slight needlestick injuries--dangerous?

[smith2007]

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Hi. Suppose one was reaching for his syringe with a 1.5 inch needle ( was used twice on a patient and uncapped ) and grabs it inadvertently by the needle. He ends up getting a pin prick on his bare index finger. He was able to feel slight pain from the sharp needle but there was no bleeding. There's only a slight indentation/tear on the surface of his index finger.

And now finally assume that the patient has the following: HIV, Hep B, Hep C. Should the student with the needlestick injury worry about an infection? How likely is it for a successful infection? Are these types of injuries common? (exactly the one I described)

Thanks for any helpful reply.

 

[Bobblehead]

I hope this is a hypothetical discussion. I think the best thing to do is start prophylaxis and sort out whether you should discontinue it later with any type of needlestick injury where the needle involved was previously used on a patient, especially with known transmittable illnesses.

 

[smith2007]

I hope this is a hypothetical discussion. I think the best thing to do is start prophylaxis and sort out whether you should discontinue it later with any type of needlestick injury where the needle involved was previously used on a patient, especially with known transmittable illnesses.

But I thought the needle has to actually penetrate a vascular supply before making an infection successful.

Also, we're assuming that the person poked himself on the index finger and felt the sharpness of it. He was able to withdraw his finger before the needle went in deep enough to cause bleeding. Afterwards, there's only a slight ( very subtle; ) tear on his finger but without any trace of blood.

Would this really require a prophylaxis?

 

[indiamacbean]

why don't you just wait and see? then, if you convert you know that you made the wrong decision. come on, is this really something you should be gambling on? it seems like the best course of action is prophylaxis. at the very least, talk with an ID attending and see what they think. trusting your HIV/HepB/HepC status to studentdoctor seems a bit ill advised.

 

[MISTERshortcoat]

I would at least consult your attending, if not go for full-on prophylaxis. You're definitely not at work to gamble with your life. They have needlestick protocols for just this sort of thing, especially if you already know the patient's Hep and HIV status.

 

[kungfufishing]

Your chances are probably less than 1/300, but why not get prophylaxis just to be on the safe side? If it was me, there wouldnt be any discussion.

 

[DrDre']

3% HCV, 0.3% HIV. Quoted often. Doesn't have to penetrate vasculature. I had a HCV stick like this from a junkie. I took the triple cocktail back in the day. It's paid for. Risk of drug side effects v. M&M? No comparison.
Cirrhosis or death v. some crap that will be transient...
I would vote for prophylaxis.

I would also vote for never asking questions like this on SDN. Your life is more important. Also, it benefits you to start HAART ASAP.

All the best,

 

[APACHE3]

Which hospital allows staff to REUSE needles..especially on a high risk patient? Hopefully for you, the needle was only used on IV tubing and
not actually venipuncture. BUt there is still a risk. You must report it immediately. You must document the stick, so IF, IF you convert, you have documentation to back-up your claim for compensation (insurance). Anyway, I hope this is some hypothetical medical ethics class question, but you need to be more careful..if a patient with HIV, HCV, did not cause you to be "extra" attentive to your sharps..then you may have a long and rocky career..GL

 

[MD1088]

any chance you know who the patient was? if so, consider testing the source (consent necesary) before beginning prophylaxis.

 

[Tar Heel Born]

Easily the most ridiculous thread I've ever seen on here. Why would anyone even consider not taking prophylaxis in such a situation? If you're embarrassed about getting stuck and don't want to tell an attending, that's foolish. It happens to the best of us. Certainly not worth risking your life over. Just take the meds.

 

[ekydrd]

OK. I felt strongly enough to reply on this topic... but everyone has already covered pretty much what I wanted to say. DO tell someone about the needle stick, no matter how minute you think it is. DO document the stick. DO follow the recommendations about HAART... your life, and career, depends on it. DO NOT just ignore it and pretend it never happened. I don't want to lose another collegue to something that can be prevented with appropriate treatment.

 

[scrub monkey]

I agree, please do go DOCUMENT and REPORT the needle stick.

If you do unfortunately contract HIV or Hepatitis, at least this way your program will help pay for your meds or your future liver transplant.

 

[Scanner]

Didn't see date of original post, but I believe prophylaxis is only started within 72 hrs of exposure. If it is past this window, it is a wait and see game.

 

[DAMOS148]

One of the senior neurologists reuses the same pins for pinprick testing on patients. He says he usually doesn't draw blood. However, is this really safe for patients? I don't want to make trouble for him if this is considered acceptable practice. He jabbed me with one of the pins to show the patient it wouldn't hurt. I didn't see any blood, but also didn't feel I could say anything, either.

 

[Faebinder]

Prophylaxis absolutely...must do blood checks absolutely. This can potentially destroy the student's career.. You must protect that.

 

[Faebinder]

One of the senior neurologists reuses the same pins for pinprick testing on patients. He says he usually doesn't draw blood. However, is this really safe for patients? I don't want to make trouble for him if this is considered acceptable practice. He jabbed me with one of the pins to show the patient it wouldn't hurt. I didn't see any blood, but also didn't feel I could say anything, either.

Talk to the attending in private and tell him in this day and age _YOU_ don't feel comfortable about being pricked with a needle that is used over and over again... even if it doesn't draw blood. Show him that you think it's a good idea to break a wooden cotten swab and use that sharp end for pain testing.

 

[sdnetrocks]

Talk to the attending in private and tell him in this day and age _YOU_ don't feel comfortable about being pricked with a needle that is used over and over again... even if it doesn't draw blood. Show him that you think it's a good idea to break a wooden cotten swab and use that sharp end for pain testing.

I don't know, I always worry about splinters when using broken wood...

Just go to KMart/Walmart and buy a huge bag of safety pins...put a bunch of them on one, and append that one to your white coat (the "sign" of the neurologist, at my institution).