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 contrast, in veterinary medicine needlesticks are (unfortunately) largely considered “regular” events that aren’t really a big deal. Most of the time perhaps they’re not. They hurt, but serious consequences are rare. However, “rare” is not the same as “non-existent” – and if you’re the one that gets the “rare” complication, then it’s a very big deal to you.
While most needlesticks associated with animals and veterinary procedures/medications just hurt, sometimes bad things happen, such as:
- Infection from bacteria from the patient’s skin or the person’s own skin (especially if the needlestick involves a joint, tendon sheath or other sensitive structure)
- Allergic reaction to medication on or in the needle
- Known effects of the drug on or in the needle (e.g. exposure to a sedative)
- Adverse effects 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 potential issue: transmission of a patient’s infection to a veterinarian. This same scenario, involving the same pathogen, has been previously described (Ramsey JAVMA 1994). I mention this risk when I talk about needlestick issues, but this new case report is a good reminder. Here’s the summary:
- 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). This procedure involves sticking a needle into the mass to try to extract some cells for testing. In the process, she stuck her finger by accident. 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 animal-associated exposures. Sometimes important information like this isn’t passed on. The veterinarian was treated with an antifungal and fortunately 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 the consequences (especially infections). 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 is “don’t be a case report.” I can’t completely prevent that, but by reducing the risk of a needlestick injury, 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 really take much 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 else
- Always dispose of needles immediately into an approved sharps container
- Never leave needles in lab coats or other laundry (yes, this still happens and people get stuck… and understandably pissed off)
- Consider using safety devices that include 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 even 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 change and culture change are the bigger challenges. Sometimes taking a few seconds of time and having some basic awareness is all that’s needed.
Image below from Amoroso et al. Clin Infect Dis 2020