A Forgotten Cath Lab Danger: Needle Sticks
It was a typical fall day when a man in his 60s was brought to the cath lab for a cardiac arrest with refractory shock, where he received a percutaneous coronary intervention to the proximal right coronary artery. Perhaps I was overly confident as I walked to the patient’s bedside to pull a venous sheath, but after a simple request, I also removed an interosseous needle. This extraordinarily sharp needle clearly had fresh blood on the tip, and as I carelessly turned to dispose of it in the sharps container, I pricked my finger. While watching the single teardrop of my own blood seep through my glove, my initial response was typical of any interventional fellow – complete and utter despair.
I frantically attacked my finger with soap and water, then squeezed and exsanguinated the finger for minutes until I was “pre-syncopal.” After washing my finer again, I tried everything to clean it out; chlorohexidine, betadine, alcohol and even what they use to clean the hospital floors. I asked the staff to draw both a human immunodeficiency virus (HIV) and Hepatitis C from the patient; the HIV returned negative and the Hepatitis C returned reactive. At the end of a long day before a holiday weekend, I proceeded to one of the busiest emergency rooms (ER) in New England. As I sat waiting in the ER with patients staring at me in my scrubs, asking me for help with their eyes, I felt like a police officer drinking a coffee while the café is being robbed.
Around 384,000 needle stick injuries, along with other sharps-related injuries, occur each year, equating to over 1,000 sharps injuries a day. The total cost of needle sticks amount to over one billion dollars in health care costs. However, this number of injuries is underreported, and multiple surveys have shown that over 50 percent of needle sticks are not reported. A recent study published in December 2017 surveyed interventional radiologists throughout the country. Of those who responded to the survey, 90 percent reported having been stuck by a needle, with a 0.2 percent risk of accidental injury per year
Currently, interventional cardiology focuses on orthopedic and radiation occupational hazards as primary occupational hazards, but the physical and emotional toll a needle stick can have on a physician should not be forgotten. The major concern of needle stick for most people is HIV, rightfully so considering the rate of transmission is 0.3 percent. Hepatitis C, on the other hand, has a rate of transmission after a needle stick or sharps exposure to Hepatitis C positive blood is approximately 1.8 percent ranging from 0 – 10 percent. Seeking treatment for needle stick injuries is critical as there is a post-exposure prophylaxis for HIV. Hepatitis C does not have post-exposure prophylaxis, but has a cure for particular genotypes. Physicians have been known to neglect their own health, but it is important to remember the concern of disease transmission to a loved one or spouse, which can be more worrisome than one’s self-inflicted injuries.
A few days of sleepless nights followed my long evening in the ER. I was subsequently paged that the viral ribonucleic acid load was greater than three million; to a physician, receiving this type of page is likely unorthodox, but none the less was effective to keep me worried. The new few days were spent trying to explain to my significant other why we should take precautions for the possibility that I acquired Hepatitis C. Two weeks of anguish passed and my first blood test was negative, and two weeks after that I was still negative. Employee health has requested I preform a blood test at three months and six months to ensure with 97 percent certainty I am Hepatitis C negative.
I am quite certain that I am in the clear, but I hope this story serves as a stern reminder for everyone to be careful. Ensuring that physicians and health care staff are safe in the workplace is everyone’s responsibility. However, physicians must take action to protect themselves. To avoid injuries, it is paramount that physicians avoid the recapping of needles, ensure that needles are disposed in the sharps disposal containers and provide clear communication where the exposed sharps are located during a procedure. This precaution is in everyone’s best interest, if not for only one’s physical health but mental health, as well. Please be careful.
This article was authored by Charles Beale, MD, Fellow in Training (FIT) at Brown University in Providence, RI.