Needlestick injuries and blood borne viruses

摘要

HEALTH professionals in the course of their duties occasionally sustain a needlestick injury or otherwise have a wound or abrasion exposed to the blood or body fluids of patients. Those working in crime prevention or the emergency services may also suffer this kind of injury. They may be concerned that they are at risk of having contracted a blood borne virus (BBV) and may be advised to undergo post-exposure prophylaxis which should be commenced as soon as possible.These drugs have side effects, which may be severe, including acute renal failure, diarrhoea, nausea and vomiting. BBV infections typically have a long incubation period which means that the worker will be anxious about their status for several months, leading to possible post-traumatic stress reactions. He or she may have their professional practice restricted for this period, such as exclusion from carrying out exposure-prone procedures, and may be advised to refrain from sexual intercourse. But if the blood of the source patient can be tested and it can be established that they are not infected none of these precautions will be necessary-or at least they can cease as soon as the results are back - and the worker can be reassured. ■ Healthcare workers may be at risk of sustaining a bloodborne virus infection if they suffer a needlestick injury from an infected source patient ■ As a general rule, patients must give their consent before their blood or stored sample is tested ■ In practice, most patients will give consent to test their blood to prevent the risk of a healthcare worker having to take a course of post-exposure prophylactic drugs to prevent HIV infection, as the drugs can have unpleasant side effects ■ Testing without consent can be lawful if it is in the patient's best interests ■ The Supreme Court has suggested that the 'patient's best interests' might extend to'altruistic sentiments and concern for others' ■ Guidance from the British Medical Association says that, in the absence of contrary evidence, it is legitimate for doctors to assume that the patient would want to'do the right thing', and that this can be used as an argument to justify testing the blood from a patient who cannot give consent ■ If the source patient dies or is dead, consent is needed from a person with a 'qualifying relationship' to the deceased ■ Qualifying relationships are defined in the Human Tissue Act as a spouse or civil partner, partner, parent, child, or other close relative or long-standing friend