In need of protection
Needlestick injury prompts nurse to help keep others safe

Interview by Mary Elizabeth Hopkins
October 30, 2000

Lisa Black, RN, tested positive for HIV and hepatitis C after she sustained a needlestick injury at northern Nevada hospital. Since her injury, Black has become an active proponent of safe-needle legislation.


	You've read the article. Now tell us what you think. Related sites Breakdown of how the figure of 590,000 annual injuries is arrived at Text of the FDA Alert

Lisa Black, RN, works with the Nevada Nurses Association to introduce state legislation designed to protect health care workers from the potentially devastating effects of a needlestick injury.

In October 1997, Black sustained a needlestick injury at a northern Nevada hospital. The patient had AIDS, and Black subsequently tested positive for HIV and hepatitis C. Before the injury, she was a healthy mother of two girls. She now takes 22 pills every day, gives herself six painful injections every week to keep the viruses in check, and questions daily whether she will be alive and well long enough to raise her daughters.

What are your feelings about the day-to-day care for the HIV and hepatitis C viruses? How do the pills make you feel? What side effects do they have?

Prior to my needlestick injury and subsequent seroconversion, I was a very healthy person who rarely took a pill and visited my physician only for routine care. Now it seems that my life revolves around physicians, medication and illnesses. I’ve had to learn to take 22 pills every day just to maintain my health. This is when I am doing well. And this is just to maintain the status quo. These medications cause me to have a lot of nausea and fatigue. To keep my liver "healthy" in the face of my hepatitis infection, I give myself daily injections of interferon, which causes me to have periodic fevers, chills, muscle aches and extreme fatigue.

The combination of medications causes my bone marrow to not produce adequate numbers of white blood cells, so I also give myself three weekly injections of a medication called neupogen, which stimulates my bone marrow to produce adequate numbers of these infection-fighting white blood cells. This medication causes me to have a lot of "bone pain," meaning that hips, spine and legs ache for a day or two after each injection.

How do others react when they hear of your diagnosis and how it came about?

Fortunately, as a society, we have come a long way since the Ryan White days of HIV, and the population is a little more educated about the risks of transmission. Consequently, I have not faced a lot of stigmatizations and prejudice. I think the mode of transmission of my infection has a lot to do with this, however. Because of the way I was infected, I am often viewed as an "innocent victim," while those who were infected with HIV through other means [sex, drugs, etc.] are viewed quite differently. I think this is very sad. No matter how a person became infected with these viruses, the reality of living with them does not differ depending on the route of transmission. It’s an odd phenomenon that people do not react unfavorably to me and are usually quite compassionate, but remain cruelly judgmental of people who are infected through other means.

How could the injury have been prevented?

If the hospital had implemented a needle-free IV connection system, I would have had to only screw a syringe onto the port, rather than insert a needle into it to accomplish my task.

What federal safety alert did the FDA issue in 1992 about using safe and needle-free IV connection equipment wherever possible? Why was this alert not heeded?

You can read the text of the FDA alert on the Web.

Basically, it urges that facilities abandon the practice of using needles to access IV lines: "Although the FDA cannot recommend use of specific products, we strongly urge that needleless systems or recessed needle systems replace hypodermic needles for accessing IV lines."

The reason for lack of adherence to this alert is that the FDA cannot mandate such a thing – it can only provide a recommendation. Therefore, the FDA alert creates no legal obligation to comply.

What kind of legislation would mandate that health care facilities protect their employees from needlestick injuries? What legislation has already been passed? In what states?

Sixteen states have passed needlestick legislation thus far: Alaska, California, Connecticut, Georgia, Iowa, Massachusetts, Maryland, Maine, Minnesota, New Hampshire, New Jersey, Ohio, Oklahoma, Tennessee, Texas and West Virginia. The specifics for each state vary, but these are the main components:

Replace injury-causing sharps with devices that either eliminate the need for a needle to be used or render the used needle harmless by way of retraction, blunting, shielding or encapsulation.
Maintain a needlestick injury log that documents injuries and includes details such as how the injury occurred and whether there was a safety feature in place that functioned as designed.
Involve bedside employees in the selection process of which devices are to be used.

This link gives details on which states have passed legislation so far and briefly mentions the requirements set forth in each: www.med.virginia.edu/medcntr/centers/epinet/.

How can nurses pay more attention to safety in health care?

I see the issue here more as, "What precautions can be taken to ensure the safety of health care workers?" The mindset that tends to blame the victims’ "carelessness" for the injury contributes to the status quo of apathy that exists in regard to this issue. It’s easy to tell nurses and other health care workers to just "be more careful" and "take a little more time." The reality is that health care workers do not sustain in excess of 590,000 needlestick injuries every year as a result of individual carelessness. It is unconscionable that we have the technology available to us to prevent upwards of 80 percent of these injuries, yet this is not being done without a legislative mandate.