Management of needle stick injuries from incapacitated patients

Introduction

This survey investigated current UK intensive care practice in testing patients for blood-borne viruses following needle stick injury when the patient lacks capacity for consent. Needle stick injuries are a common occurrence in the National Health Service, with an estimated incidence of 113 to 623/10,000 healthcare workers/per year [1]. Current UK law [2, 3] does not permit the testing of a patient's infective status for the benefit of a healthcare worker involved without the patient's consent. Incapacitated patients cannot give consent. The General Medical Council (GMC) guidance for the management of needle stick injuries from incapacitated patients reflects this [4].

Methods

A questionnaire was sent to the clinical lead of the 225 general ICUs within England, Wales and Northern Ireland. Responses were anonymous.

Results

Ninety-nine consultants replied out of 225 (44% response rate). Sixty-two of the 99 consultants (63%) reported incidences of needle stick injuries to their staff from incapacitated patients in the past year. In six incidents the patient was not tested because their full blood-borne virus status was already known. Thirty-six of the remaining 56 incidents (64.5%) stated that patients were tested without consent. Sixty-one per cent of consultants (22 of 36) reported that the patient was informed once conscious that the test had been performed. Two consultants discussed the decision to perform the test with the family prior to proceeding. One patient, not tested at the time of injury, refused consent on regaining capacity. Sixteen patients out of the 62 incidents were blood-borne virus-positive (26%), six being new diagnoses following the needle stick injury (37.5%).

Conclusions

Despite the recent change in legislation, the majority of incapacitated patients are being tested for blood-borne viruses when unable to give consent. This has significant beneficial effects for the healthcare worker involved; a negative test allowing prophylactic antiviral treatment to be discontinued and minimises anxiety. This survey highlights the need for further discussion involving healthcare professionals, the legal profession and legislators regarding needle stick injuries from incapacitated patients. Is there a duty of care to the healthcare worker that is not acknowledged in current legislation?