A 26-year old resident physician in training was working the night shift of his 24-hour rotation and covering call for the intensive care unit (ICU) when a patient arrived through the Emergency Department (ED) following an accidental overdose of heroine. The patient had been
uncooperative in the ED with laboratory draws and the ICU nurse was also having difficulty obtaining blood to send for testing. The nurse called the physician for assistance with the blood draw because most of the peripheral veins were difficult to locate, and the decision was made to draw blood from the patient’s femoral vein. The patient’s hepatitis status was unknown.
A needleless intravenous system was used to obtain the blood sample. Personal protective equipment was donned by all of the nursing staff however the physician had left the ED to assist in the ICU and needed to return quickly as it was announced a major vehicle accident had occurred and ambulances transporting the accident victims in serious condition had already notified an estimated time of arrival of 20 minutes to the ED. The physician applied gloves however opted to not wear a face shield or gown while obtaining the blood sample from the patient’s femoral vein. During the procedure, the patient became agitated and suddenly jerked the leg where the needle had been advanced and the physician quickly had to abort the procedure to avoid injury to the patient. As the needle was removed quickly, the existing aspirated blood drawn into the syringe under suction pressure splattered up at the physician’s right eye. The physician washed the eye area after discarding the needle appropriately into a biohazard needle container and moved onto the emergency cases due to arrive.
The healthcare facility had provided the PPE, which included the face shield, head covering, gloves and gowns, which were immediately located outside every ICU patient room in a convenient cupboard so that clinicians performing procedures with reasonable anticipation of exposure to body fluids could protect themselves with impervious coverings from blood splatters or potentially infectious material.
As noted in the above sections, the health employer followed OSHA standards that required the employer to “undertake measures to reduce occupational exposures to blood-borne pathogens”, and the physician was protected from risk of exposure through “engineering controls that minimize the risk of sharp injuries (i.e., needleless intravenous medication systems, blunted suture needles)…”13 Other key measures required by OSHA that the employer followed to reduce risk of occupational exposure in this case included annual education on blood-borne pathogen transmission and ways to reduce the risk of exposure, and immunization to hepatitis offered at no cost to the employee.13
The employer had supplied every opportunity to avoid accidental blood-borne pathogen exposure however the harried physician
(working late and probably tired) bypassed safety while prompted by a need to return to the ED quickly to attend to another emergency call.