I recently sustained a ‘sharps’ or needlestick injury whilst operating. This is not unusual in the field of surgery and is under-reported and under-estimated. One study reported that the rate of sharps injury per surgeon per operation was 23% and another found that 44% of those surveyed had sustained a sharps injury. In the latter study, only 9% followed the locally agreed policy, with 70% performing first aid measures and 21% ignoring the incident and continuing.
In the recent case, I followed the locally agreed policy which requires form filling and blood sampling of the patient for viral screening with the patient’s consent and also blood from myself. However, I have not always folllowed this practice and have on different occasions behaved like the surgeons in the above study – either performing my own first aid measures or ignoring it all together. The latter can be associated with a certain surgical bravado and dismissive attitude to any attendant risks. It was not unusual for me during my training to see other surgeons do likewise.
The main concern for needlestick or sharps injuries is the risk of blood-borne viral (BBV) transmission for viruses like HIV, Hepatitis B and Hepatitis C. The risk of BBV transmission is higher for hollow bore needles but in principle can occur with any needle or sharp injury that allows any exposure to blood. The risk of BBV transmission via sharps injury to a healthcare worker from an infected patient is quoted at 1 in 3 for those infected with Hepatitis B and e antigen positive, 1 in 30 when infected with Hepatitis C and 1 in 300 for those infected with HIV. There are reports of documented transmission between patients and healthcare workers, although the overall risks are low ( 0.3% HIV and 3% Hep C). The immunisation of Healthcare workers for Hepatitis B has effectively reduced the risk for this group to contract Hep B.
It is not just sufficent to rely on the patient’s own history and knowledge of whether they do or do not have one of these infections but blood testing must be performed. For example it is possible for people to be infected with Hepatitis C and not be aware that they have the infection and many are oblivious to the fact until it presents with end-stage liver disease. The incidence is rising and it has been called a viral time-bomb, thus potentially increasing the risk to healthcare workers or anyone where there is the risk of blood borne transmission.
Thus whilst the overall risk is low, it is not zero and thus adherence to good practices, techniques and policies is required in order to reduce the risk for any one individual. One of the main sources of transmission of Hep C has been needle-sharing in the drug-using community. Even within these communities there is growing awareness around the risk of needle sharing and measures being taken to reduce this. Of course within the medical profession and surgical community it would be unthinkable to re-use needles, sharps or scalpels that had already been used on another patient. However, there have been reports of Hep B transmission and possibly HIV due to repeated needle use in acupuncture where the needles were not properly sterilised between patients. In addition, there have been reports of bacterial infection in acupuncture patients due to the re-using of incompletely sterilised needles.
Once any needle is removed from its sterile packaging and handled by a doctor or practitioner and inserted into an individual it is no longer sterile. The needle will be colonised by bacterial flora from the skin of the practitioner holding the needle and also the skin of the person on whom the needle is inserted. So if that needle is re-used without complete sterilisation procedures there is the risk of bacterial infection as well as BBV transmission. These bacterial infections are usually localised and minor but can be more serious.
From an esoteric perspective, the manifestation of illness and disease comes back to the individual and the development of individual responsibility. In addition, illness and disease are seen as the body’s way of clearing that which is energetcially harming to it. This may mean not ingesting certain foods or substances that are toxic to the body and likewise means not taking undue risks with behaviour that is dismissive or disregarding of the known risks eg. permitting use of unsterile needles.
As I have become more self-caring, it makes sense to adhere to the local policy for sharps injuries as well as adhering to good practices to prevent such injuries and to drop the disregard and self-dismissive attitude I had before. For me, it is consistent with energetic integrity and responsibility to adhere to such practices – even if at times it seems like over-kill.
Esoteric chakrapuncture is a healing modality that also uses fine needles with minimal skin penetration. Even though the risks of BBV transmission are most likely to be even lower with this technique than with surgery or standard acupuncture the same principles apply. Having recently undertaken a course in esoteric chakrapuncture it was clearly presented that the disposable needles used are only for use on one person. To do otherwise would go against both true energetic integrity and responsiblity and standard medical practice. It could even be argued that it is part of one’s own personal responsbility to ensure that all needles inserted are fresh sterile needles thus not permitting the disregarding practice of repeated needle use that has been reported in the above acupuncture studies.
Some have suggested that in order to reduce the risk of BBV transmission we should treat every needle as if it has come from a patient with a viral infection, with strict adherence to the ‘one needle for one patient’ rule. With the increasing incidence of patients with Hepatitis C. who may not even know they have the disease. this would be wise practice.