Know The Protocol and Important Information About a Needlestick or Body Fluid Splash

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Statistics:
According to Johns Hopkins – “Researchers surveyed surgery residents at 17 medical centers and, of 699 respondents, 415 (or 59 percent) said they had sustained a needlestick injury as a medical student. Many said they were stuck more than once. Of the surgeons-in-training whose most recent needle stick occurred in medical school, nearly half of them did not report their injury to an employee health office, thereby avoiding an evaluation as to whether they needed treatment to prevent HIV or hepatitis C.”

Always report any and every incident!!!

OCCUPATIONAL EXPOSURES TO BLOOD

If you are injured with a used needle or other sharp object that has been exposed to body fluids, or if a patient’s body fluid(s) are splashed onto broken skin, mucous membranes or into your eye(s) you may be at risk to contract an infection. Although there are other pathogens to consider the ones of primary concern consist of HIV, HBV, and HCV.

If involved in needle stick (or other sharp object), or a splash of an HIV positive patient’s body fluid goes onto mucus membranes or broken skin, treatment is available that can reduce the risk of acquiring HIV infection. The U.S. Centers for Disease Control and Prevention recommends that for maximum protection, you should receive treatment within two hours of exposure. Post exposure prophylaxis (for HIV) must be started within the first 72 hours. If involved in a blood splash from an HIV and HCV positive patient it is possible to test HIV negative up to one full year if infected with HCV. In the situation where confection is possible, if you test Positive for HCV be sure to test for HIV up to one full year from exposure.

“Ancient document reveals The Most Important Skill a Physician or Surgeon Can Ever Have”

William ‘Ozzy’ Osler (left) not to be confused with ‘Ozzy’ Osbourne (right)

A brief history
William ‘Ozzy’ Osler was the head-banging, axe-shredding prince of medicine in his day. He was a rock star. He’s the Osler in Osler’s nodes and the Osler in Osler-Weber-Rendu disease. A brief history: Dr. Osler was an esteemed diagnostician and clinician who earned his M.D. from McGill University. Throughout his career, he sat on the faculty of some of the finest medical schools, including McGill, The University of Pennsylvania, Johns Hopkins University (the second of the four original faculty members appointed at Hopkins) and Oxford University. His Regius Professorship of Medicine at Oxford was that most prestigious academic appointment in medicine in the English-speaking world at the time.

Revolutionizing Medical Education
He revolutionized American and Canadian medical education by combining the best aspects of the English and German systems. He championed a patient based approach, believing that students learned best through practical clinical experience. He also modeled postgraduate training in America after the German system, instituting a 1 year general internship followed by several years of residency. To add to his legacy, The Principles and Practice of Medicine, a textbook which he authored would be the gold standard in clinical medicine for the next forty years. His CV goes on for pages.

Ancient Language Re-Written
If you’re interested in learning what Dr. Osler considered to be the most important quality a physician can possess, and how just about anybody can acquire it, then read every lick of this article. Dr. Osler reveals what this quality is in his famous valedictory address to the medical graduates at the University of Pennsylvania (class of 1889) titled Aequinimatas. It was hard to read and interpret since the language used was pretty ancient, so I’ve re-written selected passages from this speech in modern language. This is just my interpretation of course. None of these ideas can be attributable to me. If you want the full-effect of the eloquence and romance of Osler’s speech, you’ll have to read the original. Though I think you’ll agree that I’ve preserved the core meaning of this brilliant piece.

Enjoy.


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Know The Protocol ... (continued)

What is an exposure?
  1. Percutaneous injury (by needle or sharp)
  2. Fluid contact with Mucous membrane(s) and eye(s).
  3. Splash on non-intact skin
What Fluids are infections or considered infectious?
  1. Blood (or any fluid with blood in it)
  2. Semen
  3. Breast Millk
  4. Vaginal secretions
  5. CSF
  6. Amniotic fluid
  7. Peritoneal fluid
  8. Pleural fluid
  9. Synovial Fluid
What are the initial steps in exposure management?
  1. Clean the exposed area immediately regardless of what fluid made contact.
  2. Skin wounds should be cleaned extensively with soap and water for several minutes.
  3. Mucous membranes: flush with copious amounts of water as soon as possible following exposure for several minutes. Flush eyes out with water or normal saline for several minutes.
  4. Report incident to attending physician and go to emergency room (you should identify yourself as a medical student who has just sustained an exposure) so that the level of risk associated with the exposure can be determined.
  5. Depending on the level of risk associated with the exposure, post exposure prophylaxis (PEP) may be an option and should be discussed with the treating physician. It is recommended that PEP be started no later than 72 hours after exposure; this is why an immediate assessment is paramount after exposure.
  6. If you have not already completed the HBV vaccine series it should be considered. If your treating physician does not discuss this with you, bring it up.
If there are any questions please read Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis. Additionally ask your university, ask your attending, or ask a treating physician if you have been exposed to infectious fluids or if there are any questions regarding the hospital’s exposure guidelines.

Before beginning any rotation ask for a tour of the facilities and be aware of the location of sinks and/or eye wash stations in the event of exposure. Additionally wear protective gear, not only gloves but goggles or splash guards, whenever warranted. If the University has a student exposure protocol in place be sure to know the contact information for the parties involved.

Links:
  1. U.S. Centers for Disease Control and Prevention
  2. U.S. Dep. Of Labor Bloodborne Pathogens and Needlestick Prevention
  3. CDC: Exposure to Blood What healthcare Personnel Need to Know





Author:
Joseph Kelly MS-IV
Spartan Health Sciences University
Ancient document reveals ... (continued)

Aequinimatas
Equanimity is an essential virtue for us in the noblest of callings. For the physician or surgeon no quality is as important. Simply put, equanimity is the ability to keep our mental and emotional composure in stressful situations. Equanimity [origin: latin aequanimitas] is steadiness in storm, clarity of judgment amid danger – fearlessness.

A physician without equanimity will outwardly demonstrate worry and anxiety, will be indecisive in ordinary emergencies and will be prone to disaster. He will quickly lose the confidence of his patients.


Be Bullet Proof
It is a divine gift for some, though the majority of us can acquire it through education. We must condition our medullary centers to not permit dilation or constriction of our facial vessels under any professional circumstance, as this may reveal our blushes of shame. Such fearlessness will be forever linked with one’s experience and intimate knowledge of the various diseases. A physician equipped with experience and knowledge will always know the possible outcomes and course of action to take in a given situation. Therefore, his mental equilibrium cannot be disturbed.

This precious quality, this intrepid demeanor is bound to be misinterpreted as harshness or callousness. While keen sensibility (sensitivity) is a virtue, a judicious level of insensibility is preferable as it allows one to move forward toward the greater good to be done in spite of less important considerations. It is a necessity in exercising calmness of judgment during delicate operations. Therefore we must foster a temperament of courage and firmness without, at the same time being so obtuse as to “harden the human heart by which we live.”


“Knowledge comes, but wisdom lingers”
In order to ensure good-natured equanimity, one must not expect too much of their patients. In matters medical, the ordinary citizen of today doesn’t know much. Their faith in homeopathy and other fads which do not offer verifiable benefits should be pardoned. We must have infinite patience and offer charity toward our fellow man.

The life of a physician is one in which our aim is to seek absolute truth in our sciences and arts, though this is unattainable. Absolute truth is fragmented into a thousand pieces and scattered by the four winds, as in the Egyptian story of Osiris. We may but pick up a fragment or two in the reconstruction of truth’s divine form. In this way we are like archaeologists.


Making Life Worth Living
Equanimity is a necessity in both success and failure! It has been said that in prosperity equanimity is what allows us to bear the misfortune of our neighbors with composure. While nothing disturbs one’s piece of mind more than limited financial means and the lack of material things, I must warn you about the test that awaits some of you – when you are running a large and successful practice. You may find yourself so consumed with earning and spending that there is no place in your soul for the simple pleasures of life that make it worth living.

Overcoming Adversity
It is sad to think that some of you will fail. Anxiety and the incidents of professional life are inescapable of course. So stand up bravely against the worst of it. If your hopes and dreams do not materialize… if you find yourself left to struggle alone at night, fight on; for in persistency lies victory, and with morning your desired blessings may come. But this isn’t always true. Some of you will have to bear struggle with defeat. Exercise cheerful equanimity in these times. Remember, too, that sometimes, “only from our desolation does the better life begin.” It is better to face imminent disaster standing tall with a smile on your face than to put your head in the sand as it approaches. If the fight is one of principle and justice, like Childe Roland before the dark tower, set the trumpet to your lips, blow the challenge and await conflict calmly. It has been said that “in patience you shall win your souls.” This patience is but equanimity which allows you to rise above life’s trials.

Privilege Entails Responsibility
Towards the end of his speech Dr. Osler addresses the faculty in attendance, stating, “Gentlemen of the faculty – noblesse oblige.” Meaning, as we are appointed to such important positions, we are morally obligated to act with honor.

Source:
  1. http://www.medicalarchives.jhmi.edu/osler/biography.htm
  2. http://www.medicalarchives.jhmi.edu/osler/aequessay.htm
Author:
Cesar Orellana, M.D
ValueMD Member  Cesar Orellana. M.D

Cesar Orellana is a recent graduate of Ross University School of Medicine and co-author of the book: How to Get a 4.0 GPA in Medical School – No Matter What Your MCAT Score or College GPA. He has helped medical and pre-medical students from all over the United States and Canada achieve dramatic turnarounds in their academic performance by teaching them to walk around hoops instead of blindly jumping through them.

For the next 7 days only, ValueMD members can get this book at a substantial discount off the regular price.


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