'Anything on a needle' is a bloodborne risk
Follow-up should look beyond HIV, HBV, HCV
No new confirmed cases of occupationally acquired HIV have been reported since 2000. The hepatitis B vaccine has led to a dramatic reduction in new occupationally related cases. But the risk of transmission of disease from bloodborne pathogens to health care workers remains very real a risk that isn't limited to hepatitis and HIV.
Although transmission of other pathogens from needlesticks is rare, there have been published reports involving almost three dozen agents, including tuberculosis, Staphylococcus aureus, and dengue.
In a 2001 case, a nurse in Paris suffered a needlestick while drawing blood from a patient of Kenyan origin who was being tested to see if she was infected with malaria. In the follow-up from the exposure, the nurse learned that the source patient was negative for HIV and HCV. She had been vaccinated against HBV.
But no one told her of the potential risk of transmission of other bloodborne pathogens, and the nurse didn't mention to the treating physician that the patient was suspected to have malaria. Ten days later, she developed a high fever, myalgia and fatigue. She was eventually diagnosed and treated for malaria.
The follow-up after an exposure should consider pathogens beyond HBV, HCV, and HIV, the authors concluded.1
In another case, a nurse cut herself with a needle that had been inserted in a central line catheter of an AIDS patient, who was on a ventilator due to respiratory failure. She immediately washed the wound with a water and iodine solution and began antiviral therapy.
She developed a skin lesion at the site of the needlestick and high fevers. Six weeks later, she was diagnosed with tuberculosis and began treatment. She remained negative for HIV infection.2
Case reports such as these "just underscore the importance of needlestick prevention strategies, in addition to the use of safety devices," says Jane Perry, MA, director of communications for the International Health Care Worker Safety Center at the University of Virginia in Charlottesville.
Janine Jagger, PhD, director of the center, has tracked occupationally transmitted pathogens and commented, "Pretty much anything that can make it onto a needle can be transmitted to a health care worker."
Occupational transmission of the following bloodborne pathogens has been reported, according to an analysis by Jagger, Perry, and researchers with the Italian Study Group on Occupational Risk of HIV Infection:3
Bacterial infections
- Brucella abortus
- Corynebacterium diphteriae
- Corynebacterium striatum
- Neisseria gonhorreae
- Leptospira icterohaemorrhagiae
- Mycobacterium marinum
- Mycobacterium tuberculosis
- Mycoplasma caviae
- Orientia tsutsugamushi
- Rickettsia rickettsii (Rocky Mountain spotted fever)
- Staphylococcus aureus
- Streptococcus pyogenes
- Treponema pallidum (syphilis)
Viral infections
- Creutzfeldt-Jakob disease
- Dengue virus
- Ebola/Marburg virus
- Hepatitis B virus
- Hepatitis C virus
- Hepatitis G virus
- Herpes virus simiae
- Herpes simplex virus
- Herpes zoster virus
- HIV
- HTLV-II
- Simian immunodeficiency virus
Fungal infections
- Blastomycosis of the skin
- Cryptococcosis neoformans
- Sporotrichum schenckii
- Protozoal infections
- Plasmodium falciparum (malaria)
- Toxoplasmosis gondii
Tumors
- Human colonic adenocarcinoma
- Sarcoma
References
1. Tarantola AP, Rachline AC, Konto C, et al. Occupational malaria following needlestick injury. Emerg Infect Dis 2004; 10:1,878-1,880.
2. Kramer F, Sasse SA, Simms JC, et al. Primary cutaneous tuberculosis after a needlestick injury from a patient with AIDS and undiagnosed tuberculosis. Ann Intern Med 1993; 119:594-595.
3. Jagger J, De Carli G, Perry J, et al. "Occupational exposure to bloodborne pathogens: Epidemiology and prevention." In: Wenzel RP, ed., Prevention and Control of Nosocomial Infections (4th edition). Baltimore: Lippincott Williams & Wilkins; 2003, pp. 430-466.
No new confirmed cases of occupationally acquired HIV have been reported since 2000. The hepatitis B vaccine has led to a dramatic reduction in new occupationally related cases. But the risk of transmission of disease from bloodborne pathogens to health care workers remains very real — a risk that isn't limited to hepatitis and HIV.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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