You are supervising a registrar who suffers a needle stick injury during the insertion of a central line in a patient with a history of intravenous drug use.
Outline your approach to this problem.
Answer and interpretation
- Stop the procedure
- Ensure patient is safe
- Takeover / delegate patient management as required
- Wash the registrar’s wound immediately with soap and water
- Express any blood from the wound
- Initiate injury-reporting system used in the workplace
- Patient may need to be consented and then tested for HIV, hepatitis B, Hepatitis C
- Refer registrar to designated treatment facility: Emergency Department / Infectious Disease Physician / Immunology as per hospital protocol
- With consent, registrar to be tested immediately and confidentially for HIV, hepatitis B and C
- Document the exposure in detail for your own record and for the employer
- If the patient is HIV positive, post exposure prophylaxis needs to be started within two hours of the exposure.
- For possible Hepatitis C exposure, no treatment is recommended but advice must be obtained from Infectious Disease Specialist
- If the source patient tests positive for HIV, hepatitis B, hepatitis C, get post-exposure prophylaxis in accordance with CDC guidelines and as per recommendations from Infectious Disease Specialist or other expert.
- Registrar to have follow up with post exposure testing
- Advise re: taking precautions (including safe sex) to prevent exposing others until follow up testing is complete.
- If exposed to blood borne pathogen, he/she should not donate blood for six months until cleared
- While definitive testing is essential, counsel the registrar that the risk factors for infection are: deep injury, visible blood on devices, and needle placement in a vein or artery, lower risk with solid suture needle.
Related to procedure:
- Review of registrar’s technique, equipment used, unit policy for procedural training, assessment of competency, etc.
- Pass rate: 74%
- Highest mark: 7.6
- Candidates who failed did not give enough detail, e.g. “take bloods” without specifying for which investigations.