Copyright 1999 Boston Herald Inc.
The Boston Herald
September 19, 1999 Sunday ALL EDITIONS
SECTION: ARTS & LIFE; Pg. 065
LENGTH: 753 words
HEADLINE:
Needle sticks transmit fear; HIV, hepatitis infections worry
health-care workers
BYLINE: By KARYN MILLER-MEDZON
BODY:
According to the Centers for Disease Control
in Atlanta, the risk of contracting AIDS from a needle stick is
0.3 percent - a mere three in a thousand. Yet for the nation's health-care
professionals, few mishaps are more dreaded than accidental needle punctures.
"It's a very real concern to us because it's something we're exposed to
every single day," said Dr. Andrew Ulrich, an emergency physician at Boston
Medical Center. "It's something we have to keep in mind every time we do
something that is related to sharp objects. "You don't know that somebody isn't
HIV positive when you're treating them," he said. "And that mandates caution."
Although CDC statistics show 188 cases of job-related HIV transmission
to health-care workers through December 1998, many believe the numbers are
significantly higher because no rigorous reporting system exists.
As for
needle sticks, the American Nurses Association estimates there are between
800,000 to 1 million a year, resulting in up to 5,000 new cases of Hepatitis C,
Hepatitis B and HIV annually.
David Hamer, associate director of the
Infectious Disease Clinic at New England Medical Center, said needle sticks in
hospitals are fairly common.
"In any hospital, there are
dozens of people a year who will need to go on prophylaxis,"
Hamer said, referring to the preventive drug regimen sometimes given
to needle stick victims. "It's a relatively common thing."
Dr. Harrison
Farber, director of the Intensive Care Unit at Boston Medical Center describes
similar numbers. "We get called with needle-stick-type questions a little less
than once a day - from inside the hospital and from outside," he said.
"These won't all require treatment. But we're still better off having
people call who don't need treatment than missing one who does."
Although every needle stick is taken seriously, physicians agree that
not all punctures are equal.
Hollow needles, used for injections and
drawing blood, retain bodily fluids and are therefore more likely to transmit
HIV than suturing needles. Deep punctures and those that pierce veins and
arteries are more risky than superficial injuries.
Another often elusive
- but critical - piece of risk-determining information is an HIV-infected
person's viral status. An affected individual with uncontrolled, end-stage AIDS
is more likely to transmit the virus than someone whose viral load is lighter.
Though no treatment provides a guarantee against becoming HIV positive,
several powerful regimens are considered excellent options. For most at-risk
patients, the CDC recommends what's known as the basic regimen, Farber said.
This includes four weeks of treatment with AZT and Lamivudine, two powerful
antiviral agents.
"It's not 100 percent," Farber said. "But it clearly
reduces the conversion rate."
Patients whose risk is considered very
high are treated with the expanded regimen, which adds a protease inhibitor such
as Indivavir or Nelfinavir to the roster of daily medications.
The key,
Farber said, is starting treatment immediately: "We're talking within hours. You
don't wait until Monday - you want to be treated as soon as possible."
Side effects of the treatment include exhaustion, nausea, headache, loss
of appetite and diarrhea.
Like other health-care workers, Farber agrees
the ideal way to battle needle sticks isn't through potent drugs, but through
prevention. That includes wearing protective clothing (gloves and eye wear),
disposing of sharps immediately in appropriate containers, using needleless
systems wherever possible, using retractable needles to avoid recapping needles
and conducting safety training.
Though some hospitals take prevention
seriously, a general inconsistency in policy led the Massachusetts Nursing
Association to draft the state's Needle Stick Prevention Act (Bill 969),
expected to be passed by December.
Association president Karen Daley
tested HIV positive in January, six months after an on-the-job needle stick that
she told the American Nurses Association would not have happened if a safer
system had been in place in her work setting.
If passed, the new
legislation will give the Department of Public Health a mandate to create
safety-training programs, an advisory committee and a list of the safest
hospital equipment available.
It will also require hospitals to use
safety devices where feasible, create a written exposure plan and
keep an exposure log that will be used to determine which devices and situations
increase risk.
LOAD-DATE: September 19, 1999
