Needlestick - Dang it!

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WELL, THIS SUCKS!

This is not the post I was expecting to make today... or any day, for that matter. I'll keep this brief and informal today.

Needlesticks

Needlesticks occur when a needle being used to inject a medication or draw blood punctures through the skin of someone other than the intended target (the patient). These injuries are common and often multifactorial, but often due to a less-than-ideal technique. The major concern with needlesticks is the risk of transmitting bloodborne infections, particularly HIV and various forms of hepatitis (especially hepatitis B and C).

Yes, I was a bad boy and got a needlestick today

It happens to people once in a while. I was attempting to get arterial blood from a critical patient's wrist today (he was just intubated and sent to the medical intensive care unit, and the arterial blood tells us whether he's receiving the correct amount of oxygen). His mental state was confused/lethargic, and he was moving around a bit, so I had a bit of a challenge in trying to obtain the blood. I repositioned myself a few times while trying to get the blood. I got flashes of blood, but not enough to fill the container; I ultimately asked for help and it took some experts a few tries to get the blood work done.

I suspect that the needlestick happened sometimes during this attempt. While I was attempting this blood draw, I was getting pages and phone calls off the hook for other patients (I was the only resident covering 60 patients at that time - not such a wise idea, right?), and ended up trying to rush the process. After removing the needle from the patient's skin rather quickly (and closing it so that the needle would not remain exposed), I quickly removed my gloves and answered my phone to tell people that I was busy with a critical patient. I then quickly threw out the covered needles, with gloves off, and immediately sanitized my hands.

Lo and behold, I feel a sting on my finger and see there's blood coming from it. I initially thought this was the patient's blood until I realized that it was all mine. Apparently I had been bleeding even prior to removing the gloves, so I must have gotten this while trying to draw the blood. I never felt it happen, but there was no other source of this cut!

Infection risk

This patient was here with hepatic encephalopathy, which, in short, is a degeneration of mental status due to cirrhosis of the liver. This usually happens from chronic alcohol abuse, but could also happen from hepatitis infections.

Now, as it turns out, this patient was tested for hepatitis a few years ago. He tested positive for hepatitis A and B antibodies, but not antigens. When antigens are positive, this means there's an active infection. When antibodies are positive, this means that the body has already fought the infection, or received a vaccination. When both antibodies and antigens are present, that means the body recognizes the infection and is actively fighting it. This is very simplified, of course, but I hope you get the gist!

So, naturally, I was concerned. I don't know whether the patient had a hepatitis infection in the past and whether he may have one now. Especially since he's from an endemic region for hepatitis infections (South Asia), I have reason to be a bit concerned. Of course, HIV is also a concern, but less so due to his age. Nevertheless, he was never tested for HIV, so it's all a mystery.

What did I do next?

It took a few more hours until I finished my shift... and ate my lunch after the shift ended. I ordered hepatitis tests and an HIV test in addition to the patient's regular bloodwork so that I would know whether he has an active infection (this means he might get one or maximum two extra tubes of blood drawn). Then I finally got the opportunity to go the ED, where I had the same tests performed on me.

Additionally, I received what is known as post-exposure prophylaxis (PEP). These are antiviral medications for suspected HIV exposure. Lovely!

I totally expected that I'd receive these, and was thinking about it for an hour before I agreed to take them, because it's kind of difficult to be compliant with my crazy schedule. I'll make it work - it's only for a month.

I'm not going to rush in the future

Was the rushing worth it? No, absolutely not. It didn't help myself nor the patient. I'm just going to ignore the absurd pressure placed on me and instead focus on my own safety first. All this rushing got me was a free needlestick and HIV medications... for which I might still end up paying a bill.

The funniest part of this is that I wasn't scheduled to work today - but was helping cover someone else's shift. As the saying goes, "No good deed goes unpunished!" 🤪

Thanks for reading my little rant, StemSocial.

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Sources: 1 2 3 4

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