incidents have involved being stuck with a needle or contact with blood or blood fluids.
Health professionals are increasingly afraid, though the risks are low. Dr. Douglas
Whitehead, an urologist in New York City (where the rate of infection is the highest in
the nation), performs procedures such as transurethral resections of the prostate. The
procedure involves scraping tissue to remove obstruction of urine flow. Frequently,
some splattering of urine and blood occurs when removing tissue.23
(1) The CDC states that universal precautions should always be practiced.
But, Dr. Whitehead says that it is impractical in emergency situations where time is
critical. Surgeon Dr. Susan Cutler says, "Accidents are unavoidable in surgery which is
a very manual skill. Instruments can easily pierce you. During suturing, to obtain an
adequate fixation of tissue and exposure, sharp instruments come in close
approximation of one's hands. Some measures have decreased inadvertent needle
sticks, such as increased care in the way in which instruments and needles are
passed."24
(2) The problem is that not everybody is following these procedures. Some
studies indicate that 80 percent of all accidents could be avoided if proper sterilization
were followed. Other studies show that protective clothing is worn in only half the
instances required.25
(3) Dr. June Osborne says, "If health care providers took the proper
precautions all the time, the rate of infection would go down." The risk of contamination
with an infected needle is one in 333, a relatively small risk. Many of these incidents
occur when recapping a needle after it has been used. "As prevention measures are
perfected, the rate will decrease," says Osborne. "If we had a receptacle for sharps
[needles, scalpel blades, and so forth, conveniently located at every bedside] so nobody
tried to recap, the rate would be reduced. In many cases, trays are now used to pass
instruments. Wounds are stapled rather than sutured.' At the University of California in
San Francisco, the frequency of needle stick injuries is being studied,as well as whether
double gloving and disinfecting after exposure would make a difference.
(4) Despite the relatively low risks and improved preventive measures,
health care providers want even more information. They want to know which patients
are infected. Medical ethicist Art Kaplan says, "I know for a fact, that many doctors and
nurses are ordering HIV testing as part of a routine screen of blood without getting
admission to the hospital. This is illegal and unethical."27
(5) Dr. Douglas Whitehead contends that such testing shouldn't be illegal. "I
have stuck myself, been stuck and stuck others, as all surgeons have. I can think of a
relatively recent case in which I stuck a surgeon assisting me and we didn't know the
status of the patient. The surgeon is worried, and so am l."28 As a result, the Centers
for Disease Control is issuing, at this writing, guidelines recommending patient testing
for hospitals in high risk areas, such as Newark, NJ, New York City, NY, and San
Francisco, CA. As the above discussion shows, the debate goes on with no clear-cut
solutions in sight.
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