Copyright 2000 St. Louis Post-Dispatch, Inc.
St.
Louis Post-Dispatch
December 3, 2000, Sunday, FIVE STAR LIFT
EDITION
SECTION: EVERYDAY MAGAZINE, Pg. E1
LENGTH: 1835 words
HEADLINE:
NEEDLESTICKS: A NURSE'S NIGHTMARE
BYLINE: Marianna Riley; Of the Post-Dispatch
BODY:
Even as a little girl, Marjorie
Whaley knew that she would grow up and become a nurse -- trained and licensed to
care for people who were sick and in need of help.
Now she is
paying a terrible price for achieving her goal.
Whaley suffers from
hepatitis C, a disease she contracted by accidentally sticking herself with a
contaminated needle while on the job.
Since that accident nine years
ago, Whaley has had to face bouts of depression, fevers, chills, aches, hair
loss and an overwhelming drug regimen to keep her alive. And she had to give up
the profession she loved. Hers is one of an estimated 600,000 needlestick
injuries in this country each year. Of those, about 1,000 result in serious
infection -- some in death. Hepatitis C and HIV, the virus that causes AIDS, are
the most common diseases that come from the sticks.
After years of
complacency, legislators and health-care administrators in the St. Louis area
and around the nation are finally starting to take notice. They are mandating
the use of safer needles and medical devices -- some of which have been around
for years and, if they had been in use, could have saved thousands of
unfortunate nurses from sickness, suffering and even death from needlesticks.
"It's not something you can take back, but it is something you can
prevent," said Lisa Black, a nurse in Reno, Nev., who is working for legislation
in her state that would prevent the catastrophe that befell her on Oct. 17,
1997.
On that day, she got infected with both hepatitis C and HIV after
being stuck with a patient's needle. Unable to work for nearly two years because
of resulting illnesses so serious they have from time to time caused her to be
hospitalized in intensive care, Black must take 22 pills a day to keep her HIV
under control. She prays she will see her little girls grow up.
"With
safer equipment I would not have been stuck and would not have been infected,"
she said.
A stinging sensation
Julie Naunheim-Hipps of
Glendale, a St. Louis oncology nurse working in home care, will never forget the
date of her stick: Oct. 29, 1999.
She'd gone to a patient's home to
change dressings for a foot infection. She also drew blood from the woman, who
was on antibiotic therapy. It did not appear to be a high-risk situation.
But the house was cluttered, an "uncontrolled environment" is what
professionals would call it. A 5-year-old child was running around, and
Naunheim-Hipps was acutely aware that she should keep the child away from the
needle she was using.
She worked from a kneeling position because her
patient was in a recliner. When she had finished, she collected all the trash in
her left hand and pushed herself to a standing position with her right. That's
when she felt a sharp stinging sensation in her left thumb.
The prick
was from the back end of the needle, which was in a rubber sheathing that had
been punctured during the blood-drawing process.
Blood -- this time her
own blood -- was oozing from her glove. As she gasped, the patient asked, "Did
you stick yourself?" When Naunheim-Hipps nodded, the patient continued: "I
forgot to tell you I have hepatitis C."
A dangerous rite of
passage
Nurses say such sticks are almost routine. Historically, they've
been a sort of professional rite of passage. But since 1981 and the beginning of
the AIDS epidemic, needlesticks have become an increasingly dangerous rite.
Furthermore, much of the danger is unnecessary, health-care workers say.
That's because devices that greatly reduce the risk of such sticks have been
available for more than 10 years.
But across the country, they haven't
been available to most health-care workers because hospitals and their
purchasing groups didn't choose to buy them.
If Whaley and Black and
Naunheim-Hipps had had such devices, they might have been spared month upon
month of sickness and anxiety. Maybe, even their lives.
Now a major
global health problem, viral hepatitis C was just discovered in 1989. The
discovery of that virus ended a period of international research on an elusive
"non-A, non-B" virus that was known to be the cause of hepatitis that occurred
after blood transfusions.
According to the Centers for Disease Control
and Prevention, almost 4 million Americans have been infected with hepatitis C.
Of those, 2.7 million are chronically infected.
Hepatitis C can cause
chronic liver disease or failure. It can also lead to liver cancer. It is the
most frequent infection resulting from needlestick and similar injuries.
Before 1992, when routine blood screening started, the virus could be
transmitted through transfusions. Now, its usual method of spreading is through
needle-sharing among drug users or through sex with multiple partners. Other
practices such as ear-and body-piercing and tattooing may also prove to be
conducive for hepatitis C.
An unfamiliar disease
Hepatitis C?
Marjorie Whaley didn't even know what the virus was
that fateful day in late August 1991.
Whaley, 50, had just finished
flushing a patient's intravenous line and had inserted the needle into what
turned out to be a defective needle-s torage container. As she was putting in
the used needle, another needle rolled up and hit her left index finger.
Despite the fact that she was wearing two pairs of latex gloves as a
precaution, she immediately had blood running down her arm and inside the
gloves. She had no way of knowing from what patient the needle that stuck her
had come.
Eight months later she learned she had hepatitis C.
After she started her drug therapy, Whaley suffered fevers, chills, body
aches, hair loss and mood swings and, worst of all, her liver enzymes kept
climbing, meaning she was not responding to the drug.
Whaley felt as if
she were going crazy; she fell into a severe depression and had suicidal
thoughts, along with hallucinations.
She got so weak there was no way
she could continue working full time, much less doing private-duty nursing on
the side. Still, she managed to get a night job as a triage nurse with a health
maintenance organization, alternately dealing with patients on the phone and
throwing up into her wastebasket.
She finally had to quit working
altogether and for a while lived with one of her sons because she could no
longer make her rent payments and was too sick to take care of herself. She now
receives Social Security disability payments.
The human cost is
obvious. But so is the financial toll.
Whaley's medicine costs about $
1,500 a month. Naunheim-Hipps' is $ 2,000. She estimates her care will cost up
to $ 1 million.
The costs to the health system is huge as well. It's
estimated that up to $ 400 million is spent each year on testing. Treating
exposed workers with prophylactic drugs can cost almost $ 4,000 each.
Finding safer devices
As legislators are beginning to understand the
needlestick issue and push to mandate compliance, administrators in local
hospitals are beginning to understand the necessity of changing to safer
devices.
BJC Health Care, for instance, is in the process of testing
several new devices. Some are already in use in various departments throughout
the hospital system.
Training in their use is crucial, said Dr. Vicky
Fraser, the medical director of infection control for BJC. "We need to train
people to do the right thing consistently, but it's like people who know they
should use their helmets or wear their seat belts -- but they don't always do
it," she said.
She stressed that all the new devices have to be tested
before the hospital makes them available. "When we first started, there were
very few safety products available, they were expensive, and there was no data
to show they even worked," she said.
Just looking at the numbers, the
risk to health-care workers would seem to be low -- about one in 600
needlesticks resulting in serious infection.
Fraser said that fewer than
one in 100 sticks from needles used for hepatitis C-infected patients results in
a hepatitis infection to the health-care worker. For HIV, it's one in 300.
But activists such as Black point to the human faces behind these
numbers. "I am one of those statistics, and I am significant," Black said.
Keeping the faith
While Naunheim-Hipps and Black have
found that their activism has helped them deal with their illnesses, Whaley has
a new-found spirituality that has seen her through her illness.
She
finds she gets an almost miraculous rejuvenation by going to her church --
Abundant Praise Fellowship in Arnold -- and for the first time learned to trust
a power other than science. "I start praising, and a renewal comes over. It's
like I become a new person," she explained.
About a year ago, Whaley
went off her treatment. Not because she was cured. She just got so tired of
being sick all the time that one day she called her doctor's office to say she
couldn't continue on the drugs any longer.
She did well. She found she
could go out to eat without getting sick. S he could do her own grocery
shopping. She even visited her sister in Houston.
But several months ago
she felt the old tiredness returning, and she knew she could no longer prolong
the inevitable. In September, she started a new drug regimen.
Her
doctor, Bruce Bacon, director of the division of gastroenterology and hepatology
at St. Louis University Hospital, said he is confident that some changes he
plans to make in the treatment will work for Whaley.
"We're going to get
Margie better. We're going to do it differently this time in order to get
through a whole course of treatment," he said.
So far, Whaley is
tolerating the medicine better than in previous years. Some days are better than
others. She's lost weight and most of her hair. But she's feeling more positive.
A part of her is still afraid. Her voice trembles as she contemplates
the future: "If this doesn't do it," she said, pausing and looking up, "God will
keep me going 'til something else comes along. I'll make it through this. I will
if I keep my faith."
============
For additional
information:
Call the American Liver
Foundation,
St. Louis chapter, at 314-352-7377. With a
mission to prevent, treat and
cure hepatitis and other liver diseases through research and education, the
foundation
provides a support group for people with hepatitis C.
===========
An estimated 600,000 accidental pricks occur
in this country each year.
Of those, about 1,000 result in serious
infection (such as hepatitis C and HIV) or death. After years of complacency,
legislators and health-care administrators are finally pushing for safety
measures such as the mandatory use of safer needles and medical devices.
============
According to the Centers for Disease Control
and Prevention, almost 4 million Americans have been infected with hepatitis C,
which was discovered in 1989. Of those, 2.7 million are chronically infected.
NOTES:
To contact reporter Marianna Riley: E-mail:
mriley@postnet.com Phone: 314-862-2162
GRAPHIC: PHOTO
PHOTOS BY KEVIN MANNING / Post-Dispatch:
(1) Color Photo - Julie
Naunheim-Hipps gives herself an injection of Interferon in preparation for
chemotherapy. A nurse who contracted hepatitis C through an accidental
needlestick, she now cannot work in her chosen profession and has become an
activist for making nursing safer.
(2) Photo - Marjorie Whaley, a former
nurse who suffers from hepatitis C, engages in a laying on of hands with the
Rev. Tim Wooten and members of the Abundant Praise Fellowship Church in Arnold.
She says her faith has given her strength to fight the illness.
(3) Photo -
Whaley, who is currently on a drug regimen for hepatitis C, frequently fights
exhaustion despite leading a quiet life. She cannot work and receives disability
payments.
LOAD-DATE: December 3, 2000
