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Short White Coat blogger Ishani Ganguli
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Thursday, October 18, 2007
Short White Coat: Needle-stick debrief
Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at firstname.lastname@example.org.
Last week's needle-stick pseudo-scare has all but resolved itself. The on-call doctor never received my page, it turned out. This has happened before, and doctors at University Health Services are looking into the reasons for the miscommunication.
Ruffled by the lack of an authority figure's oversight, I picked the brains of my colleagues in training. These accidents happen fairly frequently at Harvard hospitals and elsewhere, I discovered. A friend at another medical school cited a classmate who had stuck himself twice and started prophylactic antiretroviral therapy for HIV both times, until he could be sure the needle's previous target didn't have the disease.
My first thought -- what a waste of anti-retrovirals. But we had learned that treatment within days of the exposure can prevent infection. And though the chance a needle-stick from an HIV-positive patient would actually infect the recipient is only 1 percent (it's up to 50 percent for hepatitis B and C), it isn't zero. My source-patient was not a stranger, or a patient I knew only peripherally; it was my housemate. But out of a mixture of curiosity and sense of duty, I went with her to University Health Services at lunchtime on Friday to officially report the accident and find out what we needed to do next.
We sat down with the doctor and went through the Centers for Disease Control and Prevention guidelines for post-exposure precautions. Given the fact that I was wearing gloves and that my housemate had been cleared for blood donation at the Red Cross within the last month, I decided to forego the treatment.
Though it seemed a no-brainer, it really is a personal decision, we were told. For some people, the anxiety provoked by even a tiny risk of infection may be worth the side effects and hassle of taking the meds. We each got blood tests, just in case, doubling my left arm Band-Aid count to two. At least this was good practice for next time.