Needle stick injury, risk of transmission?

[Happiness87]

Hi everyone,

At the moment I am feeling uncertain and nervous with a lot of "what ifs". I had a needlestick injury while working as a volunteer healthcare worker in a rural Tanzanian town. I sustained the injury while inserting a urinary catheter. Now you would be wondering what the sharp was doing there with IDC insertion. In that hospital you need to prick a rubber connector with syringe and needle to blow up the catheter making sure it's secured in the bladder. There is no connection between this and the urine. 

So the sequence of events were: I had surgical gloves on, performed deep vaginal examination with my right hand while the left hand was holding the labia open. And then I used the right hand to insert the urinary catheter, connected it to the urine bag, all good. I withdrew 2.5mL normal saline, injected the saline to the bung. I took another 2.5mL of saline and this second time the needle went through the side of the rubber bung pricking my left thumb as I was holding it with my left hand. I think it was quire superficial as I could see the needle on the side of the bung and realised that my thumb was bleeding a little bit. I quickly rinsed the thumb with chlorinated water that was available and the bleeding stopped in about 10-20 seconds.

At first we didn't know of the patients infectious status. We performed the rapid HIV testing with finger prick and the patient was found to be HIV positive. Not sure if the patient underwent further HIV testing to determine the viral load but she had not been aware of the HIV status beforehand.

Now, I have spoken to some experienced staff in the hospital where PEP was readily available and this occurrence was not uncommon. All of them told me that PEP wasn't necessary for me, as the needle did not touch the HIV positive patient hence there was no risk of blood exposure. And then I started thinking what if the vaginal secretion on my gloves was exposed to the open wound from the puncture? Note that I performed the deep vagina exam with my right hand and the left hand was just touching the outside of the vagina. And of course amongst other horrible possibilities.....

Any thoughts on the risk of transmission? I will get myself tested in about 3 months time anyway just for the peace of mind.

Thanks for the input! 

[Jeff G]

The staff where you work was correct that you were not at risk and do not need PEP .

HIV is fragile and is not viable outside the human body . Due to slight changes in temperature and PH HIV becomes damaged and unable to infect so you need not worry about vaginal secretions being infectious . HIV can be isolated in vaginal secretions and tears but not in quantity's to be infectious, this is why vaginal secretions are not infectious for HIV and why fingering is not a risk .

Also, you were pushing sterile fluids and not infectious fluids or blood and that's is also a key reason why you did not have a risk .

Its understandable that you would want to test for peace of mind so go ahead and do that but you should fully expect a negative result .   

[Happiness87]

Hi Jeff,

Thanks for the timely response and reassurance. I knew it would not pose any harm but knowing that the needle stick happened in the vicinity of a HIV positive patient was more traumatising that I had thought with a lot of what ifs. I will try not to think about it as much.

[Jeff G]

You are welcome and I'm wishing you the best .

[Ann]

I knew it would not pose any harm but knowing that the needle stick happened in the vicinity of a HIV positive patient was more traumatising that I had thought with a lot of what ifs.

Happiness,

As a medical professional, you MUST understand that ANY patient you come into contact with is potentially infected with hiv, hep B, hep C, or any other blood-borne pathogen and protect yourself accordingly.

Surely you know about "Universal Precautions" and practice them at all times while dealing with your patients. Universal Precautions are there to protect both you AND your patients from cross-contamination and/or infection.

If you cannot handle the fact that ANY of your patients may be infected with something, then maybe you should be in another profession.

As Jeff and your co-workers have told you, you were NOT at risk from the needle-stick injury you sustained during this procedure. I just wanted to emphasis that fact.

While you're here, I may as well remind you of what you need to know in order to avoid hiv infection, sexually speaking:

You need to be using condoms for anal or vaginal intercourse, every time, no exceptions until such time as you are in a securely monogamous relationship where you have both tested for ALL sexually transmitted infections together.

To agree to have unprotected intercourse is to consent to the possibility of being infected with an STI. Sex without a condom lasts only a matter of minutes, but hiv is forever.

Have a look through the condom and lube links in my signature line so you can use condoms with confidence.

Anyone who is sexually active should be having a full sexual health care check-up, including but not limited to hiv testing, at least once a year and more often if unprotected intercourse occurs.

If you aren't already having regular, routine check-ups, now is the time to start. As long as you make sure condoms are being used for intercourse, you can fully expect your routine hiv tests to return with negative results.

Don't forget to always get checked for all the other sexually transmitted infections as well, because they are MUCH easier to transmit than hiv. Some of the other STIs can be present with no obvious symptoms, so the only way to know for sure is to test.

Use condoms for anal or vaginal intercourse, correctly and consistently, and you will avoid hiv infection. It really is that simple!

Ann
 

[Happiness87]

Hi Ann,

Thanks for the input. I did the best to my ability to keep safe but the needlestick unfortunately happened due to faulty equipment. I can handle the fact that all patients are potentially infectious, but the real experience of needlestick injury following a procedure on a HIV pos patient had considerable psychological impact on me. Saying that I should be in another profession because I express my fear of transmission following a needlestick is a bit harsh.

I think I'm just reading too much into it. I have kinda accepted that I was not at risk. But this morning I recalled that following the deep vaginal examination, I grabbed some cotton wool soaked with saline in a bowl, and squeezed the saline out a little bit with the examining hand before cleaning the vaginal area, thereby potentially transferring some of the deep vaginal secretion to the saline in the bowl. I was stuck with the needle containing the saline from the same bowl. Would this carry the same risk as fingering?

[Ann]

Would this carry the same risk as fingering?

Do you mean fingering as in NO HIV RISK sexual fingering? Neither fingering nor being fingered are risks for hiv infection.

As for hiv being in the saline solution - you're getting into the realm of wild speculation here. Hiv is a fragile, difficult to transmit virus that is primarily transmitted INSIDE the human body, as in unprotected anal or vaginal intercourse where the virus never leaves the confines of the two bodies.

Once outside the body, small changes in temperature, and pH and moisture levels all quickly damage the virus and render it unable to infect. For this reason, any hiv that may have been on the swab (or subsequently in the water) posed absolutely no threat to you.

Saying that I should be in another profession because I express my fear of transmission following a needlestick is a bit harsh.

I don't think it was harsh at all - I was being truthful. As an hiv positive person myself, I know all to well how it feels to be treated by a medical professional who harbours the type of deep-seated, irrational fear that you do.

You were told by "experienced staff in the hospital" - where treating hiv positive patients is a common occurrence - that you had no risk, yet you still came here "traumatised" (your own word) by a NO RISK incident. That indicates to me a deep-seated fear that education doesn't seem to be shifting.

Ann

[Jeff G]

I agree with Ann completely . Her remarks gives you an opportunity to grow as a medical professional .

I once had a hernia that was protruding from my belly and was in severe pain so my HIV doctor referred me to the best surgeon he knew of thinking that I would be rushed to surgery in a day or two . The surgeon took my medical history and looked at my belly with my guts poking through but he never touched me and told me that he could not see where I had a problem at all even though he had an ultra sound of the hernia to back up the diagnosis . My HIV doc was embarrassed and appalled and sent me to a place that did the surgery the next day .

My point is that if this surgeon was that frightened of HIV there had to be a culture of ignorance in his whole staff about HIV where they were not getting proper training in universal precautions . 

Ann was pointing out that if you are to continue on in your profession you owe it to your self and the people you serve to educate yourself . The questions you are asking shows that you have not done that and it must be pointed out or we are not doing our job here as HIV educators . Please do not think that a patient cant sense your discomfort at working with them at a very vulnerable moment in their life .

The advice here may seem harsh but if you really care about treating sick people you will take it to heart and see it as opportunity . I'm glad you found us and I hope this helps .