THE WRONG END OF THE NEEDLE

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THE WRONG END OF THE NEEDLE. DR M G ASHTON CONSULTANT GASTROENTEROLOGIST CHESTERFIELD ROYAL HOSPITAL. THE INCIDENT. 7/3/05 5 PM – END OF BUSY ENDOSCOPY LIST  INPATIENT WITHOUT IV ACCESS CANNULA INSERTED -MOVEMENT DEEP NEEDLESTICK INJURY – HOLLOW
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THE WRONG END OF THE NEEDLEDR M G ASHTONCONSULTANT GASTROENTEROLOGISTCHESTERFIELD ROYAL HOSPITALTHE INCIDENT
  • 7/3/05 5 PM – END OF BUSY ENDOSCOPY LIST 
  • INPATIENT WITHOUT IV ACCESS
  • CANNULA INSERTED -MOVEMENT DEEP NEEDLESTICK INJURY – HOLLOW BORE NEEDLE INTO LEFT INDEX FINGER USUAL MEASURESTHE BOMBSHELL
  • “THIS PATIENT HAS HEPATITIS C”
  • THAT NIGHT ON THE INTERNET
  • ·RISK OF HCV TRANSMISSION – 2  10%
  • ·REPORT OF PHYSICIAN SUCCESSFULLY
  • TREATED WITH INTERFERON
  • ·VERY LITTLE SLEEP
  • THE NEXT MORNING
  • ·SEEN BY OCCUPATIONAL HEALTH
  • ·G.U.M PHYSICIAN COUNSELLING
  • ·SOURCE BLOODS - MY BASELINE
  • BLOODS - CONFIRMED
  • ·GRADUAL RESOLUTION OF ANXIETY
  • ·WAITING FOR 6 WEEKS TESTING
  • SYMPTOMS·18 APRIL BLOOD TEST for HCVAB and HCVRNA
  • ·THAT WEEK – NAUSEA IN THE MORNING
  • ·ONE DAY OF VOMITING FOR 12 HOURS
  • ·NEXT DAY DARK URINE = BILIRUBINURIA
  • ·NOT OBVIOUSLY JAUNDICE
  • ·GP CHECKED LFTS = BILIRUBIN 60 ALT 1600
  • ACUTE HEPATITIS C
  • ·20% SYMPTOMS
  • ·26% SPONTANEOUS CLEARANCE
  • ·YOUNG FEMALES DO BEST
  • VIROLOGY
  • VIRAL LOADS OVER NEXT FEW WEEKS
  • GENOTYPE 3A
  • 400,000 to 9,000 (72)To 21,000(79) but results took 7 days to return
  • DAY 79 – Decided clearance unlikely
  • 1ST INJECTION PEG IFN 2b + RIBAVIRIN (Combination therapy)
  • My Experience on Treatment
  • 24 weeks in acute Hep C
  • Weight loss
  • Bad weekends but able to work after 2 weeks
  • Occasional insomnia
  • Avoided fiddly tasks due to short fuse
  • Hb 11 and Neutrophils 1.1
  • Conclusion ;relatively lucky
  • Outcome
  • CLEARANCE at 10 , 24 weeks and SVR 24 weeks after TX.
  • Clear three years later
  • Reflections
  • The first night was the worst but intermittent dark times especially on tx .
  • Feeling of Isolation ;nobody really understands.
  • I counsel needlestick injuries recipients .
  • I have extensively researched all aspects of needlesticks , acute hepatitis c and chronic hepatitis c. Unique position/experience and positive outcome.
  • IT COULD HAVE BEEN WORSE ;HIV EXPOSURE
  • 2006 : EYE OF THE NEEDLE 2 - HPA
  • ·2002 – 2005
  • ·369 p/c exposures TO HEP C
  • ·212 TO HIV
  • ·POOR COMPLIANCE IN POST EXPOSURE TEST
  • ·HCV SEROCONVERSIONS
  • ·11 IN 8 YEARS
  • ·      181 TOOK PEP FOR PC HIV exposure
  • Final Messages
  • Needlestick is an emergency ;re HIV and PEP
  • In random needlestick ,you are 50 times more likely to contract HCV than HIV
  • Ignorance, arrogance and complaisancy are the main obstacles to overcome in the battle to reduce /eradicate needlestick injuries .
  • PREVENTION,PREVENTION and PREVENTION
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