In human medicine, a needlestick is a big deal. That’s not surprising because of concerns about transmission of bloodborne pathogens like hepatitis B and HIV.
- In veterinary medicine…it’s largely considered a regular event that’s not a big deal.
Most of the time it’s not. It might hurt, but consequences are rare.
- However, ‘rare’ and ‘non-existent’ aren’t the same (and if you’re the one that gets the ‘rare’ complication, it’s not good).
While most needlesticks from an animal just hurt, sometimes bad things happen, such as:
- Infection from bacteria on the patient’s skin or the person’s skin (esp if the needlestick involves a joint, tendon sheath or other sensitive structure)
- Allergic reaction to medications
- Intended effect of a drug (e.g. sedative)
- Adverse effect of the drug in people (e.g. people have died from inadvertent injection of the cattle antibiotic tilmicosin)
A recent case report in Clinical Infectious Diseases (Amoroso et al 2020) describes another issue, transmission of a patient’s infection to a vet. The exact scenario has been previously described (I mention it when I talk about these issues), but the new case report is a good reminder.
The veterinarian was performing a fine needle aspirate on a mass from a dog that was ultimately diagnosed with blastomycosis (a fungal infection caused by Blastomyces dermatitidis). That involves sticking a needle into the mass to ty to extract some cells for testing. During the process, she stuck her finger. Three weeks later, she went to her doctor because the finger was swollen and painful. She had surgery to open up the infected finger joint and testing revealed Blastomyces dermatitidis. Presumably the vet had informed her physician about the dog’s diagnosis, but surprisingly, that’s not always the case in occupational or pet-associated exposures. Sometimes important information like this isn’t passed on. Fortunately, the vet was treated with an antifungal and the infection resolved.
I try not to be alarmist when it comes to emerging diseases, but we can’t be dismissive either. There wasn’t much attention paid to needlesticks in human medicine until people started to get sick (and die) from them. You don’t know about an emerging disease until it’s emerged. Infection control is inherently reactionary. Actions are most often taken in response to a known problem, rather than a potential issue.
One of my mantras ‘don’t be a case report’. I can’t completely prevent that but by reducing the risk of a needlestick, I can reduce the risk of me being the ‘first reported case of ___ acquired by a needlestick from an animal.’
Unlike many infection control activities, needlestick injury risk reduction is straightforward and doesn’t take much real time or effort. It includes things like:
- Never recap a needle
- Never leave an uncapped needle on a surface
- Never pass an uncapped needle to someone
- Always dispose of needles immediately into a sharps container
- Never leave needles in lab coats or other laundry (yes, this still happens and people get stuck….and pissed off)
- Consider using safety engineered devices that has sharps injury protection mechanisms like retracting needles or sheathes that are pushed over the needle
I’ve done all of the ‘never’ list above, except maybe the laundry one. As a busy medicine resident, in particular, I was pretty cavalier and got stuck many times, usually because we were rushing with an emergency but also because I gave it little thought. There was never a culture of needlestick injury prevention or event reporting (even when a patient broke a bunch of my ribs).
Like a lot of things in infection control, the science is easy. Behaviour and culture change are the main issues.
Taking a few seconds of time and basic awareness is all that’s needed.
Image from Amoroso et al 2020, Clin Infect Dis 2020