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Needlestick injury
Author(s) -
Mines R.,
Natajaran A.
Publication year - 2010
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2010.06545.x
Subject(s) - medicine , harm , intensive care unit , needlestick injury , human rights , health care , human immunodeficiency virus (hiv) , intensive care medicine , medical emergency , family medicine , law , political science
As someone who has received a needlestick injury in an intensive care unit, I read with great interest the article by Burrows and Padkin and accompanying editorial by Hartle [1, 2]. It is sad that despite an editorial by White in this journal in 2007 [3], three years later we do not have clarification on this issue. The Human Rights Act applies to both parties and this matter must be clarified as soon as possible, as the editorial states. A recent World Health Organization publication states that access to human immunodeficiency virus (HIV) post exposure prophylaxis (PEP) is an important component of compliance with protection obligations deriving from national and international human rights laws [4]. Surely, some form of anonymous testing must be possible to ensure that a patient does not have to find out the result? The issue of physical harm to the patient is minimal given that most patients in an intensive care unit have central venous and arterial cannulae in-situ, and the loss of a few millilitres of blood is harmless. The side effects of PEP are not to be underestimated. A rapid HIV test is available that provides results within 1 h with over 99% sensitivity and 99% specificity [5]. When applied, this would help in decisions regarding early post exposure prophylaxis and alleviate the stress of waiting for results (four days in my case). The other major problem is getting to PEP quickly if you are the lone anaesthetist in an intensive care unit or in theatres. It is unacceptable to leave a patient under general anaesthesia or an unstable intensive care patient, but there may be no one available to relieve you. The other question that remains unanswered, is what to do in the case of exposure to a high-risk patient with a negative HIV test. The risk of infection during the period when the patient is seroconverting, and therefore tests HIV negative, remains unknown. Also, what is the risk in aHIVpositivepatientwith an undetectable viral load? Ultimately, the decision regarding PEP remains a risk ⁄ benefit decision and all available information is necessary. R. Mines A. Natajaran Guy’s Hospital, Guy’s and St Thomas’ NHS Trust, London, UK Email: rebeccamines@hotmail.com