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Poked with dirty needle...

36 posts in this topic

Posted · Report post

So, yesterday, a medic who rode with us to the hospital while transporting an 87yro female from nursing home, SOB with wheezes.

Incident:

He attempted an IV, 22 gauge, blew the vein, pulled out, blood started flowing out, he asked for a 4x4, I turned to the counter, opened one, folded it, turned back and put my hand toward the bleeding hand which he was holding, and the anterior part of my pointer finger hit the needle he was still holding in his hand. Went in deep (for a finger).

Comments:

Stupid accident. The needles retract automatically when you press the button (we were pulling up to hospital, so he wasn't going to try again) and he had enough time. He was really fast paced, so I was trying to keep and should have done things slower. TWICE earlier that day, I had remarked to my partner and a trainee about how going slow and steady causes fewer mistakes, but I let someone else influence my style. My mistake.

Patient/Clinic Info:

ANYWAY, 87yro white female, hx dementia (so she can't consent to blood test), urosepsis. My company's workers comp clinic gave me a prescription for "Combivir (300mg Zidovudine / 150mg lamivudine) #62 T PO BIN x 31 days" as a precaution.

My Concerns/Questions:

Apparently, it's the HIV cocktail, makes you throw up, beats the hell out of your liver, so I'd have to go in for followups to check liver output. Needs to be starting within 72 hours (this happened last night). No alcohol for a month (so much for this birthday weekend in Vegas).

Has this happened to anyone else? Did you choose to take the cocktail? What did it do to you? Discussed incident with ER doctor at receiving hospital. He said with the patient's hx, he wouldn't recommend any meds. We were looking off the nursing home papers they sent. No IV abuse hx seen. HIV emerged in 80s in US, right? I kind of doubt she was promiscuously-sexually active at age of 60?

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Posted · Report post

Yes sounds low risk. I haven't had any needle sticks but I have had multiple exposures to the usual suspects.

I am not sure but people I have come in contact with that have had needle sticks, don't usually take the meds unless it medium to high risk. That however is a decision you have to make. Couldn't they contact a family member of the patient for consent on testing her? It sounds very low risk, but if you need to know for piece of mind, thats fine too.

The needles are als providers use now are the protective caths, when they withdraw them the needle locks inside. We also use the protective lancets.

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Posted · Report post

First thing first

you should write out an incident report and talk to you supervisor. You work in a system that I believe has some sort of infection control person right?

The infection control nurse at the receiving hospital should be someone you contact to but go through channels to get it done.

Sounds low risk but even people who don't look like they have a communicable disease may have one.

STart the ball rolling buddy just in case if you ask me.

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Posted · Report post

Oh and one other thing, the behaviour of your medic ridea long should be reported too. He sounds like he's gonna get someone else hurt. Why didn't he retract the needle when he should have.

address this with him or your supervisor and make sure he doesn't screw anyone again.

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Posted · Report post

Got ball rolling last night. Did incident and exposure report forms and had blood drawn our company's clinic. Today, I got a callback from the hospital's infection control. Patient's doctor agreed to a blood draw.

I called the nursing home again and spoke to an administrator who gave me a more thorough patient report than the one last night.

The in-house doctor's diagnosis (May 12, 2007) when she first came to the nursing home:

-Poliomicrobic cystitis

-Bacteremia

-Advanced DAT (I have to find out what this means)

-Stage 4 Pressure sores on sacral area

-Type II Diabetes, HTN, Chronic Anemia, Dementia with Alzheimers

Her blood test will take 3 - 4 days to come back...after the point which I'm supposed to start the HIV/AIDS precautionary cocktail.

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Posted · Report post

Anthony wrote:

Advanced DAT (I have to find out what this means)

Its advanced dementia of the an Alzheimer's patient.

Good luck

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Posted · Report post

Anthony,

I don't think you have to take the " HIV cocktail " if her blood test comes back negative for the virus. It is my understanding that one only need start treatment when there is a positive test result. If I'm wrong, I know I'll be corrected. :wink:

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Posted · Report post

He may have to have the cocktail if it was a very high risk patient but this one sounds like they are low risk.

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Posted · Report post

In this exposure, it's risk vs. benefit. This is exactly why rapid HIV tests were invented. You can find out within an hour if the pt. is HIV+, then take the cocktail if indicated. The drugs are not "risk free", and yeah, they'll make you feel like crap. That should not discourage anyone from taking them when indicated. Taking them for one month sucks, taking them for a lifetime sucks more.

I'm not going to say whether or not you should take them. Another doc- YOUR doc- says you should. You can always stop taking them once the test comes back.

I agree with what Ruff said. Your company should (hopefully) have a policy where you can check into the ER at the receiving facility and testing of the patient can be done. Next time, do that. There is a house officer there 24/7 that knows how to handle this sort of thing immediately.

Here in Ohio, a patient cannot refuse testing after an exposure of a healthcare worker to the pt's blood.

'zilla

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Posted · Report post

I don't think you have to take the " HIV cocktail " if her blood test comes back negative for the virus. It is my understanding that one only need start treatment when there is a positive test result. If I'm wrong, I know I'll be corrected. :wink:

Just to correct you here, :D the antiviral cocktail must be started ASAP after an exposure. Within an hour or two is best. If the rapid (1 hour) HIV test isn't available, then it usually takes 4-7 days for the HIV test to be completed, and it would behove the exposed employee to take the cocktail until the test comes back.

'zilla

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Posted · Report post

I wish they had that test here.

Wonder if I could even pay for it out of pocket...I don't think they're even available, though.

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Posted · Report post

I've been told by an ER doc here that the best thing an EMT can do for themselves after an exposure is to present themselves to triage after transferring care and request an evaluation. Something along the lines of the hospital having more options legally that way.

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Posted · Report post

I don't understand how it is that a city the size of LA doesn't have the capability to do a rapid HIV test when we can do them in a small town close to us with a pop. of only 18,000 and a small hospital with only 36 beds. I would be doing some checking into that. By the rapid not being available you are put in the position of having to take the precautionary meds until the results of the patients test comes back.

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Posted · Report post

Well, the hospital we were delivering too honestly wasn't a great one. There are some nice hospitals in LA, but a lot of really overworked overstrained underbudgeted ones. This wasn't a big hospital. They said they have to send the labs to a company and company sends them back. They probably don't own the more expensive test equipment, probably b/c no one who uses it can pay their bills probably.

I wonder if I can pay for it myself.

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Posted · Report post

Make the medic pay the bills. His screwup and carelessness resulted in you getting stuck.

OraSure makes the Rapid HIV test. It is produced in Bethlehem, PA.

I'd be more worried about Hep C.

Good luck bro.

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Heh, I already left them a message a few hours ago, wondering if they had dealers here or if they had to ship from there and get that part taken care of. Guess she could still be a Hep carrier, though (she wasn't symptomatic). Nursing home's going to get me in touch with family to ask about transfusions, dialysis, drug use, travel hx...can't really ask about sexual hx, I guess.

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Posted · Report post

What are your protocols for follow up? I dont know how your protocols are there but here when we get a needle stick we get the intital testing, 3 months later another, then 6 months post stick, then a year and yearly after. We dont have a rapid test here either and waiting those days seems like an eternity.

But i agree with the rest of these guys the Medic needs some thing needs done with the medic that is why the retractable needs were invented was to stop accidents like this, but none the less they still happen.

terr

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Posted · Report post

In our area, as I stated, there is one hospital that can do the rapid test. The blood draw is taken by ambulance to the hospital (not crew involved plus lab tech) and they wait for the results and bring them back to the ED. The reason for the ambulance personnel taking them is to ensure proper handling and to expedite transport as time is of the essence. Yes, they do go L & S. This is standard protocol for our area as a needle stick is considered a life threat. No results are EVER given over the phone from the lab to the ED. They do the initial test. Another a month later, six months after that, another six months later, and then yearly. They also test for HEP although it is required that we are inoculated for it.

Anthony, I do hope all goes well for you. I will keep you in my thoughts and say some prayers for you. Oh yeah, at a minimum, slap the medic.

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Posted · Report post

In our area, as I stated, there is one hospital that can do the rapid test. The blood draw is taken by ambulance to the hospital (not crew involved plus lab tech) and they wait for the results and bring them back to the ED. The reason for the ambulance personnel taking them is to ensure proper handling and to expedite transport as time is of the essence. Yes, they do go L & S. This is standard protocol for our area as a needle stick is considered a life threat. No results are EVER given over the phone from the lab to the ED. They do the initial test. Another a month later, six months after that, another six months later, and then yearly. They also test for HEP although it is required that we are inoculated for it.

Anthony, I do hope all goes well for you. I will keep you in my thoughts and say some prayers for you. Oh yeah, at a minimum, slap the medic.

HOLY CRAPOLA BATMAN!!!!!!!!!!!!!!!!!! You're joking Kat right? A needlestick is considered a lifethreat? Maybe a ways down the road but no needlestick has ever been considered an emergency that requires the response that you say your service provides. OY VEY.

your service transports a blood test to a hospital while going emergency???? That's insane and Absurd. What happens if the ambulance hits someone or crashes? How will your service justify the running hot with a blood test on board.

I'm just flabbergasted. Which bright star in your service thought of this?

Why does it take a medic and and EMT or a full crew to guarantee that this test is handled properly? don't you have supervisors who have a explorer or some type of supervisor vehicle that can do this job?

In essence, your service is putting the community at risk to get a blood test to the hospital.

Good luck trying to defend that in court.

"Oh your honor, we were transporting a blood test to the hospital when we broadsided the car with young Johnny in it. We didn't mean to kill him but we had to get this blood test to the hospital."

Judge to you "I find you fully negligent in the death of little johnny. Johnny's mom, how big of a check do you want Kat's company to write out?? 500K, OK and I'll tack on Treble damages for grievously putting the public at risk to transport a blood test to the hospital"

You are out of a job, your company pays out millions to the victim and receives terrible press all because someone in your company (some bright star) decided that a blood test, a freakin blood test needed to be transported to the hospital emergency.

Yes yes, my reply with the court room verbage sounded rediculous but the response of your service is also rediculous.

I'd like to see what others have to say on this. Maybe it's just me but I dont think it is.

Kat, do you think this level of response is justified?

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HOLY CRAPOLA BATMAN!!!!!!!!!!!!!!!!!! You're joking Kat right? A needlestick is considered a lifethreat? Maybe a ways down the road but no needlestick has ever been considered an emergency that requires the response that you say your service provides. OY VEY.

your service transports a blood test to a hospital while going emergency???? That's insane and Absurd. What happens if the ambulance hits someone or crashes? How will your service justify the running hot with a blood test on board.

I'm just flabbergasted. Which bright star in your service thought of this?

Why does it take a medic and and EMT or a full crew to guarantee that this test is handled properly? don't you have supervisors who have a explorer or some type of supervisor vehicle that can do this job?

In essence, your service is putting the community at risk to get a blood test to the hospital.

Good luck trying to defend that in court.

"Oh your honor, we were transporting a blood test to the hospital when we broadsided the car with young Johnny in it. We didn't mean to kill him but we had to get this blood test to the hospital."

Judge to you "I find you fully negligent in the death of little johnny. Johnny's mom, how big of a check do you want Kat's company to write out?? 500K, OK and I'll tack on Treble damages for grievously putting the public at risk to transport a blood test to the hospital"

You are out of a job, your company pays out millions to the victim and receives terrible press all because someone in your company (some bright star) decided that a blood test, a freakin blood test needed to be transported to the hospital emergency.

Yes yes, my reply with the court room verbage sounded rediculous but the response of your service is also rediculous.

I'd like to see what others have to say on this. Maybe it's just me but I dont think it is.

Kat, do you think this level of response is justified?

Well stated. Couldn't agree more.

And Kat, be thankful that they test for Hep in the blood work. Your vaccination covers only one (commonly the Hep B vaccine) type of Hep. I've gotten the Hep A & B vaccine's. But there are still multiple other strains of Hepatitis. They don't have vaccine's for every type of Hep there is. Be thankful they test for it. They just go about handling it in the wrong manner.

Shane

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Posted · Report post

I did not say we drive like idiots. utmost caution is used when driving. Speed limits are not broken. The lights and sirens are used to move traffic out of the way as the only access is a two lane road with lines of traffic that can be endless.. That doesn't mean the crew fly down the road faster than the speed of light. It also doesn't mean they fly through intersections like they are owners of the road. Even if we are on a run we approach every intersection with extreme caution and more often than not come to a complete stop before entering it.

The reason for the life threat is that there is a high incident of heroin use and have been many reported cases of HIV. It is a small liberal community with a great outreach program. I will say that I only know of one needle stick that has taken place and that was before we got the retractables. BTW: The lab tech rides with to care for the sample. The crew has no contact with it and no, the supervisor has no vehicle other than his personal vehicle. We are a city owned, hospital operated service. We are not connected to the fire department other than rescue helps with extrication. We have four trucks and run two per shift. The other two sit in the garage not being used. We are not taking a unit out of service or crew as many of the crew live close by.

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Posted · Report post

You can drive like the safest driver in the world, obeying all the traffic laws and such but accidents still happen.

Your company has NO I repeat no defense if there is an accident and you are transporting the blood work.

this is a trainwreck waiting to happen.

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So would it be ANY different if it were a courrier company and they had the accident? The only difference is they would be liable and they drive like sh*t. It falls under the same actions as if it were an organ being transported except they drive like raped apes to get there with that organ/s. I have seen that happen on more than one ocassion by the biggest service in our state. We take pride in our service and the fact that we are accident free and we intend to keep it that way. Yes, accidents happen but that is why we are taught to be proactive drivers not reactive drivers. We are always looking ahead for any dangers and approach everything with caution whether we have the right of way or not. As I stated, the driver MUST follow all traffic laws, stopping when required. Once the crew reaches the city limits the lights and sirens are turned off and they run routine. The main reason for the lights and sirens is to gain passage on the two lane road that is heavily traveled. It was something that was okayed through the State so apparently they agree that it is a neccessity.

BTW: Not that I don't want to continue this...but we are getting off topic from Anthony's original post and I don't want to be a post stealer. You can pm me if you would like to. I have no problem with that.

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Posted · Report post

ok, fair enough but even though the state says it's ok you are ultimately still liable.

Not once did I criticise the driving, I did not say you all drove like idiots, I distinctly said that even if you follow all the rules of the road, all the preventive driving that you can, there is still the possibility that an accident can occur.

Plus your companies argument falls flat that when you run hot on the two lane road and then turn off your lights and sirens when you hit the city makes your companies arguments that the state said you could do it this way moot.

let's hope your company never has to defend itself in court for a accident caused or not caused by your driver while transporting a blood tube. I do not believe that you can defend this policy.

I'll stop arguing this point but I do want to see what others have to say about this particular policy your company has.

Anyone want to chime in?

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Anthony,

I speak to you as an EMS OSHA designated officer, infection control officer, OSHA instructor in-house as well as an OSHA consultant in the EMS field.

When it comes to risk, Doc is right, to a point.

Looking back through history in regards to HIV and AIDS, your patient would have been 60 years old when a name was put to this disease. This disease, it should be noted, did exist well before this time (around 1980).

Your patient may have contracted it though several means, and does not fit the most likely age grouping to submit for a test after the disease was named and the full scope of the epidemic was determined.

Regarding other diseases.

HEP B, HEP C, and a number of other less potent diseases are probibly of more concern.

(AS medic ccjh noted)

Did your company offer you a blood test (on yourself) as well as medical blood test surveillence on yourself over the next 6 months?

They have to.

Did your company offer you counciling regarding the exposure with a psychologist?

They have to.

Did your company pick up the bill for the prophelactic medications?

They have to.

Did your company council you on the risks of the exposure before you were given the medication?

They have to.

Theres a lot more, but this is the basics. If your exposure was down to the muscle, then you really should be receiving three things.

Regular blood test medical surveilence, at thtime of the exposure, 6 weeks, 12 weeks, 6 months, and 12 months.

did you get a HEP B innoculation? Did your company offer it to you?

They were supposed to.

EMS is ages behind compliance in infection control and infectious diseases.

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