Needlestick Injury

[jeddy666]

Hi,
  I'm a pharmacist who has immunizing authority. Today, I had a needlestick injury after giving someone a flu shot. I used a 25 guage, 1 inch needle and the shot was into the deltoid muscle. After giving the shot, before I could retract the needle, there was a quick poke through my glove into one of my fingers. It did not bleed right away. It only bled after I squeezed it. The bleeding was minimal. I kept squeezing on it so that the blood would come out and kept it under running water for a few seconds. Then, I took an alcohol swab and wiped it.  I didn't do anything else.  It seems that the puncture was so minimal as it does not hurt and I cannot tell which finger was injured. The patient that I gave the shot to does not have any blood-borne viruses as indicated on the questionairre. She is also not taking any medications for such diseases. I have been immunized for hepatitis B ( 2 years ago). I did not report this incident to my employer. Do you think I am at risk of acquiring any diseases? I truly feel like I'm not. Maybe, I'll wait about six months and then get tested for hep B, C and HIV??
Hopefully Dr. Park will read this!
Thanks!

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Hello,

A couple thoughts/questions in response to your posting:

1. Needlesticks that occur in the course of employment should reported to your employer. I am curious...why did you not report the needlestick to your employer./

2. If you have been immunized against Hepatitis B, do you know if you completed the three immunizations in the series? Did you have a titer to confirm immunity?

3. When needlesticks occur, it is generally a best practice to order baseline labs in the exposed worker (Hep B, Hep C, HIV) and then follow-up labs at 2,6,12,26 weeks.

4. The patient's questionnaire only reflects self-reported health status and does not necessarily represent the person's true health history and current health status. Whenever possible, the source patient should be asked to grant permission to provide a blood sample to confirm Hep C, HIV, Hep B status at the time of the needlestick.

5. Risk: Based on the information that you have provided in your posting regarding the circumstances surrounding your needlestick, your risk is low because: the volume of exposure to you is likely to have been very small; you correctly expressed blood from the wound; you correctly washed the area.

Please follow-up with any additional questions that you may have.

Helpful links:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm
http://www.cdc.gov/HAI/pdfs/bbp/Exp_to_Blood.pdf
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a3.htm
http://www.cdc.gov/niosh/topics/bbp/
http://www.osha.gov/SLTC/bloodbornepathogens/

~ Dr. Parks

This answer provided to you is not intended as and does not substitute for medical advice. The information presented in this Medhelp.org posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Hello again,

How are you feeling now?

It is not likely that the symptoms that you describe in your posting would be related to the exposure even if you had been exposed to Hep B or Hep C or HIV. The time course is insufficient.

Reporting work related injuries can be challenging depending on the employer that you work for. However, reporting the injury is always the right thing to do.

The CDC (Centers for Disease Control and Prevention), Infectious Disease Society of America, and Society for Healthcare Epidemiology of America all recommend expressing blood from the site of a blood borne pathogen exposure and immediately washing with soap and water.

The CDC does not explicitly recommend that you have your immunity checked after receiving the Hepatitis B vaccine series. However, most healthcare companies and hospitals confirm a positive titer in their healthcare workers. In general, checking a Hepatitis B titer following the series is a good idea.

~ Dr. Parks

This answer provided to you is not intended as and does not substitute for medical advice. The information presented in this Medhelp.org posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[jeddy666]

Dr. Park,
             I seem to have developed mild symptoms of a cold, right the day after the injury.  Symptoms include very mild runny nose and a little bit of fatigue. These couldn't be signs of an infection, could it?

Do you think I should go for blood testing? I practice in a remote town, and the earliest I could get to my family doctor back home would be sometime next week.

[jeddy666]

Oh and I forgot to mention,
        I did have all three shots in the series for the hep B vaccine and this was back in 2008 or 2009.  I did not get myself tested right after for immunity. I thought once I receive the shots, I'm good. But I"m thinking of getting myself tested now.

Thanks once again.

[jeddy666]

Thank you Dr. Park for you prompt and knowledgeable response.

The reason I did not report this injury is because I did not want my manager to think I'm dumb. We have retractable syringes in order to help prevent injuries like this, but despite this, this accident happened. I guess after giving so many shots, I became tired and a bit to relaxed and did not retract the needle fast enough. So, I guess you can say, it's a bit embarrassing.

Dr.Park, I did not wash the affected area with soap. I only let it bleed a little bit by pressing down on it and forcing the blood to come out and I ran it under tap water for a few seconds, followed by swabbing with the alcohol swab. Was soap necessary? I guess I was trying to be quick and also did not think too much about the prick at that time.

Thank you kindly for your advice.