Needle Stick Risk

Sept. 9, 1992. Lynda Arnold was working the evening shift at a hospital in Lancaster, Pa. Just a few months out of nursing school, Arnold was living her dream of being a critical care nurse.

The intensive care unit was lightly staffed that night. And the evening shift supervisor got called to another floor. Arnold was left behind to handle the unexpected.

"We got a critically ill patient who came directly from the outpatient clinic," she recalls. "There were no doctor’s orders, and we weren’t sure what was wrong with the patient. But I knew I had to start an IV catheter. It was standard ICU protocol."

She gathered her supplies, found a good vein in his left arm, near his wrist, and inserted the catheter. "The patient suddenly moved. . . . It was violent and he hit my hand, the one that held the needle," she says, recounting the details that never seem to fade. "It punctured my latex glove and was thrust into my left palm."

She walked to the sink and took off her glove. There was a jagged tear in her palm and she was bleeding. "I was 23 years old, four months out of nursing school, working in a 206-bed hospital in the middle of Amish land," Arnold says, recounting her early thoughts. "I decided nothing would happen to me."

Arnold later discovered that the patient had AIDS. He died two weeks after the injury. Six months later, she tested positive for the human immunodeficiency virus (HIV) that causes AIDS.

"As soon as I walked in the door of the employee health office, I knew," she says. "I looked at the nurse and she had tears in her eyes, and I started crying. It was all over."

Needle stick injuries are not uncommon. Thousands of health care workers each year are injected with patients’ blood when needles that have been used to perform often life-saving procedures suddenly become virulent projectiles penetrating a palm, a wrist, a finger, a thigh. Approximately 800,000 U.S. health care workers will be injured by patient needles this year, according to estimates used by the federal Centers for Disease Control and Prevention (CDC).

Combined estimates from the CDC and EPINet—a computer-based standardized injury tracking system used by about 1,500 U.S. hospitals—suggest that more than 2,000 of those workers will test positive for new infections of hepatitis C, another 400 will get hepatitis B and 35 will contract the AIDS virus.

While AIDS is the most feared infection, hepatitis B and C are also serious and life-threatening. Both diseases can lead to liver damage, cirrhosis and cancer. A vaccine is available for hepatitis B, which has helped reduce the number of health care workers infected each year from a high of 17,000 in 1983.

But there is no vaccine for the C virus, which public health officials believe has infected more than 4 million Americans. "The risk [of getting hepatitis C from a needle stick] is ten times greater than HIV," says Robert Ball, an infectious disease/HIV consultant and epidemiologist for the South Carolina Department of Health.

For medical workers, the hazard of contracting a potentially fatal disease is a constant worry. "It’s not going to go away, needle sticks happen. This is a huge public health threat," says Arnold, now 29.

With a swipe of a hand, a careless act or an unexpected bodily jerk, a medical worker’s life can be forever altered. Considered an occupational hazard that’s long been worn like a red badge of courage, this injury remains under-reported and under-protected, according to public health officials.

"Every year up to a million health-care workers receive a needle stick, and for many it is a death sentence," says Andrew Stern, international president of Service Employees International Union, the largest health care workers’ union in the country, which is campaigning to have all workers use specially designed safety needles. "It’s an outrage. This is a preventable crisis. More die of needle sticks than died in the ValuJet crash, but ValuJet sparked all kinds of investigation."

As the crisis mounts, public health officials are meeting here yesterday and today at the Frontline Healthcare Workers Conference to discuss the issue. Charles E. Jeffress, assistant secretary of labor for OSHA, acknowledged that more research needs to be done, but said the first step in the process is gathering information. In the administration’s first public remarks on the matter, Jeffress said, "OSHA will be issuing a formal request for information, calling for public comment and research results. . . . We believe a comprehensive strategy represents the best approach to preventing needle sticks. But we’d like to hear from you on the front lines."