Roger-Luc Chayer
We have not talked enough about it for 30 years, but a non-negligible proportion of cases of HIV transmission from one person to another goes through needle accidents. I’m not talking here about sharing dirty or potentially infected needles, but about an accidental, unplanned sting with a syringe left in an unsuspected place like a park bench, a cinema seat, a bus seat or subway or at the bottom of a bag that we decide to pick up to put in the trash, and we know nothing about the user.
HIV is naturally thought of immediately, but it is not only this infection that can be transmitted by a freshly contaminated syringe. There are hepatitis, herpes, skin infections, STBBIs and some can change a life if the contaminant manages to enter the system. This is the kind of accident that happens occasionally with health personnel, paramedics, firefighters or people who have to handle syringes in the course of their work.
Fortunately, thanks to the expertise of these same health care people, there is a quick intervention protocol for accidental needling with a syringe, no matter who is the person who has just used it. When you leave, you must realize that anyone can potentially carry infections and diseases that can be transmitted by a used syringe. It is therefore important to avoid the magic thought by thinking that the person looks healthy, that it is not known for HIV or other problems, because it is in the speed of the application of the crisis management protocol that it can be effective and above all that it can save your quality of life in the long run.
On the website Nurses.com, published by the Health Profession Group, a very strict protocol is published in the event of an accidental sting that would occur. The wound or the injured skin must be cleaned with running water and soap. Then, rinse and disinfect it preferably with pure Dakin® or 0.1% bleach for at least five minutes. If splashing on mucous membranes or eyes, rinse thoroughly with saline or tap water (order of preference) for five minutes.
A precise serological follow-up must be carried out. This includes: the achievement of HIV, HCV and possibly HBV serology (note, vaccination against hepatitis B is mandatory for health professionals, except in situations of contraindications to vaccination) in the 8 days following the accident. Then, serological checks at 2 months and 4 months if a post-exposure treatment (TPE) is prescribed (as is the case if the patient is HIV-positive). Post-exposure treatment should be started as soon as possible after exposure, ideally within 4 hours, and no later than 48 hours.
The risk of contamination depends on three main factors: the severity of the blood exposure accident, the characteristics of the source patient (such as elevated viraemia) and the absence of post-exposure treatment. Specifically, the probability of transmission is directly related to the depth of the injury and the type of needle involved. For example, large-bore, blood-stained hollow needle stings are the most likely to cause contamination. Only blood or body fluids containing blood have been proven cases of contamination. The viral load of the patient is a determining factor.