Needlestick injuries

I read the editorial by Hartle [1] and the survey by Burrows and Padkin [2] with insight and overwhelming frustration. I recently experienced the unwanted, embarrassing and stressful experience of a needlestick injury from an unconscious, high-risk patient. I was advised to start post exposure prophylaxis (PEP), but the added complication of possible pregnancy made it an incredibly difficult decision. I dutifully (and with hindsight possibly naively) followed the hospital protocol. It was made abundantly clear to me that unless testing for infectious diseases was in the patient’s best interests, no tests would be carried out. Throughout this experience, it was apparent that my best interests were not a relevant consideration. Discussions with colleagues made me question my decision to follow standard protocol. It seems many needlestick injuries go unreported, therefore avoiding occupational health involvement and enabling prompt (possibly unlawful) testing of patients. In many circumstances, a reason can be ‘invented’ to justify patient testing. If staff felt protected in these circumstances, more incidents would be reported and the real scale of the problem would become evident. It seems that as employees we have no protection. The Mental Capacity Act (2005) is clear that any investigation or treatment carried out on a patient lacking capacity may only be performed in the patient’s best interests [3]. The General Medical Council (GMC) withdrew its advice about testing patients for serious communicable diseases in exceptional circumstances. Currently, the GMC states that the law does not permit testing the infection status of an incapacitated patient solely for the benefit of a healthcare worker [4]. Health and safety are an obligation for all employers, but it seems to be disregarded in this context. I can testify that the physical side effects of PEP are extremely unpleasant, but the psychological impact is altogether more terrifying. As much as you tell yourself everything will be fine, your mind runs through all the most negative scenarios and there are feelings of guilt for exposing your family to the situation. Hartle comments that ‘testing without consent risks undermining public and political confidence in the healthcare profession’, and I agree. It’s therefore imperative toapproach thisproblemfrom a different perspective, whilst lobbying to change the law. The Mental Capacity Act began in 1989 with a Law Commission investigation and did not gain royal assent until 2005 [5]. Changing the law will not happen quickly! Rather than argue about what is in the patients’ best interests and addressing the problem after the event, we need to review our approach to testing for infectious diseases in all hospital patients. Expectant mothers are routinely asked if they agree to human immunodeficiency virus (HIV) testing and no counselling is offered. I believe that screening for infectious diseases should be carried out on all patients admitted to intensive care. The rate of HIV infection in the UK continues to rise with an estimated 83 000 infected at the end of 2008, with 27% unaware of their infection [6]. Prompt recognition and treatment of this illness would fundamentally be in the patient’s best interests. Should we consider asking for informed consent to screen blood for infectious diseases routinely in all elective and emergency surgical patients? This approach could ensure the prompt management of healthcare workers exposed to potentially infective body fluids, avoiding inordinate levels of stress and the unnecessary use of PEP. Department of Health guidelines recommend PEP be started within the first hour whenever possible [7]. Prior knowledge of a patient’s infective status would enable an individual to make an informed and timely decision about commencing treatment. I think the majority of the public would support these ideas and would be surprised at the current situation. More importantly, is a healthcare professional going to be functioning safely in view of the constant fear and anxiety he ⁄ she would be experiencing? Patients must be treated by someone who is concentrating on the here and now, and not on what a blood test will show in six months.