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04-11-2010 | Anaesthesiology | Article

Needlestick injuries from incapacitated patients throws up legal minefield

Abstract

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MedWire News: Testing blood from incapacitated patients following needlestick injuries to UK healthcare workers is common, despite the uncertain legal ground, shows research published in the journal Anaesthesia.

In an editorial, Andrew Hartle (Imperial College Healthcare NHS Trust, London, UK) said that the study, for the first time, gives solid evidence for the "legal limbo" facing healthcare workers who sustain needlestick injuries from incapacitated patients.

He added that, although nursing staff are most usually affected, anesthesiologists are highly likely to be responsible for the patient from whom the injury has been sustained.

Recent legislation, namely, the Human Tissue Act 2004 and the Mental Capacity Act 2005, makes it lawful to take and test blood from patients unable to give consent only if it is in their best interests.

Consequently, all healthcare workers who sustain needlestick injuries when treating such patients may require prophylactic medication, in case the patient has unrecorded blood-borne viruses such as HIV.

Lorna Burrows (University Hospitals Bristol) and A Padkin (Royal United Hospital, Bath) found such needlestick injuries to be commonplace. They obtained anonymous responses from the heads of 44% of 225 intensive care units surveyed, 62.6% of which reported a needlestick injury obtained from an incapacitated patient within the preceding 12 months.

Of these patients, 64.3% were tested for blood-borne viruses without consent, and 25.8% of these tested positive. Four of these patients had a history of blood-borne viruses, but six new diagnoses were made. This is consistent with reports that up to 40% of HIV-positive patients are unaware of their status, says the team.

Twenty-two (61.1%) of the tested patients were informed of the testing on regaining consciousness. One patient who was not tested refused consent on waking.

Just 30.6% of healthcare workers who sustained needlestick injuries took prophylactic medication; this rose to 50% of those who sustained injury from a patient with a history of a blood-borne virus.

One respondent commented that the risk of transmission from needlestick injuries is regarded as low, but Burrows and Padkin say that it is "difficult to see how any needlestick injury from a blood-borne virus-positive patient could be classified as a low-risk exposure."

Hartle is chair of the multi-disciplinary working party recently set up by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) to explore the issue.

He said: "We are very conscious that testing without consent could leave our members open to criminal law, civil law, and professional misconduct proceedings.

"That is why we and our working party colleagues - who include the Royal College of Anaesthetists, Intensive Care Society, Royal College of Nursing, ethicists, and patient representatives - feel that urgent clarification is needed."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Eleanor McDermid