I got pricked by a discarded syringe

iwellbc | Coalition | Saturday, 18 July 2009

[NOTE: The advice that follows is based on the recent experience of a Morningside area resident who stuck herself with a used needle while cleaning up after her dog, and on her research of public health resources and doctors' advice. Be warned that she is not a medical expert.]
If you stick yourself with a discarded syringe, don’t panic but do seek medical advice as soon as possible.
Treatment to forestall possible infection with Hepatitis (types A and B) and, in the unlikely worst-case scenario, HIV needs to begin very soon – within hours to about a day – in order to be effective.

1. If possible, save the syringe/needle. While it’s not routine to run tests on the needle (because there’s usually not enough moist blood in/on it for effective testing), it can be helpful for your doctor to examine the syringe and see what type it is and how fresh it seems to be. The longer the needle has been lying there, the better off you are (although you’ll probably still need a tetanus shot).
Experts believe that HIV doesn’t live for more than a few hours outside the human body. Hepatitis can live longer and is much more infectious. The less blood is in/on the syringe, the better. The kind of disposable syringe usually used by addicts is less dangerous in terms of accidental disease transmission than a syringe that a health-care worker would use to draw blood, because the needle is smaller and less blood (or none) is actually drawn back into the syringe. To carry and store the syringe safely, it’s recommended that you put it in a screw-top glass container – tip downward, of course.

2. If you can make the needle-stick wound bleed, do so. That helps to flush it out. Hold the wounded spot below your heart so blood will flow to it. Then wash it well (with antibacterial soap if available) and put a dressing on it.

3. See a doctor promptly. The New York City Health Department suggests visiting the Riverside Clinic, on 100th Street between Columbus and Amsterdam (call first: 212-865-7757). It provides HIV and Hepatitis screening/treatment for free, plus it’s one of the few locations where you can have truly anonymous testing done. [However, visiting your regular physician and/or an infectious diseases specialist is helpful.]
The doctors’ potential concerns were, in descending order of seriousness: HIV, Hepatitis, tetanus, and simple infection.

- HIV is apparently extremely unlikely in this context; you may be comforted to know that the CDC has no documented cases of HIV transmission resulting from an accident involving a discarded needle outside of health-care settings. Nevertheless… your doctor may give you an HIV test immediately, even though an infection from the needle accident won’t yet show up. (They do this in order to establish that you don’t already have HIV so their reporting is accurate.) You can then be tested again in six weeks, by which time a new infection would show up. If your doctor feels there is any realistic risk that you may have been exposed to HIV, he or she can prescribe a course of powerful (i.e., unpleasant) anti-viral drugs that must begin immediately.

- Hepatitis A and B can both be prevented from developing if you start the immunization process within a couple of days of the incident. Several vaccinations over a period of six to nine months are needed to provide full immunity. There’s no vaccine for Hepatitis C but there are treatments, so your doctor will probably test you for that too.

- Tetanus booster shots are necessary if it’s been years since your last one. No big deal!

- And in terms of simple infection, keep an eye on the wound and make sure it’s not getting red or swollen. If it does, ask for antibiotics.

4. Take precautions. The CDC recommends that, for the sake of others’ safety, you should act as if you have a serious infectious disease until you know for sure that you don’t. In other words, don’t share body fluids or donate blood or organs until you know you’re in the clear (the CDC says six months). Also check in with your doctor if you notice a fever up to six months after your needle-stick.

5. Finally… Ask lots of questions and make sure your fears are taken seriously by your doctor(s), even if you know the odds are strongly in your favor.

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