The needlestick that changed her life

ANA pres recalls injury that led to HIV, HCV

Karen Daley, PhD, MPH, RN, FAAN, remembers the stick as if it happened in slow-motion, the details still clear to her 12 years later. She had helped a co-worker draw blood from a patient in the emergency department. She turned to reach behind her for the sharps container. Mounted high on the wall, it was overfilled, but she couldn't see it well because it was above eye level.

As she released the device, she felt a deep puncture through the index finger of her gloved hand. Someone else's needle had stuck her. Source patient unknown.

The odds, seemingly, were in Daley's favor. What's to say that source patient had a bloodborne disease? Even if he or she did, the rate of conversion for hepatitis C is estimated at just 5 in 1,000 (.5%) and at 3 in 1,000 (.3%) for HIV.

At first, she was inclined to just rinse off her finger and ignore the injury. "I wanted to just forget about it and go home," she recalls.

She reported to urgent care for evaluation because her co-worker urged her to do so. She declined the post-exposure prophylaxis for HIV because she was aware of the toxic nature of the side effects of the anti-viral medicines.

Even when she began to have symptoms — weight loss, nausea, fatigue, abdominal pain — she didn't connect them to the needlestick. After all, she was suffering from emotional stress because of the recent death of her brother.

But Karen Daley, now president of the American Nurses Association in Silver Spring, MD, was doubly unlucky. She became infected with both hepatitis C and HIV from that needlestick. It was a moment that altered her life — and made her a vocal advocate for sharps safety.

"When my needlestick occurred, few employers were making safety devices available to workers. Only 15% of employers provided any type of sharps safety device," says Daley.

Laws spurred sharps safety

California became the first state to mandate safety-engineered sharps devices in 1998. In 1999, when the National Institute for Occupational Safety and Health issued an alert to hospitals regarding sharps injuries, an estimated 600,000 to 800,000 health care workers were being stuck every year.

Yet hospitals were still arguing that new safety devices were too expensive. "You hope employers and workers will do the right thing for the right reason. That's not always the case and it wasn't the case here," says Daley.

Daley traveled the country, speaking out about her needlestick and its dire consequences — and the simple device that could have saved her health. She testified before state legislatures and Congress, and helped promote ANA's campaign, "Safe Needles Save Lives."

Other states began requiring the use of safety devices, but the passage of the Needlestick Safety and Prevention Act in 2000 propelled the issue forward with a mandate that employers purchase the safety devices.

Now, when Daley has her blood drawn for regular lab work, she is gratified to see the nurse or phlebotomist using safety equipment. "Nurses who practice now as recent grads don't know there was a time when we didn't have access to these devices. It's just the norm," she says.

Maintaining enforcement is critical, she says. "I want every nurse in the country and every employer to realize what their obligation is under this law, and I want to see them comply with that," she says.

Moving forward after stick

The day that Daley learned she was both HCV and HIV positive was her last day of work as a practicing nurse. Emotionally, the news was devastating. "I was dealing with a life-threatening illness," she says.

Physically, she was in bad shape. She developed acute hepatitis and she had a high HIV viral load. She went on a year-long therapy for hepatitis C and was able to clear the infection. She also took anti-viral drugs for HIV, which was a struggle.

"I had a difficult couple of years trying to get on a regimen that was tolerable for me," she says. "At one point, I had to stop the entire treatment. I couldn't eat. The fatigue was so excessive."

She tried about four different drug protocols until finding one she could maintain. She has been on the same drug regimen for seven years.

As ANA president, Daley is committed to working on some of the remaining gaps in sharps safety — the lack of access to safety devices in the OR, the failure of some employers to include frontline nurses in device selection (as required), the lack of availability of safety devices in some categories.

Most of all, Daley wants to promote a culture of safety that compels workers to report their injuries and that encourages timely post-exposure prophylaxis.

"Where there are opportunities for us to make the workplace a healthier, better place, we have an ethical obligation to do so," she says. "We've still got some work to do."