After the stick

Nursing,  Jun 1999  by Jagger, Janine,  Perry, Jane

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DEALING WITH A NEEDLE STICK OR body fluid exposure can be an emotional experience. Know what to do before you're in this position. If your institution has a follow-up plan in place, read it carefully. If it doesn't, one should be established.

The following steps are based on recommendations from the Centers from Disease Control and Prevention (CDC) and hospitals that have developed comprehensive postexposure follow-up plans:

Immediately disinfect a needle stick with soap and water. Thoroughly flush blood and body fluid splashes to nose, mouth, or skin with water. Irrigate eye splashes with clean water, 0.9% sodium chloride solution, or sterile irrigants appropriate for ophthalmic use.

Report your exposure to the designated department or person, such as the employee health or infection control nurse or the hospital epidemiologist. Also notify your nurse-manager or supervisor immediately. Evaluation and treatment must be provided during all working hours, including nights and weekends. The evaluation should include filling out a standard blood and body fluid exposure form.

Reporting your injury promptly is essential to preserving a workers' compensation claim and to determining whether you'll need postexposure prophylaxis (PEP), which needs to be started within 2 hours. It must be available 24 hours a day, 7 days a week. If you need PEP, be sure to take the full course (unless otherwise advised by your physician) and participate in follow-up monitoring to track drug toxicity and treatment response.

If you have questions about the treatment or advice you get, call the CDC's HIV PEP treatment hot line: 1-888-448-4911.

As soon as possible after the exposure-usually within 24 hours-get baseline tests for HIV, hepatitis B virus, and hepatitis C virus. If you develop an infection following the exposure, this step helps substantiate that it was occupationally acquired. If you've been exposed to HIV, the CDC recommends follow-up testing at 6 weeks, 12 weeks, and 6 months.

Your facility needs to get detailed information on the source patient, including HIV status and antiretroviral drugs taken. If the patient refuses to be tested, you may have to decide whether to take PEP without knowing if it's necessary. If the patient is unconscious, next of kin can give permission for tests. In some states, source patient consent isn't necessary for HIV testing; check with the risk manager regarding the laws in your state.

Don't blame yourself-especially in writing. Statements such as "I stuck myself" or "If only I hadn't..." in an exposure report could be used against you if you file for workers' compensation.

If a safer device could have prevented your injury, you should have had access to it. Your employer has an obligation (in a growing number of states, legally mandated) to provide the safest technology available to prevent needle sticks.

Copyright Springhouse Corporation Jun 1999
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