Needlestick?

[Serenity89]

I think I was wrong in my decision not to report.

I was in the OR 2 weeks ago and wasn't careful enough when I left a needle on the field. When tying I felt the needle poke me. I was double gloved, I immediately ungloved, unscrubbed and inspected my skin in the area where I felt it. I saw no scratch and no blood from the area where I felt the poke. I washed my hands and stood there while considering to report or not to report. My decision was partly influenced by the nurses who were like "This guy probably had 1 partner his entire life. His risk is low. Plus you don't see any blood". His risk is probably low, but I now realize I should have at least asked him to be tested. Would have saved me so much anxiety. My first stick was a hollow borne needle on a 90 year old, who tested negative on all accounts subsequently. I don't even think about that one now, when that was so much riskier.
Now I won't know if anything happened and I got anything from the OR unless I get tested in a couple of weeks and then again at 6 months. Which I will just for the peace of mind.

Part of my anxiety currently lies with a nightmare I had last night before my step 3 in which I dreamt I tested HIV +. I have my other part of Step 3 tomorrow. Maybe I am overthinking and projecting my anxiety of step 3 into it. I don't know. Tell me what you guys think.


PS I wonder how accurate this is:
http://www.mdcalc.com/hiv-needle-stick-risk-assessment-stratification-protocol-rasp/
Made me feel better. 1 in 200 000 for mine (or 1 in 20 000 even if I put the guy into high risk category)

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[SouthSideSteve]

Hep C is what should worry you more.

I don't have pt tested unless I see blood.

 

[Pir8DeacDoc]

Stressed about step 3? That sounds like a bigger issue.
**** happens a lot in surgery. You'll be fine

 

[rigid]

solid needle, double gloved, no mark or blood -- I wouldn't bother

 

[Rifampicin]

It's curable now, ask Pam Anderson. Between that and anti-retriviral therapy, I don't know why I even bother with gloves in the OR anymore.

Isn't the cure rate, like, 50-50 for chronic Hep C?

 

[Serenity89]

My personal algorithm is:

Hollow bore needle report every time (fortunately hasn't happened)

Solid needle through gloves with blood, patient high risk = report (twice in career)

Solid needle through gloves with blood, patient low risk = don't report (a few times)

Solid needle through gloves with no blood = don't report regardless of patient factors (more times than I can count)

That is actually pretty smart

I am probably just more stressed than anything. Havent thought about it for 2 weeks until I had that dream. Now obsessing over it

 

[ACSurgeon]

My personal algorithm is:

Hollow bore needle report every time (fortunately hasn't happened)

Solid needle through gloves with blood, patient high risk = report (twice in career)

Solid needle through gloves with blood, patient low risk = don't report (a few times)

Solid needle through gloves with no blood = don't report regardless of patient factors (more times than I can count)

I agree with the above except the part about high risk/low risk. If you see blood that means you've been exposed. Regardless of perceived patient risk, you should get tested.

Maybe I'm just jaded after spending a year in the SICU taking care of liver failure patients. Most chronic hep C patients aren't ones you could easily profile into high risk patients if you saw them 10 years ago for an elective case.

If you feel a sharp with no break in the skin or blood, that's a near miss and wouldn't need to be tested...

 

[ACSurgeon]

What you say is reasonable in a medicine/critical care scenario where sticks are rare.

In my case, it happens so often that I have to draw the line somewhere. Between bone shards, hardware, instruments, etc, I would be in employee health every month if I didn't do risk stratification.

I'm in general surgery and did a critical care fellowship. Exposures are not rare.

My point was if you break skin you've been exposed. Mentioning liver patients was to say they don't fit a stereotype that you'd be able to predict hep C.

You decide what you want. I just wanted to clarify for others based on what our employee health instructs us to do. When in doubt, call employee health and describe the situation and see if testing is warranted.

 

[rigid]

Historically yes. But apparently there's some new combo drug that's got a 90-100% cure rate.

I don't keep up with that stuff because I always spit on my needles before I add a new home tattoo with my buddies, so I don't worry about diseases. But there's a bunch of stuff on the net about it, and they asvertise it on TV now (and Pam Anderson did aome interview about it).

Yeah combo of two protease inhibitors seems to be giving great results for curing chronic hep c with 3-6 months treatment and its peg interferon free. For some genotypes only i think? (what would i know im not an internal med weenie).

 

[Gastrapathy]

There's (a very little) more to it for the moment but, basically, HCV is curable for the price of 1-2 Teslas.

 

[Rifampicin]

Historically yes. But apparently there's some new combo drug that's got a 90-100% cure rate.

There's (a very little) more to it for the moment but, basically, HCV is curable for the price of 1-2 Teslas.

Whoa, those are some crazy numbers...

 

[Goro]

That's a wonderful (but stark) analogy !

There's (a very little) more to it for the moment but, basically, HCV is curable for the price of 1-2 Teslas.

 

[Dr.LeoSpaceman]

That's a wonderful (but stark) analogy !

Interesting recent article on this topic if you are interested in cost-effectiveness analyses (which I am). It's not cheap, but it's also cheaper than managing the sequelae of chronic HCV.

Hepatology. 2015 Nov 2. doi: 10.1002/hep.28327. [Epub ahead of print]
Cost-Effectiveness of New Antiviral Regimens for Treatment-Naïve US Veterans with Hepatitis C.
Chidi AP, Rogal S, Bryce CL, Fine MJ, Good CB, Myaskovsky L, Rustgi VK, Tsung A, Smith KJ.


Abstract
Recently approved, interferon-free medication regimens for treating hepatitis C are highly effective but extremely costly. We aimed to identify cost-effective strategies for managing treatment-naïve US Veterans with new hepatitis C medication regimens. We developed a Markov model with 1-year cycle length for a cohort of 60-year old Veterans with untreated genotype 1 hepatitis C seeking treatment in a typical year. We compared using sofosbuvir/ledipasvir or ombitasvir/ritonavir/paritaprevir/dasabuvir to treat: (1) any patient seeking treatment, (2) only patients with advanced fibrosis or cirrhosis, or (3) patients with advanced disease first and healthier patients one year later. The previous standard of care, sofosbuvir/simeprevir or sofosbuvir/pegylated interferon/ribavirin, was included for comparison. Patients could develop progressive fibrosis, cirrhosis, or hepatocellular carcinoma, undergo transplantation, or die. Complications were less likely after sustained virologic response. We calculated the incremental cost per quality-adjusted life year (QALY) and varied model inputs in one-way and probabilistic sensitivity analyses. We used the Veterans Health Administration perspective with a lifetime time horizon and 3% annual discounting. Treating any patient with ombitasvir-based therapy was the preferred strategy ($35,560; 14.0 QALYs). All other strategies were dominated (greater costs/QALY gained than more effective strategies). Varying treatment efficacy, price and/or duration changed the preferred strategy. In probabilistic sensitivity analysis, treating any patient with ombitasvir-based therapy was cost-effective in 70% of iterations at a $50,000/QALY threshold and 65% of iterations at a $100,000/QALY threshold.

CONCLUSION:
Managing any treatment-naïve genotype 1 hepatitis C patient with ombitasvir-based therapy is the most economically efficient strategy, although price and efficacy can impact cost-effectiveness. It is economically unfavorable to restrict treatment to patients with advanced disease or use a staged treatment strategy. This article is protected by copyright. All rights reserved.

 

[ACSurgeon]

Interesting recent article on this topic if you are interested in cost-effectiveness analyses (which I am). It's not cheap, but it's also cheaper than managing the sequelae of chronic HCV.

Cheaper than transplanting a liver...

 

[Apollyon]

There's (a very little) more to it for the moment but, basically, HCV is curable for the price of 1-2 Teslas.

What does MRI have to do with it?

(Joking!)

/nerd