 months. Fortunately, I continue to remain fairly healthy.

Now days I keep PPE in the car.

Sorry to hear that, talk about some bad luck. A few years ago at my school, one of our medical students developed Hep C from a finger stick. This 1-2 % of american's have hep C is a meaningless stat b/c in most university hospitals the % of patients with hep C is MUCH higher. And when you consider how common finger sticks are . . .

 

[kinetic]

This may be ig'nant, but how are you guys getting stuck by your attendings? I mean, are you retracting with your teeth or something? ("Ooo! That one hit my gums, you bastard!")

 

[Seaglass]

I got stuck by an attending when I was retracting for a vag his. She was looking Waaaaay in there and wasn't paying attention to my hands.

 

[FliteSurgn]

This 1-2 % of american's have hep C is a meaningless stat b/c in most university hospitals the % of patients with hep C is MUCH higher. And when you consider how common finger sticks are . . .

This is especially true in the VA patient population. The numbers there are more like 30%.

 

[calidoc2004]

Im not a resident but curiously reading all these forums.

Are these needle sticks occuring mostly in Surgical fields?

If you had to rank specialties by risk of needle stick what would they be? Id imagine EM would be pretty high too.

What percentage of people have been stuck roughly? From this form us sounds like 100% but all my years in a hosptical i havent heard of too much trouble.

Thanks.

 

[tlew12778]

OK maybe they do double glove here. I have no idea and honestly I don't think it makes a difference. You're talking about what? an extra millimeter or two of glove that you hope the needle does not pass through. Some ppl are lucky and some aren't. Ppl still get pricked through both gloves and each hospital treats the situation differently.

I think that if you had made this a poll you would have seen some more no answers. The ppl who all answered here wrote yes bc they all explained their situation in which they were pricked.

 

[kinetic]

Double gloving actually does affect transmission rates, but not because the second glove stops the needle (obviously). As the needle bore passes through the first glove, it wicks away the body fluid, which decreases the amount of exposure you receive.

"Go ahead and shoot me! I'm wearing two gloves!!"
*watches as second glove miraculously deflects bullets and shrapnel*
(Meanwhile, all the other people who only single-gloved go down in a hail of bullets.)
"Ha ha ha!"

 

[ERMudPhud]

Double gloving actually does affect transmission rates, but not because the second glove stops the needle (obviously). As the needle bore passes through the first glove, it wicks away the body fluid, which decreases the amount of exposure you receive.

Nice theory but I don't think there is much evidence to support it. A trial of single vs double gloving that actually looked at transmission rates would require huge numbers of patients over a long period of time because the overall seroconversion rate in surgeons is quite low.

There is evidence that double gloving does decrease the number of holes found in the inner gloves post surgery.

http://www.cochrane.org/cochrane/revabstr/ab003087.htm

I've gone 7 years without a stick working mostly in the ED. I think ED rates might be lower because the procedures we do tend not to involve an assistant. In surgery you may not always be aware of where everyone elses hands are but working alone in the ED you generally know where your own hands are.

 

[DrQuinn]

I got stuck my 3rd year in the ED by a nurse with a clean needle. She was getting an IV ready while I was doing a central line on a trauma patient. Scared the melena out of me but thankfully it was a clean needle.

Q, DO

 

[ERMudPhud]

In terms of the incidence of needle stick injuries in American teaching institutions I couldn't find much data. Most studies seem to be from foreign institutions and the rabid anti-FMG folks would surely say that that data is meaningless when discussing the clearly superior american students and residents 😉 On a more realistic level the degree to which universal precautions are practiced and the characteristics of the patient population are probably different enough to make foreign data of limited usefulness.

This is what I could find
Shen C, Jagger J, Pearson RD.
Related Articles, Links

Risk of needle stick and sharp object injuries among medical students.
Am J Infect Control. 1999 Oct;27(5):435-7.
PMID: 10511491 [PubMed - indexed for MEDLINE]

>30% of medical students stuck during the course of third year 😱

2:
Hansen ME, Miller GL 3rd, Redman HC, McIntire DD.
Related Articles, Links

Needle-stick injuries and blood contacts during invasive radiologic procedures: frequency and risk factors.
AJR Am J Roentgenol. 1993 May;160(5):1119-22.
PMID: 8470590 [PubMed - indexed for MEDLINE]

3:
McCormick RD, Maki DG.
Related Articles, Links

Epidemiology of needle-stick injuries in hospital personnel.
Am J Med. 1981 Apr;70(4):928-32.
PMID: 7211929 [PubMed - indexed for MEDLINE]

4:
Buergler JM, Kim R, Thisted RA, Cohn SJ, Lichtor JL, Roizen MF.
Related Articles, Links

Risk of human immunodeficiency virus in surgeons, anesthesiologists, and medical students.
Anesth Analg. 1992 Jul;75(1):118-24.
PMID: 1535489 [PubMed - indexed for MEDLINE]

An interesting attempt to mathematically model lifetime rates of seroconversion with comparison to historical hepatitis B data.

5:
Vergilio JA, Roberts RB, Davis JM.
Related Articles, Links

The risk of exposure of third-year surgical clerks to human immunodeficiency virus in the operating room.
Arch Surg. 1993 Jan;128(1):36-8; discussion 38-9.
PMID: 8418778 [PubMed - indexed for MEDLINE]

 

[kinetic]

I got stuck my 3rd year in the ED by a nurse with a clean needle. She was getting an IV ready while I was doing a central line on a trauma patient. Scared the melena out of me but thankfully it was a clean needle.

Q, DO

Why were you scared of a clean needle? I'd be all, "hit me again!" Clean needles are like candy.

 

[Foxxy Cleopatra]

Yes, I have been stuck multiple times, one of which was with a blood-covered scalpel during a line placement @ a code. Got the line in, but I am still very aware of what the consequences may be.

I know multiple people (attending-level) that are Hep C + and one with HIV. Scares the hell out of me, which is why I remind myself that no matter how many people roll their eyes when I want to take the time to put the extra pair of gloves on they can stand there and wait for 20 seconds- it's the rest of my life at risk.

 

[kinetic]

Yes, I have been stuck multiple times, one of which was with a blood-covered scalpel during a line placement @ a code. Got the line in, but I am still very aware of what the consequences may be.

I know multiple people (attending-level) that are Hep C + and one with HIV. Scares the hell out of me, which is why I remind myself that no matter how many people roll their eyes when I want to take the time to put the extra pair of gloves on they can stand there and wait for 20 seconds- it's the rest of my life at risk.

That sucks ass. 🙁

If someone laughed at me for double gloving, I'd punch them in the face. Then, I would deglove, and reglove.

 

[Whisker Barrel Cortex]

I've been stuck twice. Once by an attending who threw his needle driver on my hand. Barely pierced skin.

Second time was while injecting sub-Q lidocaine for a IVC filter placement. I think interventional radiologists are at high risk because so much of the work we do involves needles and relatively sharp catheters. We consider 0.018 guidewires for placment of lines to be sharps since the stiff end can puncture skin (one of our techs got stuck when the rad did not remove it from the table).

 

[MoosePilot]

I know multiple people (attending-level) that are Hep C + and one with HIV.

Any idea if they picked these infections up at work?

 

[kinetic]

Any idea if they picked these infections up at work?

Oooo ....low blow! (Just the way I like it.)

 

[MoosePilot]

Oooo ....low blow! (Just the way I like it.)

Not at all intended 🙁

Sorry if this is a stupid question.

 

[kinetic]

Not at all intended 🙁

Sorry if this is a stupid question.

Oh ...you weren't ...joking ...........

Oh ..................





This is awkward. And a lot less funny.

 

[MoosePilot]

Oh ...you weren't ...joking ...........

Oh ..................





This is awkward. And a lot less funny.

I'm laughing

Just definitely not at these folks. However they came by these diseases it's tragic, but if they got them at work through needle sticks, it will also be yet another scary thing I'm concerned about.

 

[Mirror Form]

Not at all intended 🙁

Sorry if this is a stupid question.

yes, it is a stupid question.

 

[Vukken99]

 

[Purifyer]

I know multiple people (attending-level) that are Hep C + and one with HIV. Scares the hell out of me, which is why I remind myself that no matter how many people roll their eyes when I want to take the time to put the extra pair of gloves on they can stand there and wait for 20 seconds- it's the rest of my life at risk.

You can continue working as a surgeon while hep C/ HIV positive in the states?

 

[kinetic]

You can continue working as a surgeon while hep C/ HIV positive in the states?

Yes. The only thing was that a few years back people were raising a ruckus about "you have to tell your patients that you're HIV+!" Hey, *****s, it ain't enough that I picked it up taking care of your HIV+ ass, now I have to tell you an irrelevant piece of information that you're stupid brick head is going to interpret incorrectly? (I.e., physicians pick up blood-borne illnesses relatively easily because of all the douchebags we take care of and the incidence of needle-sticks, but I don't believe any cases of physician-to-patient contact have been documented.)

 

[unregistered]

but I don't believe any cases of physician-to-patient contact have been documented.)

That's not true. Do a medline search. I remember reading a report of a CT surgeon somewhere in New England that infected several patients with hep C. I think that there also have been instances of transmission of HIV from dentist to patient.

 

[kinetic]

That's not true. Do a medline search. I remember reading a report of a CT surgeon somewhere in New England that infected several patients with hep C. I think that there also have been instances of transmission of HIV from dentist to patient.

Well excuuuuu-uuuuuuuuuuuuse me!

The point is still valid: many many more docs get infected by patients than vice versa.

 

[zoolander]

You may be able to practice but... buying malpractice insurance is another story.

This happened to a family friend in plastics, who found out he had HCV secondary to bleeding problems in his 50's. Where it came from, he'll never know. The only good part was that he was closer to retirement than, say, at age 30. Now he's sold his practice and teaches residents w/out practicing b/c of insurance issues- either not available or too expensive, not sure which.

There is/was a 10-year statue of limitations on being sued after you stop practicing so the MD needed to carry some heavy liability insurance for at least 10 years after he stopped operating.

A person probably could do volunteer work in foreign countries (correcting facial deformities in the 3rd world for example) but practicing in the US was limited.

Maybe it's changed in the last 10 years?

 

[MErc44]

That's not true. Do a medline search. I remember reading a report of a CT surgeon somewhere in New England that infected several patients with hep C. I think that there also have been instances of transmission of HIV from dentist to patient.

the famous dentist to patient hiv transmission was I think because the dentist wasn't wearing gloves. I remember learning about it in my intro bio classes. I'm sure most people have heard about this story if they were science majors.

 

[flighterdoc]

the famous dentist to patient hiv transmission was I think because the dentist wasn't wearing gloves. I remember learning about it in my intro bio classes. I'm sure most people have heard about this story if they were science majors.

I thought he also wasn't cleaning his instruments too well.

 

[skb21]

I've worked as a surgery tech for the last two years. I've been stuck once. It was on an abdominal hyst. I was the first assistant holding the cokers clamped around the round ligament when the OB/GYN pulls the suture back and sticks the very end of my finger.

As far as double gloving goes, I work with an orthopod that puts on three pair of gloves. He drapes, and then pulls the outer pair off. I double glove, but after a while, my fingers get very numb.

 

[MErc44]

I thought he also wasn't cleaning his instruments too well.

maybe but I thought HIV wasn;t able to survive outside of a host for very long

 

[rubyness]

I also got stuck by an attending who threw the used needle & driver down onto my hand. Tore a big hole through the glove.

He was being careless. And he didn't even notice that he did it and seemed suprised when I scrubbed out to wash my hands.

It makes me angry when someone else's carelessness gets you hurt. From now on I never place my hands on the table during a procedure while any sharps are on the field!

 

[NSGYResident]

I used to double glove, now I single glove again, because of hand cramping and finger numbness. upsizing my glove size didn't help either because they just are too big and get in the way. Also, I like the tactile feel of only one pair of gloves.

I've been stuck probably 3 times with non-hollow bore needles. HIV and HCV negative as of July.

It is a sucky risk, but relatively low risk.

If you are stuck with a hollow needle, filled with HIV infected blood with a high viral count... the likelihood of transmission/conversion is around 3% or 3 in 100. For Hep C, it is much higher... around 10%. That is assuming you already know they are infected and have high viral counts. If you take all patients with unknown viral status, and get stuck by a hollow needle with blood in it... the chance of getting HIV or HCV is around 0.3% (3 in a 1000). It is much much smaller with a solid needle (suture needle).

The moral... avoid it if you can, but the risk during the OR is relatively small. Usually the needles are solid needles, or if they are hollow (like for lidocain infiltration) they are not filled with the patient's blood.


NSGY Res, PGY4

 

[undecided05]

BF has been stuck once in our entire 6 year relationship. The patient was tested for HIV and Hep C and a myriad of other diseases. No meds were given to BF bc all the surgeons just brushed off the incident saying it happens a lot when one choses a career in surgery.

Re: the HIV... at BF's hospital all surgical patients have routine bloodwork including an HIV test. If a patient is positive, the surgical team is made aware so that they can take the necessary precautions. I have never heard of anyone contracting HIV here due to a needle prick in the OR.

Ever hear of universal precautions?

 

[Idiopathic]

I remember reading a report of a CT surgeon somewhere in New England that infected several patients with hep C.

I believe one of the reasons that Oklahoma PLI is in such bad shape is because of a CRNA who was reusing needles of some sort/not cleaning instruments and infected 30+ people with HCV. Each case was awarded something like 8 figures.