HCV-infected nurse recalls moment that changed life

'I don't know what lies ahead'

(Editor's note: The following account is from a nurse occupationally infected with HCV following a needlestick. She agreed to be interviewed by Hospital Infection Control on condition of anonymity because she is still working in health care. The basic authenticity of her story was endorsed by an infection control professional familiar with the case.)

Beyond the guidelines, policies, and philosophical debates about follow-up for health care workers exposed to hepatitis C virus, there is the real world of long work hours, moments of distraction, and needlesticks.

Such was the case in December 1985, when a nurse at the end of a double shift drew blood into a syringe to make a routine assessment of a patient. She attempted to recap the needle and was stuck in the finger. Now strongly discouraged, needle recapping during certain procedures was relatively common at that time, especially for that particular task, since it involved removing the needle to pour the blood into a tube, the nurse explains.

"The circumstances just came together to make for a bad end to a long day," she says. The patient was an elderly man who had been transfused a lot of blood in the preceding months of hospitalization. Though she had transfused the patient with two units of blood that night, the nurse was not particularly worried about infection following the needlestick because she had been immunized for hepatitis B virus and the patient did not appear to be at high risk for HIV. The test would not be developed for HCV until 1989, but it was then known as non-A, non-B hepatitis.

"Unfortunately, it was a 15- or 16-hour day," she says. "I was almost done. I could kick myself for not skipping it. I went to recap it, and somebody had the TV on and I turned around to see what all of the noise was. There was a football game on. I don't even watch TV -- not football anyway. But I heard all of this noise and I turned around, and when I did that I was recapping, and I stuck my finger."

With the help of a nurses' aide she washed the wound, squeezed it to make it bleed, and applied an antiseptic ointment and dressing.

"My finger was dripping," she says. "I've had needlesticks before -- it certainly wasn't the first one over 20 years -- but it was a bad needlestick."

Still, perceiving the situation to be a low risk for infection -- given the patient profile and her HBV immune status -- the nurse did not report the exposure or go to the emergency department for additional care.

"I was never really thinking that there were other hepatitis [viruses]," she says "I kind of ignored it. About a month later in January of 1986, I started having chest pains, and I kept thinking it was gallbladder or something. Then I started getting jaundiced. I could see it, but other people really couldn't."

Enzyme and liver function tests were indicative of hepatitis, and even though the incident had not been initially reported, the nurse was allowed to file it as a workers' compensation claim. She went back to work three weeks later, though the chest pains were to continue for six or seven months.

"I thought that was the end of it," she says. "Three years later, every year I started getting laryngitis, a sore throat that would linger for about a month. I would end up with no voice at all. I thought that was odd."

Insurance coverage uncertain

Eventually, as testing became available and she sought additional care, she was formally diagnosed as having chronic HCV infection. She ran into some resistance from her facility, however, when she sought additional medical treatment under the old workers' comp claim. She remains uncertain exactly how insurance will cover her future medical needs. Though relatively symptom-free at present, she has been advised of her long-term risk of serious liver problems. She is currently uninterested in going on drug therapy with interferon and is adamant that liver transplant is not an option for her.

"I just feel like I don't need all this grief in my life," she says. "I figure there are a lot of people in the country who don't even know they have it -- they are just walking around oblivious. On the other hand, I was never a sick person. I thought I was going to reach 80 without having a health problem. I don't know what lies ahead, what might come of this."

She sometimes thinks back to that "stupid little second," wondering how different things might be if she had not been momentarily distracted or not had to work that second shift.

"I had a lot of bitterness about the whole thing when it happened," she says. "Then you just figure, it happened. You can't undo it." *