Wednesday, October 25, 2006

Stick me baby one more time

Unfortunately I have sustained my second needlestick injury in 12 months. This time, I was jabbed by one of my registrars. She managed to impale our scrub nurse as well in the same operation.

I cannot blame her for the event. We are new to each other, and still getting used to operating together. She is left-handed, and I am not. There is a clash on the operating table where we both like to put our hands. Goggles and visors reduce visibility but protect us from splashes. Double gloving reduces infection risk but reduces sensitivity in operating. Guarding the needle requires handling it an extra time with one's fingers.

Every protective manouevre we undertake compromises our ability to operate. If we are going to work with body fluids and sharp objects there will be a risk of exposure. We have to accept that fact of life, and draw an arbitrary line in the sand between our safety and our patients' wellbeing.

Those two blokes who got stuck in the mineshaft in Tasmania knew that they were at risk. What made that risk acceptable to them?

In any case, what irks me is not that it happened. Rather, it was the Infection Control Nurse* who came over with her forms and wanted to debrief us on all factors contributing to the needlestick injury. "What could we have done to avoid this event?" I could have said any number of things, like:
  • not done the operation and let the patient suffer
  • use blunt needles that would have botched the whole operation
  • not worn visors, improved visibility and risk a splash injury
  • refuse to work with left-handed female registrars
It was clear that none of these were acceptable, or would get me out of her vice-like grip so that I could go and finish the rest of my operating list. So what did I say? "I could have put my hand somewhere else." It was lame, but it filled in the space on the form so I could get away.

Even better was her parting comment. "Why should we risk our lives for our patients?" The fact is, every health worker risks their lives every day for all of their patients. I negotiate insane drivers to get to work every day. I risk being mugged walking from the car park to the hospital. I run the risk of being strangled by a delirious post-op patient every day. And I risk contracting an infectious disease every time I operate. I would love some way to eliminate all of these risks without inconveniencing me or my patients. Unfortunately, the only way this will happen is if I quit and stay home all day. I'm still considering that one.

*The Infection Control Nurse is a highly trained nurse practitioner / specialist clinical nurse consultant who has a plethora of duties, such as chastising people for needlestick injuries, chastising people for not washing their hands or using alcohol rubs, chastising people for standing in a room with a patient with "black colonies" (i.e. might have a remote chance of possibly having highly non-pathogenic VRE), and handing out jelly babies after torturing you with your annual influenza vaccination.

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