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A pointed reminder about needle sticks

by: LAWRENCE M. SHUER

Health-care workers are occasionally exposed to patient blood or secretions that may be a risk to contract a disease. Typically this occurs in the form of a needle stick. Stanford Hospital & Clinics developed a needle-stick protocol several years ago that outlines the steps for exposed health-care workers to be tested and receive appropriate counseling as to prophylaxis against potential infectious diseases.

There have been a few recent cases in which physicians and housestaff members were unaware of what to do in such situations, and so I wanted to remind you of the steps in the protocol.

When a needle stick occurs, the health-care worker should go to Employee Health if that office is open (usually between 7 a.m. and 4 p.m.); otherwise, exposed staff members should report to the Emergency Department. The Emergency Department or Employee Health nurse will start the process of getting blood drawn from the source patient during the initial risk assessment. This will include completion of an employee-accident injury form.

Exposed staff members will be screened for HIV antibody, HBsAb, HCV antibody and HCV PCR qualitative. The nurse manager on the unit is usually responsible for getting the patient's informed consent and ordering the proper needle-stick protocol tests so that they are fast-tracked, the patient is not billed, the results don't go on the patient's chart and the Emergency Department and Employee Health get the results.

The lab is staffed for at least one HIV serology test run per weekend, so if the request is received by 3 p.m. on a Friday or Saturday, the test can be performed on Saturday or Sunday. This shaves one to two days from the waiting time for the staff member, but this fast-tracking only occurs when the needle-stick protocol is followed.

It is crucial to follow the protocol to avoid confusion and a possible breach of confidentiality. Ordering the tests by either the patient's or staff member's name causes problems for the lab and delays the results. Neither the patient nor the health-care professional is to have their personal insurance billed for these tests. If the tests are not ordered through the protocol, it is difficult to separate them out for proper accounting.

The protocol also ensures that the proper test is used and that the results are handled confidentially through Employee Health or the Emergency Department by assigning aliases to the patient and staff member.

Employee Health is responsible for maintaining confidential records of such occurrences and following up with the staff member on any further testing or counseling. We track needle sticks because they are considered a work-related injury and we are interested in minimizing such occurrences. This is one reason to go to "needle-less" IV systems and protective covers for all sharps in our environment.

Of course, all of us must be familiar with universal/standard precautions in reducing the risk of exposure to potential infectious material from patients. This includes hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments.

Heath-care workers at risk for occupational exposure to blood must be immunized with HBV vaccine, have immunity to HBV as acquired by previous infection or sign an HBV vaccination declination statement. HBV vaccination is offered through Employee Health at no cost to staff members.

We are interested in maintaining a safe working environment at Stanford Hospital & Clinics. We understand that exposures can occur accidentally despite compliance with infection-control procedures. It is important for us to learn from each experience and to make improvements in our processes and procedures to reduce these incidents.

If you have questions regarding the needle-stick protocol or exposure to infectious materials, please contact: Ruth Shanahan, manager of Employee Health Services, 723-5922.

Larry Shuer at lshuer@stanford.edu