medical workers become infected with the AIDS or hepatitis
viruses from accidental punctures each year.
By Kathleen F.
Phalen - The Washington Post Company
Tuesday, August 11, 1998; Page Z10
No Turning Back
The stories are
hauntingly familiar. They are doctors, nurses, technicians,
phlebotomists, dentists, aides and laundry workers, to name a
few. And when it happens, there’s no turning back.
"I felt my
heart lurch into my throat, I was so frightened at that moment
that I had irrational thoughts," says Patti Wetzel, a
Texas physician infected with HIV in 1991 after making a house
call to draw blood from one of her dying AIDS patients. She
wanted to save him the ambulance ride to the hospital.
"The needle was dangling from my finger and I could see
small drops of patient blood coating the needle, I thought
about chopping off my finger to protect myself."
And now, like the others, Wetzel is hoping for the best. She
has not developed AIDS, but about four years ago Wetzel
stopped practicing medicine, afraid of exposure to
tuberculosis. She spends about half of her time on the lecture
circuit, educating people about needle stick hazards. The rest
is saved for things like visiting with friends and family.
"I live in
the moment. I learned that my career is not the be-all and
end-all. My needs are more simple now," she says.
"If I were cured tomorrow, I hope I wouldn’t change a
Beth Anne Algie
was 22 and six months out of nursing school when she was
injured some 20 years ago. "I was injecting a sweet
little old lady, she was 93 and we considered her a low risk.
All of a sudden she swatted her hip and sent the syringe into
my other hand," says Algie about the needle stick injury.
"Right away I thought I’d be okay, she was considered
The patient had received a blood transfusion and was carrying
the hepatitis B virus, which infected Algie.
enzymes shot up and I was [critically sick] for months and
months," says Algie. "Initially I was out of work
for a very long time."
When she started
feeling better, Algie says, she took risks because she knew
she was dying. She became a flight nurse. "I was flying
on missions in Central America . . . I figured who better to
go than an ICU nurse who was going to die anyway," she
recalls. "But as I got sicker and more afraid, I knew I
had to remove myself from the clinical setting." More
recently, she has been working in public education campaigns
on the risks of needle sticks. "I live for today.
There’s no way I’m going to see retirement, so for now I
am doing what I can do to save the lives of my colleagues. . .
. They are dying and that’s intolerable."
A Lack of Concern
the injury for some workers is a lack of concern by their
employers. Arnold’s hospital has been very supportive. And
officials there continue to help with
her needs. Other
hospitals do not, health workers say. One of the most
celebrated cases occurred in Montana, where a respiratory
therapist became infected with HIV after using a defective
needle in an arterial blood gas kit that the hospital
knowingly received at no charge from a manufacturer. The
hospital refused to pay any damages. When the therapist sued,
the court ruled that the therapist could not recover damages
from the hospital because the injury was covered under
workers’ compensation. Other states have also adopted that
facilities who deny workers’ compensation," Arnold
says. "And many employees are forced to pay their own
expenses. People call me all the time because they aren’t
getting the help and support they need. They don’t know
where to turn, and they are often in dire straits."
discover only after an injury that they may not be reimbursed
for wages or medical costs. That’s what happened to Wetzel.
have workers’ compensation," she says. "In Texas,
an employer is not required to provide it."
In some cases,
injured workers have also had their personal lives come under
intense scrutiny as employers seek to determine if the
infection could have been caused by sexual relations or drug
of proof should not be on the worker," says Andi Thomas,
the executive director and co-founder of Hep-C ALERT!, a
national advocacy organization based in Florida.
employers who don’t deny claims, the costs are staggering.
"I have a
case right now where the worker has hepatitis C that she
contracted in 1996," says Colleen Holland, a senior
claims adjuster for South Carolina-based Palmetto Hospital
Trust. "The medical and indemnity costs so far are about
$165,000, and it is projected that the medical costs may
exceed $300,000 and the indemnity will cap out at
explains, every state is different, but in South Carolina,
workers’ wage compensation, which falls under indemnity, is
capped at two-thirds of the worker’s individual weekly wage
or $436 (whichever is less) for a maximum of 500 weeks. That
means that if a 23-year-old worker was totally disabled as a
result of a needle stick injury, that worker would receive
benefits for just under 10 years, or until he or she was
no cap on medical expenses if [patients] are permanently and
totally disabled," Holland says.
But the costs
can also be psychological. Donna Cieniawa, a registered nurse
in Massachusetts, was injured with a needle while working in
an emergency room in 1996. "I can’t put it into words,
it’s a daily terror you live with, and my hospital did
nothing to help," Cieniawa says.
Although the CDC
had published recommendations for treatment to help prevent
HIV infection after a health care worker is stuck by a needle
or other sharp object, the doctor who initially examined her
was reluctant to prescribe the drug combination of ZDV (zidovudine)
and 3-TC (lamivudine). After some persuasion and pressure from
a doctor at another hospital, Cieniawa was placed on the
drugs. The patient who had been treated with the needle that
stuck her had not been tested by the hospital for HIV because
of a state law requiring the patient’s consent. That law has
Wetzel and Algie, Cieniawa did not become infected with HIV or
hepatitis, but the emotional scars remain. "Their
attitude was, ‘We filled out the paperwork, we drew your
blood, you’re done,’ " she says. "When I look
back, I realize I was absolutely dysfunctional."
Mapping Strategies for Prevention
there is no one easy technique for prevention because these
injuries result from a multitude of causes and occur in a
variety of situations. Among the causes are worker inattention
and a lack of safety needles in health care settings.
"This is a
multifaceted issue," says Wetzel. "It’s not just
the workers. It’s not just the administrators or the needle
manufacturers. It’s not just the regulators. Health care
workers need to wake up and pull their heads out of the sand,
then maybe we will have the leverage to make changes."
In 1991, the
Occupational Safety and Health Administration required
hospitals to regularly educate employees about handling blood
and blood products. Most agree that hospitals comply with
these educational guidelines for all employees, and some
employees follow safety protocols to the letter. But others
safety protocols isn’t foolproof. Lynda Arnold did. Patti
Wetzel did. Beth Ann Algie did. Donna Cieniawa did. They all
got stuck. "The people I worked with made fun of me
because I always got my goggles, wore my gloves. That’s the
irony of it," says Arnold, who spends a great deal of her
time trying to educate workers about the hazards.
A variety of
safety needles are available today and they include products
that blunt during use, have protective sheaths or retract.
According to a report from the CDC, these instruments, if used
more regularly, could prevent injuries up to 76 percent of the
officials have complained that the safety products cost about
twice as much as the conventional hollow bore needles and that
manufacturers need to produce the safer devices more cheaply.
But manufacturing leaders say that it’s a matter of supply
and demand. As more are manufactured, the processes are
streamlined and costs will drop, they say.
becoming more efficient in manufacturing these devices and we
are improving our procedures. We have been reducing costs by
five to seven percent per year," says Clateo Castellini,
chief executive officer of Becton Dickinson, an international
medical technology company that focuses on disposable medical
devices and diagnostic systems. "We’ve learned that
this is a complex area and we have to work with others. . . .
We think eliminating the transmission of infectious disease by
sharps [needles and other devices that can cut or puncture the
skin] is a role we have to play. We believe it is an ethical
issue to protect users."
manufacturers, such as Bio-Plexus, manufacture only safety
needles. "Every needle we make will be a safety
device," says Tom Sutton, executive vice president of
marketing and administration. "But there is a tremendous
resistance to using safety devices. It’s just like seat
belts, you know you have to use them, but it took a long time
for people to comply."
care pressures squeezing the bottom line at most health care
facilities, executives say they can’t switch to the safety
needles until the costs are lower. But advocates such as the
Service Employees International Union, Arnold and Wetzel are
campaigning nationally for safer devices in all hospitals. And
Rep. Fortney "Pete" Stark (D-Calif.) has introduced
anti-needle stick legislation.
ought to be thinking about the cost of supporting one HIV
patient for the rest of their life," says Dana Trom,
director of materiels management for Martha Jefferson Health
Services in Charlottesville. "Just bite the bullet. You
have to look at the whole picture and you need to support your
One of the
obstacles to a stronger prevention effort is that injuries
happen in such a wide variety of ways. Arnold and Algie’s
injuries occurred while the needle was in the patient’s arm.
Wetzel’s was after the procedure. Forced to cap the needle
because there was no sharps disposal container at the
patient’s home, she was injured when the cap dislodged from
the infected needle and punctured her finger. Cieniawa’s was
with a needle she had not even used, but one that someone left
needle stick injury has a sequence of events, and you have to
break these down categorically," says Murray Cohen,
former CDC chief of medical device evaluations who heads the
Frontline Healthcare Workers Safety Foundation. "That’s
why you can’t get all excited about a product and think that
it will solve it. If it was so simple, we would have already
figured it out."
So for now
Arnold, Wetzel, Algie and Cieniawa count their good days.
"Sometimes I worry, if I die, what will happen to my
family," says Arnold about her husband and two young
children. "Health care worker safety is a right, not an
option. . . . We have to remember, there are so many others.
Somewhere out there, someone’s been infected with a deadly
virus just because they went to work one day."
1998 The Washington Post Company