Glenn,
I work in the NHS and will give you a brief outline of what is required of
us. it is Dept of Health guideline to seek testing of a donor even if the
risk is low. Although rare we have had positive tests result in patients
considered 'low risk'. Blood must be taken from the Recipient for Hep B
levels and serum storage. Discussion about giving anti-retrovirals must also
be undertaken. the taking of these drugs often hinges on how quickly the HIV
test can be done and the result made available, and before we get a lot of
e-mails about false negatives etc. this is actually very low. I am aware the
donor may be in a window period when HIV infection may not be apparent but
this should be explained to the recipient when they are deciding whether to
commence the drug therapy. If drug therapy is given the base line liver
function full blood count should be taken and then close monitoring is
required of the individual - regular blood test for liver function etc.&
help with side effects.
The recipient may require vaccination of Hep B. the green vaccination book
has a chart under Hepatitis B about when to vaccinate/booster following Hep
B exposure.
The recipient is offered anonymous testing for blood borne viruses at the
appropriate intervals.
Finally you do not clarify what you mean by 'low risk' the risk assessment
needs to consider where the injury was sustained and how deep, the device
causing the injury; was the device placed in the artery or vein of the
donor; was it covered in blood? Was it a hollow bore needle? Risk
assessment of the donor is tricky. as mentioned above never assume that
because this person is elderly/ has one partner/ doesn't appear to be a drug
user etc that they are not infected. I have had a situation where an elderly
gentlemen considered low risk was found to be hep B positive. it transpire
that he had tattoos - done when he was stationed in the far east during the
war and it is likely that he contracted hep B then. Another situation the
donor was positive to Hep C from a spell of drug taking in their youth
although they were now a respectable member of society and did not undertake
any high risk activities! Patients who had blood transfusions before BBV
testing of blood products was introduced may have contracted something.
people do get upto all sorts of things in their youth that impact on their
health later in life. HepB/C can lie dormant or not cause problems for
years.
Sorry to go on and it does sound dramatic but it is important that you are
aware of the many ramifications of a needlestick. We constantly have to
remind staff the this can be a serious injury to their health and it is
essential to report it. In the majority of case though I am happy to say
that it is usually straight forward. I know I have only covered the basics
and many others will give their comments. If you phone/e-mail me you address
I will be happy send you a copy of our information leaflets etc.(and anyone
else!)
I hope this is of help.
Sue Manthorpe
-----Original Message-----
From: Occupational Health mailing list
[mailto:[log in to unmask]]On Behalf Of Glenn Raybone
Sent: 25 June 2002 19:25
To: [log in to unmask]
Subject: Needle stick injuries
Tis me again!!
Here's one for you to think about and let me have your ideas....
If a member of staff (NHS) who is covered for Hep B sustains a needlestick
injury, and an assessment is made which deems it low risk, should there be
any need to bleed the donor?? Because even if the donor is a carrier, we
would not be doing any more vaccinations for the member of staff, or would
we? Surely just a serum save would suffice??
Let me know your thoughts,
Thanks,
Glenn Raybone
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