If you work in drug services the chances are there's an A4 poster up somewhere telling you what do do if you, as a worker, are accidentally spiked with a used needle. You may even have read it once or twice, but now its going brown at the edges and no one really notices it. But how often do we talk about this with injectors, after all they're at a far greater risk of getting spiked than we are.
OK first things first, what should someone do if they get accidentally spiked?
- Don't panic: this is the best bit of advice that Douglas Adams ever wrote, panicking won't help the situation at all. If anything it will speed up the bodies systems. Remember the actual risk of getting HepC or HIV from a single injury is relatively low.
- Don't suck the wound: while at first this seems like a no brainer, think back to the last time you cut a finger.
- Encourage bleeding: the easiest way to do this is to squeeze from behind the wound, easy if its a finger, far more difficult if you've sat on a needle. (Have you ever noticed how we always assume a needle injury would be to a finger)
- Put under running water: This helps wash the blood away that you're squeezing out, but the water temperature is important. Too hot and the blood will thicken, too cold and the wound will close. I like the term 'Goldilocks water'.
If you work in a project any you get spiked you'll also have a few extra things to do:
- Report to your line manager: I'm afraid I have no idea about health and safety law overseas, but in the UK you have to report to a line manager. This of course generates a number of bits of paperwork like incident reports, RIDDOR reporting etc. But most of that can wait until after ....
- Contacting nominated service: in my experience this has always been the local Accident & Emergency department. You need to tell them that you have a needle injury from a 'high risk source' (any used needle injury should be considered a high risk source, see below) you may have to push the point with some nursing staff. You may be asked to give some blood for testing, this isn't to test to see if the needle injury has exposed you to a virus, but it's to act as a baseline for a future test (normally 2-3 months). You may also be offered 'prophylactic medication' that may help protect you from a virus.
What about injectors
In all honesty I'm not sure what would happen about preventative treatment if an injector has an accidental needle injury. I'd be really interested to know if any of you have experienced an injector being offered prophylactic medication. I would say that in the UK most NSPs have access to blood borne virus testing either via referral or from a project nurse, and that if you're concerned you should access this.
Prevention is better than cure
Of course the best thing to do is not get injured with a needle, obvious really. But what steps can people take to avoid one?
- Injectors: As any regular reader of this site will already know the best first step is to use new sterile equipment for every stage of injection, and as soon as it is used to store it in a good quality sharps container. If you don't have a sharps container find an alternative like a drinks can or thick sided plastic bottle, most needle programmes should be OK with you returning equipment in these containers if you have nothing else. (If they won't, point them to this website.)
- Workers: Never handle used needles, your programme should have large volume bins that people can put used equipment into themselves, normally though a small opening on a fixed lid. But this is one of my regular annoyances, I've been in many needle programmes when I'm doing audit or consultations, and in lots of them it seems putting a lid on a bin is some kind of major problem. Large volume bins without lids are a massive injury risk, the obvious on is of course if they're knocked over, but for me the bigger risk is people putting their hands into the bins to get back something they put in accidentally. I've seen this happen too often and its something that just following best practice could easily avoid.
While it may at first glance seem judgemental there's a term used in healthcare 'universal precortions'. At it's basic this means you treat everyone as a risk factor. A needle injury from anyone should be assumed to carry a virus risk, not just from injectors but also from acupuncture needles or any other 'sharps' you may come across whether they are from injectors, staff, or the general public. After all the bulk of people with HepC are unaware they have it.
Talk to people
Talking about needle injury with injectors, giving advice on how to avoid it and talking about testing if someone gets spiked is not only great harm reduction, but is also treating people as a valuable human being. I think both workers and injector often have a habit of just assuming that needle injuries for injectors are par for the course. They're not, they're avoidable.
Nigel Brunsdon is the owner of Injecting Advice.com. He's been working in harm reduction since the 1990's, although he's previously a frontline needle programme worker he now spends most of his time developing online resources for drugs workers and users.