About three weeks ago, I was assessing a SCI patient and needed to determine her level of sensation post injury. This required me to do an ASIA impairment scale on her and in order to establish the level of sensation; I needed to use a safety pin to do so.  As I was assessing the different levels I manoeuvred the pin in my hand to write my findings at the various levels and as a result the sharp end of the safety pin punctured my skin a few times. I knew this patient was RVD +, therefore I thought I would take precaution and wear gloves…just in case.

Initially I was not sure if I should report it as there was not any blood or bodily fluids visible and I was unsure if I was just being paranoid or if it was a valid enough reason for me to report it to the physiotherapy department. As it was my last patient for the day and the whole staff was in a meeting, I decided to call my friend who is a Dr to discuss how serious she thought it was, and to rather report it in the morning, than to disturb their meeting.

My friend advised me to check if my skin was actually punctured by running something over my skin that could burn any open skin i.e. surgical spirits or de germ. I did this as soon as I got home and indeed discovered that my skin had been punctured by the safety pin. Despite there not being blood, there was still a chance of contracting the virus due to the pin puncturing her tissue and then mine.

The first thing the next morning (i.e. 08h00), I reported what happened, due to me being the first student this happened to, the clinician we were told to report it to, was unsure of their protocol and had to ask her supervisor which steps to follow. My clinician then phoned my supervisor, who then phoned the university. The university told me I needed to get the placement to complete a specific form pertaining to injuries from sharp objects. Due to people being unsure about the protocol, I was sent to the Dr at the facility, who said to me that they have something in place to assist staff in a situation like this but due to the fact that I’m not staff, he cannot help me and my university needs to provide me with the adequate/applicable medical assistance. Regarding the form which needed to be completed, the Dr was unsure about the form, so I was sent to the health and safety person, with the hope that she could assist me with the documentation. She too was unsure about which form to complete, eventually I ended up writing my own version of what happened, printing, signing it and handing it to another clinician in charge of students. By this time (13h50), I was frustrated that completing a form was taking so many hours, in a very time sensitive situation. Due to the relevant parties needing documentation of the incident, this form needed to be sorted out and completed before I could go to the Dr to start taking PEP (post exposure prophylaxis) medication as soon as possible.

My university advised me to go to the Dr on campus, who could do the relevant blood tests and help me with the post exposure procedure. I arrive at campus, thinking this was going to soon be over, only to discover that this is a private Dr and does not assist with procedures like this. I then get referred to UWC’s health and safety officer, who has something in place for dental students but nothing for physiotherapy students. She called the occupational sister in charge of this program at Tygerberg Hospital and asked if she could please assist me, the sister leaves at 15h30, by this time it was about 15h00 already. Eventually the sister at Tygerberg assists me with blood tests and gives me medication to start immediately.

This procedure was very frustrating and disappointing as, according to (PEP, 2019) every hour counts, you only have 72hours to take action and the longer you wait the less effective the post exposure prophylaxis (PEP) medication is. I felt like it was an unnecessary waste of time and I was fortunate enough to have my own transport. What if I was a student who had to rely on public transport and was sent back and forth to different locations like I was, I would probably only have managed to receive help the following day due to people going home at 15h30. I think the matter was dealt with in a very unethical manner, as I was in a situation where my health was potentially at risk, two Drs had the resources to help me but chose not to and preferred to send me elsewhere because I was not their responsibility at that time.

According to the National Health Act; if health care workers accidently prick themselves with a HIV contaminated needle, necessary measures must be taken to ensure the health care worker has access to PEP to reduce the risk of HIV transmission (Health and Democracy, 2014). I did not receive any care/ treatment like this, as I was turned away by the facility’s Dr, clinician and health & safety officer. I was told that they cannot help me and I need to go to my university, as they need to help me now.

According to the National Health Act, it also states that when an injury occurs, the employers must enforce the necessary health and safety measures (Health and Democracy, 2014). This was not provided as mentioned above. The National Health Act also states that the facility/work place needs to provide information and training so that people are aware of risks to health and safety (Health and Democracy, 2014). During our orientation, we were told that if anything happens, we should report it as there are procedures in place, but when the time came to deal with the incident. There in fact were not really any procedures in place, nobody knew what to do and the people who could help were not willing to help and sent me elsewhere for help as I was a student.

According to a survey by Elmiyeh et al (2004), professionals who are at risk or who have experienced needle sticks; only 51% reported needle stick injuries when they occurred. Although, 80% of participants were aware that it needed to be reported when it occurs; by not reporting the incident, it could affect their health or pose as a risk to their health later on.

Another ethical dilemma I had was that all these emotions surrounding this incident, resulted in me not wanting to treat this patient, which was not fair to her, as what had happened was not her fault in any way. At times I felt like avoiding her but I knew I had to treat her, as it was still her right to be treated. According to (Constitution of the Republic of South Africa, 1996) everyone has the right to access to health care services and I cannot infringe upon that right.

If this were to happen again or if I could go back in time and act differently, I would interrupt their meeting, report it immediately and go to a private Dr, as even if I reported immediately after it happened, the university health and safety person would have gone home and the occupational sister at Tygerberg Hospital would have already gone home. So I would only be able to get help the following day.

References

Constitution of The Republic of South Africa, Act 108 of 1996, Chapter 2, section 27

Elmiyeh, B., Whitaker,IS., James, M., Chahal,C., Galea,A., Alshafi,K (2004). Needle- stick injuries in the National Health Service :A culture of Silence. Journal of the Royal Society of Medicine , 326.

PEP. (2019, August 6). Retrieved September 15, 2019, from Centers for disease control & prevention: https://www.cdc.gov/hiv/basics/pep.html

Test, C. (2007). The rights and duties of health care workers. In C. Test, Health and Democracy (p. 331 & 334).