Needle Stick Procedure

Needle stick and sharp instrument injuries are mostly avoidable but happen frequently in the health care setting, especially in a busy academic medical center. Often, the injured patient is not at fault, but risk factors do include haste, difficulties with the instruments, unfamiliarity with equipment or the procedure and inexperience. Regardless, no blame is assigned, and injuries should be reported without shame or fear of retribution. There are no disciplinary actions as a result of such reporting. Reporting ensures we change practices or equipment when needed. Reporting also allows us to complete the most efficient workup possible, at the lowest cost to the student and the system. The UMMC Student and Employee Health (SEH) Clinic is the best place for students to receive care for needle stick injuries. The UMMC Emergency Department should be avoided, if at all possible, unless the associated injury requires medical attention after hours. Contact with the UMMC ED may generate medical bills that result in significant out-of-pocket expenses for students. Unfortunately, Mississippi State Law does not allow UMMC to cover students under workers’ compensation policies for clinical activities, as many academic medical centers do.

A needle stick injury in the health care setting can be frightening and embarrassing, especially for students. There is the worry of potentially contracting a blood-borne pathogen like Hepatitis B, Hepatitis C, or HIV. There is the concern of the cost and hassle of the work-up. Additionally, there is the unsettling feeling of disclosing the injury to the patient, the care team, and the clinical supervisor. The good news is contracting any infection from a needle stick or other sharp instrument injury is extremely rare, particularly with current prevention best practices. In any scenario where a sharp instrument has been used on a patient and then breaks the skin of a health care provider, there is potential mixing of blood and possible exposure to a blood-borne pathogen. Should this occur during any clinical or laboratory activity, the following steps should be taken: If available, immediately notify the source patient that a needle stick or sharps injury has occurred. Next, gloves should be removed and the site of the injury should be washed with soap and water. Resist the temptation to squeeze the site. This is often done to confirm that the sharp instrument broke the skin but can increase the potential for blood from the source patient to mix with the injured patient’s blood. After washing with soap and water, discuss the incident with the source patient or caregiver, then ask for consent to proceed with testing for blood borne pathogens on the source patient. This can be an uncomfortable conversation, but most UMMC patients readily consent to the work up, especially if the consent is obtained in a straightforward, non-judgmental way that signals to the source patient this is standard protocol. Consent for testing is the most important step in the process because the vast majority of our patients do not have any transmissible diseases. If this is confirmed, no additional workup is necessary. To facilitate this process, blood-borne pathogen kits have been placed at many nurses’ stations around the hospital. These kits include instructions for reporting the injury, tubes and directions for collecting the source patient blood appropriately and initiating the process of laboratory work-up. If no kit is available, the floor nurses or charge nurses are able to complete the initial testing. After securing consent and drawing source patient blood, completing the Student Injury Report https://redcap.umc.edu/surveys/?s=DX3FLPYFLP will allow SEH to track the labs and follow up appropriately.

If there are any questions about what to do after a needle stick or sharp instrument injury, notify your care team immediately. This can include the clinical supervisor, resident physician, or attending physician. Whenever there is uncertainty, Student and Employee Health can be a guiding source of knowledge, as managing blood-borne pathogen exposures is part of our daily routine. SEH is available Monday-Friday from 7 am – 4:30 pm and is equipped to handle initial and follow up testing and post-exposure prophylactic measures when necessary. SEH also routinely handles the results of source patient lab follow up after hours. Completing the Student Injury Report gives the on-call provider the best information for communicating those results and coordinating additional care, when needed. SEH will ensure that all necessary steps are followed to reduce the risk of acquiring an infection from a sharp instrument injury and will help to manage the fear and uncertainty that accompanies these injuries. SEH can be contacted at 601-984-1185 or at StudentandEmployeeHealth@umc.edu