Needlestick injuries? A question for the medical folks...

[Kraeken]

I need to vent, and ask if I'm overreacting. Tonight I got into a huge argument with my wife. She is a critical care nurse in a busy MICU here in NY. Her unit (and the hospital in general) is poorly managed. Anyway, she had told me a story last year about a med student who's carelessness caused a nurse to be stuck by a dirty needle. This nurse went through seven months of heavy preventative medication and emotional turmoil. The med student who caused it was basically like "oops, sorry. You should be more careful." Nothing happened to the student, no talk, no reprimand, nothing. At the time my wife didn't understand my rage upon hearing this. What caused me to flip out tonight was that my wife said its just a matter of time before she gets stuck, as it happens a lot. I flipped my sh!t when she said this. She doesn't understand my take on this, and I certainly don't understand hers.

I was an EMT in the NYC 911 system for sixteen years, and have been a NYC fireman for fourteen. In my line of work, getting stuck with a needle is one of the worst things that can happen in a medical setting, and causing someone to get stuck is one of the worst things you can do. I've heard of people getting fired for it. There is absolutely no reason, none at all, to get stuck with a needle, ever. This is the attitude of people who use needles in the back of a moving vehicle. The attitude should apply a hundredfold in a controlled hospital setting. Why do hospital people have such a casual fricking attitude about it?

I even asked my friend (and my ex- EMS partner) who was a medic, thinking maybe I'm overreacting, and he agreed with me, and said he had the same argument with his wife, who is also a nurse. My uncle, who is a retired nurse, agreed that a needlestick is very serious but didn't agree that you should take an aluminum baseball bat and knock the teeth out of the person who caused you to get stuck.

I don't get the hospital attitude. There is no excuse for it, and apparently its a huge problem. People don't even like reporting needlestick injuries! I don't get it, and I don't know how to get my wife to see my point of view.

Is my opinion the same as all other EMS workers, or is there something wrong with us out here? Why is everyone else so flippant about it?
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[Trevloc]

i am a phlebotomist... thus needles are my life. i see your point of view, but i also see hers. i think youre more worried about it cause of the training you received. moving in the back of a vehicle will seriously up the chance of a needle stick. where in a controlled environment you dont think itll happen all that often, thus when going through the training and education, they really dont stress on it. in the 5 years i have done this job i have been stuck 2 times with a clean needle (both were prior to sticking the pt, and was a faulty needle, both were bent and so when i uncapped the hub end it dragged on my finger), and only once with a dirty needle. which happened because when i slid the needle guard up with my thumb, it broke off and my thumb was punctured. but i do feel i could have prevented all of it. but when you do it every day all day it kinda becomes second nature. when i see blood (work wise, in tubes and such. if i am helping at say a car crash, then this is different), it isnt "blood" in my mind, i dont see it as blood, i dont see it as anything, i dont really see it at all or think about it at all. its null... its all nothing and doesnt mean anything. if that makes sense. which cause needlesticks, and which causes people not to care. everything becomes a blur, and its just a daily routine. where as from an EMT point of view, you never know what to expect so youre always on your toes and prepare for the worst. we dont. hope that helps see her side a little bit. but i am on your boat, even though i am more like her in the act of it, mentally i think we should all take the precautions you have mentioned, but i dont see that happening. i know once i go to work tomorrow itll just go back to a blur and wont even think about it.

 

[combatmedic]

Former lab tech/phleb here, (Current physical therapist). I saw it at least once a month or more a nurse would stick her/him self with a needle after transfusion or routine draws whatever. Then (if the patient consented) we would do a full panel, HIV, HEP C, etc (its been a few years I forget them all) and run it as well as a panel on the nurse. Then the nurse could get a cocktail shot, in the buttocks that was supposed to inhibit anything that was possibly taken in. Lastley, in a few months they would redraw the patient and nurse again and compare labs... eh. I don't think you over reacted, but it is kind of part of the job. Like being in the military, if I deploy and get hit with friendly fire, well ****.... haha

 

[Kraeken]

If you worked at a firing range, how much negligent discharge of firearms would you consider acceptable? Most likely it won't kill someone, so I guess it's going to happen, right?

I've been doing some reading and I talked to some other people, and apparently the cavalier attitude towards needlesticks in the hospital environment is something that stems from medical school and it filters down through other tiers of healthcare. It seems the extremely competitive nature of med school fosters a careless attitude towards many things, and unfortunately doctors' beliefs and standards, good and bad, become the norm. Because they tend to make policy, and hosptials cater to them, these are the attitudes that prevail.

OSHA believes this is a huge problem as well. Aside from the med school attitude, complacency is a big issue. I think I have the right attitude. My attitude is the same as other fire/EMS/PD personnel.

In the fire department we try very hard not to be complacent about anything. But it happens. What I see in EMS isn't so much complacency, but calculated laziness. I see plenty of medics start lines without gloves, things like that. But the whole needlestick thing is always top priority, and I have never seen laziness or complacency in the field in regards to it.

Thanks for the replies! I guess I need to make my wife see it this way.

 

[Thai]

Interesting thoughts Kraeken. But, being in the medical field myself, i think that your people don't know jack. Seriously, you guys think that this is all from the doctor's being complacent or cavalier attitude?! If this is what your wife told you, then she needs to change hospital!

Basic policies are made by Jcaho, medicare, and osha. Institutional policies are made by department heads/chairs. Sure, there are a few here and there policies made by Chief of Staff and medical staff...but this is more about the actual management issues.

Basic policies (e.g. handling to sharp objects, etc.) have NOTHING TO DO WITH the medical staff (doctors included). Implementing these basic policies is up to the department heads of each department...ask your wife! Doctors have nothing to do with these things. Who do you think enforces what your wife can and cannot do? Doctors? Nope. It is her department head (who is also a nurse)...and maybe CNO (chief nurse officer).

Whether your wife does care or does not care about needle stick is her own problem, not the doctors nor the doctors who she interacts with.

Yes, accidents can happen. I got sprayed by blood a few months ago because a nurse was distracted during a code. Do i care? Oh yeah. Who wouldn't?! But, do i go screaming at the nurse and get her fired? No. That is plain stupid. The nurse who did it knew the error and apologized. I accepted and moved on.

Now, the needlestick issue is also why i handle my own sharps after a procedure (such as a central line). I don't let nurse handle it because i know where all the needles are that i used. In 10 years of pure hospital practice, i have not been stuck. (Knock on wood) But that is because i am careful and/or lucky.

It has nothing to do with doctors nor med school nor whatever else you can blame on the doctors for!

 

[Thai]

If you worked at a firing range, how much negligent discharge of firearms would you consider acceptable? Most likely it won't kill someone, so I guess it's going to happen, right?

BTW, a negligent discharged at a gun range in the direction of people will MUCH MORE LIKELY DO GRAVE HARM than being stuck by a needle from a random "donor" (aka patient).

 

[Kraeken]

Thai, if you're a doctor or medical student, I don't mean any offense.

I'm not sure what you mean by saying my people don't know jack. The conclusion I came up with is from my own experience, talking to my friends and coworkers in the business, and reading online for about three hours. I work for the one of the busiest most well trained fire departments in the world, which encompasses an emergency medical service and subsequent medical staff which is also arguably the busiest and most well trained in the world. Many (maybe all) of the ambulance departments of NYC hospitals fall under the juristiction of JCAHO. The attitudes of these ambulance departments is in line with the FDNY and OSHA and seems to be vastly different than the attitudes inside the hospital. Of course there are procedures in place, of course records are kept, of course the law is followed. Of course if someone gets stuck with a needle the proper procedures will be followed.

The problem is the attitude. All of the needlestick injuries I have ever heard of inside the hospital over the last seventeen years have been ultimately caused by doctors or medical students. In almost every case the person who got stuck was stuck because of careless placement of needles, namely sharps being put where they do not belong. In every case the person responsible was not apologetic and sometimes accused the person who got stuck of being careless. In every instance I have heard of, the person who put the sharp in the wrong place was not reprimanded or spoken to in any way.

On the other hand, outside of the hospital, if someone gets stuck with a needle, the person responsible, gets a long session of "what the hell were you thinking!" and possibly suspended depending on the circumstances. I have heard of paramedics being fired for causing a needlestick injury.

In my world, NOTHING is more important than the safety of myself and my coworkers. I am only a firefighter and a CFRD now, I no longer work EMS, but we still do plenty of medical calls. In all of my years in the back of bouncing ambulances and inside peoples homes, on the side of the highway, on fishing boats, commercial airliners, safety is ALWAYS paramount and needles are kept track of no matter what is going on and I personally only know two people who have ever been stuck.

From what I was reading and from what I have seen firsthand, the pressure and competition that medical students are under tends to make them less prone to report an injury, and more likely to downplay the incident if it is reported. This thinking seems to stick with many doctors, and their influence spreads through the medical field. My original question was why the flippant attitude inside the hospital? Even though proper procedure is followed when it does happen, why isn't the seriousness of the issue emphasized to begin with? Why the heck can't a bunch of people in a room keep track of the stupid needle? Why do people in that situation resign themselves to assuming they will get stuck one day? I never assume I am eventually going to get stuck. I understand it is a risk of my profession, but I'm not waiting for it to happen. I will tell everyone to stop CPR and stand up until we find a missing needle. Nothing is more important than safety. Working around a misplaced needle is not a calculated risk, its idiocy.

This really bothers me that my wife, and my friends wife, and my uncle, work with this thinking. (all in different, respected teaching hospitals...)

I'm going to work now, hopefully I don't get stuck! LOL.

 

[Thai]

Yeah, i think that you should NOT generalized based on what your wife feels. Frankly, INSIDE the hospital, we do care...and we do report...why? Because, the after incident care is free. There is no penalty on the reporting (victim) person.

Seriously, dude, i have no idea where you get the info that most needlestick is due to med students or doctors. Bottom line, a nurse (YOUR Wife) needs to follow universal precautions and open her eyes. If she does, then she won't be stuck...unless a doctor really hates her!

You're outside the hospital. I am inside. I don't go around flaming EMS folks for being stupid or careless. Why? Because i don't know the on-goings outside the hospital in the ambulances etc.. Your post recks of lack of knowledge about hospital precedures and educations. Sadly, it seems like your wife needs some re-education too in her field!

AND YES, WE DO TAKE CARE OF NEEDLES AND ARE VERY VIGILANT OF WHERE SHARPS ARE. We being me (doc) and my hospital staff.

 

[Kraeken]

Thai, I'm not insulting you personally. But it seems to have touched a nerve because you are now insulting my wife personally. We'll have enough of that, show some class for f*ck's sake. Just to reiterate, my wife has never been stuck. She has no problem following universal precautions and she does not need re-education in her field. Maybe you should actually read what I have written. Oh wait, you're a doctor, you didn't bother to read the whole thing, you already know. And what you write is very telling of your professional attitude- "Bottom line, a nurse (YOUR Wife) needs to follow universal precautions and open her eyes. If she does, then she won't be stuck..." You seem like you look down on people who aren't doctors and tend to blame others for mistakes that happen. Am I right? Don't answer, I actually don't care. The bottom line is actually people need to treat sharps carefully to begin with, not just be concerned with following procedure when someone gets stuck.

This attitude towards needles is pervasive in the medical field not just in the US, but all over the world. She doesn't know any different because this is what she was taught. Like I have said in previous posts, they follow proper procedure for these injuries, but many people she works with, namely interns and other doctors, have TERRIBLE habits with sharps and they get away with it. And I'm not saying all doctors, but some doctors. Most of the time it seems to be med students and interns who screw up in a way that puts other people's safety at risk. I am not insulting your profession. Why is it that we are more careful about needles out in the street, outside of the hospital? I don't know, but I believe it is the proper attitude.

The point of me posting this thread was to get other opinions on this subject and figure out how to convince my wife the attitude of her field is wrong, not have some doctor in another state get defensive and insult her. Maybe tell your peers to stop leaving needles all over the patient's bed and maybe stop throwing them at the sharps container like darts and maybe when they do something dumb to find their humility and not berate someone else for their error.

I personally have seen a ton of unprofessional actions and behavior from all kinds of medical staff, doctors included. And frankly if you do flame EMS I really don't care I'll flame them too. There are idiots in every field, call 'em like you see 'em. Get over yourself.

I'd appreciate it if you didn't post on here and insult my wife anymore. Honestly I'm no longer interested in your opinions on the subject. Have a nice night.

 

[Thai]

Kraken,

Oh no, i mean it. Your wife's attitude is wrong. She needs to RE-LEARN the importance of needlestick. It comes down to one's personality and training. I am VERY CAREFUL with needlestick...and thus, do NOT let my nurses handle any sharps of mine. You may have missed that in my post in ranting!!

Some are careful...some are not. It does NOT come from our training or lack of because needlestick injuries are grilled into us by several layers of education...EVERY YEAR, even after med school (and residency)! It does NOT come from our cockiness either because NO ONE WANTS TO GET A NEEDLESTICK.

Yes, there are idiots in every field. EMS is not excluded from this. You guys don't deal with multiple needles at one time. You guys do IVs...try a few times, and then do I/O. In the hospital setting, a central line (for instance) requires lots of sharps (scalpel, needles, etc.). And YES, as a nurse, you better be careful. You have to be vigilant. Same for doctors and techs, etc..

You seem to blatantly blame the doctors for this. That is just dumb IMO. You blame your wife's "i don't care" attitude on doctors. No, this is incorrect, whether you want to accept it or not. READ THE MANUAL. READ THE PROTOCOLS. If one chooses to ignore it, then he/she should NOT blame other people. I know that is the "american" way these days, but that is a piss poor excuse.

Opinions? You already have formed one even before posting this...an UNeducated one at that! When i gave my opinion based on FACTs, you choose to ignore it and rant further.

How is it that you form opinions on hospital personnels (e.g. doctors) when you are NOT in the hospital settings??? Based on your wife? Dude, you're an outsider...no more familiar with hospital settings than my patients. Don't go on here and preach what you do NOT know! That is my point.

Ranting and preaching about stuff you know nothing about is useless and annoying. That, sir, is NOT classy. Look in the mirror. I love how EMS folks seem to know everything...even stuff that they are not informed (properly) about!! Dude, you're EMS..nothing more, nothing less. I am a doc, nothing more, nothing less. Learn to live with it.

 

[Kraeken]

I'm not even going to ask you who the hell you think you are, because its obvious. I am the better person here so I am not going to entertain this anymore. Your tone and unbelievable rudeness here make it clear you have many issues, definitely in your professional life and probably at home too. You have zero class, and are hiding behind a computer screen. You're obviously very lonely and have low self esteem.

Have a nice day.

 

[RonMAIDEN]

Sorry,gotta close this since this isn't productive.