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RN Spreads Message After Acquiring Infections From Needle

Monday July 14, 2008
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Karen Daley, RN, MPH, FAAN, thought nothing of it when she was stuck while discarding a needle after a routine blood draw at Boston's Brigham and Women's Hospital 10 years ago.

For the 23-year veteran of the ED, needlesticks seemed a part of the job. She had been stuck three times before with no lasting consequences. And she had no reason to think this time would be any different.

In fact, she likely would have ignored the injury altogether and returned to work if a fellow nurse had not urged her to report the incident.

"So I went to the fast track in the ED and the nurse practitioner recommended, based on the nature of the stick — in particular, because we didn't know the source patient, that I begin prophylaxis. Because I assessed my exposure risk as low and had seen other healthcare workers come in feeling pretty sick after starting a prophylactic regime, I deferred. Unfortunately."

If Daley had accepted the prophylactic treatment on that July day in 1998, she might not have developed a life-threatening infection — HIV. She also acquired hepatitis C.

"At the time of my injury, we didn't know a lot about how effective some HIV meds were in preventing infection following exposure," Daley says. "There wasn't the literature that now indicates that 85 percent to 90 percent of these infections could possibly be prevented without post-exposure prophylaxis.

"Part of my message is I never thought this would happen to me, and having the opportunity to do it again, I would have taken it."

Since that December day 10 years ago when colleagues confirmed her diagnosis, Daley has been working to put a face to needlestick injuries in an effort to educate healthcare professionals and highlight the prevalence of such occurrences.

During the past 10 years, Daley has fought the infections with different combinations of drug therapies, which caused weight loss, hair loss, fatigue, nausea, rashes, and myriad other side effects. Although she no longer needs to take medication to fight the more slowly progressing hepatitis C infection, she has developed a better tolerance to her HIV medications and has returned to a relatively active lifestyle.

Not only has Daley, who was president of the Massachusetts Nurses Association at the time of the incident, traveled to 23 states, Asia, and Europe to spread her message, but she's embarking upon a new project — a doctoral dissertation at Boston College — to advance the body of knowledge regarding nurses' experience of these injuries.

"My experience was relatively positive," she says. "I got lots of support when I was ready to be visible to my colleagues and the institution where I worked at the time of my injury. Based on what I hear from individuals as I speak around the country, I don't think that's the experience for every healthcare worker."

While there appears to be a vast range of experiences described by nurses who sustain needlestick injuries, the injuries themselves are commonplace. According to the Centers for Disease Control, approximately 384,325 needlestick injuries occur in U.S. hospitals each year. What's more, researchers at the International Healthcare Workers Safety Center estimate nearly 146,000 additional needlestick injuries occur annually at non-hospital sites (based on the number of needles used at the facilities) for a total of about 503,000 such injuries industry-wide each year.

The American Nurses Association this month announced the findings of the 2008 Study of Nurses' Views on Workplace Safety and Needlestick Injuries, an independent nationwide survey of more than 700 nurses. According to the research, nearly two-thirds (64%) of U.S. nurses say needlestick injuries and blood-borne infections remain major concerns.

Further, the IHWSC estimates that HIV is transmitted to between 18 and 35 healthcare workers every year and hepatitis C to between 59 and 1,180 people annually as a result of these injuries.

More staggering still is the fact that the majority of sticks are preventable.

"With quality safety devices, up to 85 percent of these injuries are preventable," Daley says, adding that if retractable needles had been used at her facility and the sharps disposal box had been emptied instead of overfilled with needles, her injury could have been avoided.

Thanks, in part, to her efforts to spread sharps prevention awareness, the government passed the Needlestick Safety and Prevention Act of 2000, requiring healthcare facilities to use safer medical devices where feasible.

"I had no choice. I couldn't sit at home with this. I had to do something," Daley says.

And she's hoping her latest endeavor will help those like herself and the nursing profession better understand the experiences of those injured by needles, she says, adding no studies have been conducted to describe the impact and meanings of this experience. Given that nurses account for more than half of needlestick injuries, it's vital to understand how they cope with the injury and what services they require to meet their needs.

"I have concerns about there being a potential gap in [meeting nurses['] needs]. As we rush to provide care, we ignore the caregiver's needs and there may be some loss to the profession if nurses' needs are not met. [Giving] attention to the healthcare needs of nurses will, in the long run, allow the profession to better meet the needs of society."

Robin Huiras is a freelance writer in Illinois.

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