It's Time for Accidental Needle-Sticks to Come Out of the Closet
By Beth Sommers, PhD, MPH, LAc and Kristen Porter, MS, MAc, LAc
Accidental acupuncture needle-sticks can happen in any practice format. As part of a public health initiative to prevent the spread of disease, we need to bring needle-sticks "out of the closet," and create a forum for discussing precautions and procedures for dealing with accidental exposure.
Preventing needle-sticks is an issue for all health care workers, not only those who work with high-risk populations; the threat of transmitting infectious disease is shared by all medical personnel.
The underlying premise of taking universal precautions is that any exposure to blood or blood products is a potential exposure to infectious disease, and that one must prevent and plan accordingly. Underreporting of acupuncture needle-sticks has made it difficult to accurately assess annual exposures. To our knowledge to date, there has never been a reported HIV seroconversion from an acupuncture needle-stick.1
Transmission of hepatitis continues to remain our largest real risk. Vaccinations can protect against hepatitis A and B (HBV), but not against hepatitis C (HCV). Unlike the HIV virus, the hepatitis virus is stronger and more virulent, with the ability to live outside the body in dried blood or fluid for weeks. Preventing exposure is key in avoiding needle-sticks, as is creating a plan if exposure should occur.
Preventing exposure goes beyond the debate of "to glove or not to glove." Acupuncturists are considered most at risk while removing needles, and gloves are typically used during this part of the treatments (or not at all). Although a glove will not protect against a needle penetrating the latex or vinyl barrier, it will provide protection from blood and body fluids. Gloves may hamper our ability to safely place needles into a biohazard container, as many needle handles stick to latex. Vinyl gloves are a good alternative because they have less sticking power and do not contribute to latex sensitivity or allergy. Keep in mind that many lubricants, such as certain moisturizing lotions, massage oils and other liniments, may degrade latex, making the glove permeable to transmission of fluids.
Careful review of our work practices will help us make adjustments to minimize the hazard of exposure. For example:
Accounting for each needle used is essential. Do you take a needle count after insertion and upon removal?
If you utilize assistants to remove needles, are they properly trained in locating each needle?
How are the needles removed that may fall out of the ears and become imbedded in the client's hair? Utilizing magnetic wands will help to isolate and remove the needle without putting the hand at risk of accidental stick.
Do you always wash your hands before and after each patient contact?
Are you fully vaccinated against hepatitis A and B? Hepatitis B vaccinations can result in dramatic reduction of HBV transmission, but will be ineffective in approximately 10 percent of the individuals vaccinated.2 Have your levels checked post-vaccination.
The next step is creating your own plan to address an exposure if it happens. Take the time now to fully research your options, create a list of resources, and talk to your associates and your spouse or partner. Having a plan of action created under stress-free circumstances will greatly benefit you if the need should arise. Contact local hospitals to locate an occupational exposure unit (OEU). Many hospitals have these units, which specialize in needle-sticks received by health care workers. Speak with your primary care doctor about how he or she would handle this situation. Research the treatment options available, along with their side-effects and toxicities, so you can weigh them against the potential benefits.
If you incur a needle-stick or exposure, there is no need to feel embarrassed or incompetent, or to hide the situation. Even the best clinicians suffer needle-sticks. We would recommend the following immediate triage of the situation:
Remove your glove and make the spot bleed by squeezing the surrounding area firmly. (If it is unclear whether a puncture has occurred, you may want to fill the glove with water to see if it has been punctured.) The gloves are then discarded into a biohazard step can.
Pour undiluted bleach onto the site of the stick. Keep the bleach in contact with the skin for a few seconds. There is controversy around the use of bleach, however. Some providers feel that bleach will instantly kill any virus, while others feel that bleach will degrade the integrity of the skin, resulting in greater opportunity for transmission. You will need to research and make a personal decision about whichever course of action you choose.
Rinse the area in cold water. Wash your hands with antimicrobial soap.
If you have other staff, let someone know.
If you know the source patient of the needle, find out if he or she has ever been tested for hepatitis A, B or C, or for HIV. If the client is HIV-positive, the hospital will want to know the source's viral load, CD4 count and medications. This will help the hospital staff or another medical care provider better counsel you on your risk and appropriate prophylactic treatments. However, never divulge the source's identity at the hospital, as this is an egregious violation of confidentiality.
If you choose to take Western medications, you must begin within hours of the exposure, so do not delay in receiving medical care. Your local primary care, emergency room or occupational exposure unit can provide information and assistance.
Bring a new, wrapped acupuncture needle with you. This will help medical personnel to understand the type of needle that was involved.
Receive the necessary counseling to feel confident that you are making the right choices for both your physical and emotional well-being. This is a stressful situation. Being well informed will help to alleviate some of that stress.
We recommend you receive baseline HIV and HCV tests, with followup tests at six weeks and six months. If you are not vaccinated against hepatitis B, or did not have your titers checked post-vaccination, we recommend you receive hepatitis gamma globulin and add HBV into your testing schedule. The Centers for Disease Control and Prevention (CDC) recommend that health care professionals who receive needle-sticks (usually from hypodermic needles) take a 30-day regimen of AIDS medications as a prophylaxis. You should make yourself aware of the side-effects and toxicities of this regime and weigh them against your risk of contracting HIV in receiving an acupuncture needle-stick.
No one is immune to exposure or needle-stick in the acupuncture setting. Taking time to proactively review your work practices and create an exposure plan will help prevent incidents, and minimize the resulting stress if exposure does occur.