Notes from the field: A Needlestick! What to do, who to call, what to draw
A needlestick is one of those injuries we never think will happen to us. We are careful, we follow all of the rules, even use the required safety needles. But, somehow it happens.
It just comes out of no where! The tiny prick, the stab of pain, and that drop of BLOOD!! What do you do?? You must know how to respond quickly and correctly.
First and most important, do not panic. And, don’t forget the patient is still there and needs attention too!
OSHA requires that medical facilities follow the most recent U.S. Public Health Service post-exposure guidelines at the time of the employee exposure. See Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis and Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis. Whenever new guidelines are released, your OSHA safety program must be updated
Steps to follow after an exposure:
- Immediately wash the exposed site with soap and water. If necessary, bandage the site.
- Report the accident to the OSHA safety officer as soon as possible. HIV Post Exposure Prophylaxis (PEP) is best started within 2 hours of an HIV exposure.
- Obtain consent from the source patient to draw blood to test for HBV, HCV, and HIV infection. The patient’s consent must be documented in the OSHA manual. In jurisdictions that do not require consent of the source patient, “available” blood may be used for testing (know the rules for your state, before an emergent situation arises).
- If your state requires consent, and the patient refuses testing, and his/her infection status is unknown, consider medical diagnoses, clinical symptoms, and history of risky behavior. In this situation, you cannot test the patient’s blood without their consent.
- If the source consents, test for HBsAg, HBsAb, HepCAb, and run a “STAT” HIV screen.
- If the source is known to be HIV positive, OR at high risk, this is an emergency! Send the employee immediately to the ED for PEP.
- Refer the exposed employee to a healthcare professional who may provide counseling.
- The employee may decide to decline any post exposure follow-up. In that situation, the safety officer should have the employee sign a declination letter.
- Complete the Sharps Injury Log and retain in the OSHA manual.
This situation always brings a lot of confusion and anxiety. For that reason, I have created a step by step sheet of instructions. You may download it from the Tools page. I recommend that you laminate the form and hang it in your nurses station/Lab to use as a quick reference guide.
Editor’s note: HCPro’s Needlestick Prevention Training Video is a comprehensive source for OSHA compliance staff training on how to prevent contaminated sharps exposures and what to do in case of injuries. Click here for more information and to view a video clip.
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Kathy Rooker
Kathy Rooker is the safety officer and owner of Columbus Healthcare & Safety Consultants, Canal Winchester, OH (krookerchsc@gmail.com or 614-833-9092). Rooker has more than 35 years experience working in the healthcare field and currently provides OSHA and CLIA consulting and inspections for physician practices and conducts OSHA annual training seminars in and around Central Ohio. In her "Notes from the Field" posts, she shares real life OSHA compliance issues and offers solutions to these sometimes complicated situations.
Kathy has written 19 posts.
Comments
I’m concerned about how the instructions to place documentation in the OSHA manual coincides with HIPPA regulations. We usually place all needle stick injury documents in a confidential OSHA file in Human Resources. Is this not necessary?
Most sharps injury logs do not include names or personal identifiers, so the log does not have to be confidential and can be filed in the OSHA manual. If your log happens to include names or identifiers, keep it in a confidential location.
Never post or distribute a log with confidential information. All lab test results or medical consultations are also kept confidential.
What procedure is followed when a nurse, who has HIV, accidently exposes a patient by sticking his finger from a needle then while pulling back the needle he exposes the patient. Are there procedures for this nurse to follow while doing his job as a nurse in regards to what he can and cannot do…i.e. procedures. Thank You!
Sandra,
There are CDC recommendations for HCWs who are infected with HIV or HBV. States have either adopted the CDC recommendations or established their own. Your facility should confirm that the procedure in question does not meet the definition of an exposure-prone invasive procedure either by the CDC or the state you work in. If the procedure does not meet the above criteria, and if the employee practices universal precautions including the appropriate use of hand washing and protective barriers, there is nothing additional the employee need to do, according to the CDC.
Here are the links:
http://www.hivlawandpolicy.org/resources/
view/167
http://www.cdc.gov/mmwr/preview/mmwrhtml/
00014845.htm
And lastly, hopefully your office uses safety sharps, needles, and single use vacutainer tube holders.
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