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It's Time for Accidental Needle-Sticks to Come
Out of the Closet
By Beth Sommers, MPH, LAc and Kristen Porter, MAc, Lac
Acupuncture Today
January, 2003, Vol. 04, Issue 01
http://www.acupuncturetoday.com/mpacms/at/article.php?id=28131
Accidental acupuncture needle-sticks can happen in any practice
format. As part of a public health initiative to prevent the
spread of disease, we need to bring needle-sticks "out of the
closet," and create a forum for discussing precautions and
procedures for dealing with accidental exposure.
Preventing needle-sticks is an issue for all health care
workers, not only those who work with high-risk populations; the
threat of transmitting infectious disease is shared by all
medical personnel.
The underlying premise of taking universal precautions is that
any exposure to blood or blood products is a potential exposure
to infectious disease, and that one must prevent and plan
accordingly. Underreporting of acupuncture needle-sticks has
made it difficult to accurately assess annual exposures. To our
knowledge to date, there has never been a reported HIV
seroconversion from an acupuncture needle-stick.1
Transmission of hepatitis continues to remain our largest real
risk. Vaccinations can protect against hepatitis A and B (HBV),
but not against hepatitis C (HCV). Unlike the HIV virus, the
hepatitis virus is stronger and more virulent, with the ability
to live outside the body in dried blood or fluid for weeks.
Preventing exposure is key in avoiding needle-sticks, as is
creating a plan if exposure should occur.
Preventing exposure goes beyond the debate of "to glove or not
to glove." Acupuncturists are considered most at risk while
removing needles, and gloves are typically used during this part
of the treatments (or not at all). Although a glove will not
protect against a needle penetrating the latex or vinyl barrier,
it will provide protection from blood and body fluids. Gloves
may hamper our ability to safely place needles into a biohazard
container, as many needle handles stick to latex. Vinyl gloves
are a good alternative because they have less sticking power and
do not contribute to latex sensitivity or allergy. Keep in mind
that many lubricants, such as certain moisturizing lotions,
massage oils and other liniments, may degrade latex, making the
glove permeable to transmission of fluids.
Careful review of our work practices will help us make
adjustments to minimize the hazard of exposure. For example:
·
Accounting for each needle used is essential. Do you take a
needle count after insertion and upon removal?
·
If you utilize assistants to remove needles, are they properly
trained in locating each needle?
·
How are the needles removed that may fall out of the ears and
become imbedded in the client's hair? Utilizing magnetic wands
will help to isolate and remove the needle without putting the
hand at risk of accidental stick.
·
Do you always wash your hands before and after each patient
contact?
·
Are you fully vaccinated against hepatitis A and B? Hepatitis B
vaccinations can result in dramatic reduction of HBV
transmission, but will be ineffective in approximately 10
percent of the individuals vaccinated.2 Have your
levels checked post-vaccination.
The next step is creating your own plan to address an exposure
if it happens. Take the time now to fully research your options,
create a list of resources, and talk to your associates and your
spouse or partner. Having a plan of action created under
stress-free circumstances will greatly benefit you if the need
should arise. Contact local hospitals to locate an occupational
exposure unit (OEU). Many hospitals have these units, which
specialize in needle-sticks received by health care workers.
Speak with your primary care doctor about how he or she would
handle this situation. Research the treatment options available,
along with their side-effects and toxicities, so you can weigh
them against the potential benefits.
If you incur a needle-stick or exposure, there is no need to
feel embarrassed or incompetent, or to hide the situation. Even
the best clinicians suffer needle-sticks. We would recommend the
following immediate triage of the situation:
1.
Remove your glove and make the spot bleed by squeezing the
surrounding area firmly. (If it is unclear whether a puncture
has occurred, you may want to fill the glove with water to see
if it has been punctured.) The gloves are then discarded into a
biohazard step can.
2.
Pour undiluted bleach onto the site of the stick. Keep the
bleach in contact with the skin for a few seconds. There is
controversy around the use of bleach, however. Some providers
feel that bleach will instantly kill any virus, while others
feel that bleach will degrade the integrity of the skin,
resulting in greater opportunity for transmission. You will need
to research and make a personal decision about whichever course
of action you choose.
3.
Rinse the area in cold water. Wash your hands with antimicrobial
soap.
4.
If you have other staff, let someone know.
5.
If you know the source patient of the needle, find out if he or
she has ever been tested for hepatitis A, B or C, or for HIV. If
the client is HIV-positive, the hospital will want to know the
source's viral load, CD4 count and medications. This will help
the hospital staff or another medical care provider better
counsel you on your risk and appropriate prophylactic
treatments. However, never divulge the source's identity at the
hospital, as this is an egregious violation of confidentiality.
6.
If you choose to take Western medications, you must begin within
hours of the exposure, so do not delay in receiving medical
care. Your local primary care, emergency room or occupational
exposure unit can provide information and assistance.
7.
Bring a new, wrapped acupuncture needle with you. This will help
medical personnel to understand the type of needle that was
involved.
8.
Receive the necessary counseling to feel confident that you are
making the right choices for both your physical and emotional
well-being. This is a stressful situation. Being well informed
will help to alleviate some of that stress.
We recommend you receive baseline HIV and HCV tests, with
followup tests at six weeks and six months. If you are not
vaccinated against hepatitis B, or did not have your titers
checked post-vaccination, we recommend you receive hepatitis
gamma globulin and add HBV into your testing schedule. The
Centers for Disease Control and Prevention (CDC) recommend that
health care professionals who receive needle-sticks (usually
from hypodermic needles) take a 30-day regimen of AIDS
medications as a prophylaxis. You should make yourself aware of
the side-effects and toxicities of this regime and weigh them
against your risk of contracting HIV in receiving an acupuncture
needle-stick.
No one is immune to exposure or needle-stick in the acupuncture
setting. Taking time to proactively review your work practices
and create an exposure plan will help prevent incidents, and
minimize the resulting stress if exposure does occur.
References
1.
www.cdc.gov/hiv/pubs/facts/transmission.htm.
Accessed June 7, 2002.
2.
Merck Manual,
7th edition, 1992.
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