I read your review article entitled ‘The implications of HIV for the anaesthetist and the intensivist’ (Avidan et al. Anaesthesia 2000; 55: 344–54) with interest. I remember thinking at the time, probably like a lot of other readers of the article, that such an experience would be extremely frightening and so I must try to always remember to keep my practice safe. I then promptly placed it on my subconscious shelf of useful pointers. At that point, I had not thought in depth about the psychological impact of such an event, but now realise what a relevant aspect of the subject it is. The reality hits home hard. Having been a registrar for just over two months, approximately one week has now elapsed since I accidentally gave myself a potentially fatal inoculation. In view of the available statistics [1] regarding likelihood of seroconversion following needlestick injury with a sample from an HIV-positive patient (0.3%), this may sound a touch dramatic. The needle in question was only a blue 23-gauge used to infiltrate local anaesthetic subcutaneously, and had already been outside the patient's body for a few minutes. According to protocol, I managed to squeeze a considerable amount of blood from my finger immediately afterwards, and within 2 h had been to Accident and Emergency and been started on a triple therapy of antiviral drugs; a protease inhibitor Nelfinavir, and Lamivudine and Stavudine which are both nucleoside analogue reverse transcriptase inhibitors, all twice daily. Two days later, I had a consultation with an HIV consultant who explained to me the facts regarding risk, drug therapy and its possible adverse effects, future HIV testing, and also invited me to air any emotions that were worrying me. I found this episode relatively comforting. Various medical colleagues have been telling me about similar experiences of other professional acquaintances, which eventually resolved without any long-term consequences, and again I am reminded that my cause of concern is almost more a theoretical than a real one. and yet I feel a disconcerting uneasiness. It appears to me that the overall effect of such an anxiogenic event is a product of two variables; the likelihood of the worst-case scenario actually occurring (very small), and the repercussions should it actually happen. I think this second variable is immeasurably large. Hence, no matter how small the first variable, my overall feeling of worry is undeniable, and when I consciously remember it, disturbing despite its unlikelihood. Even friendly house officers, whom I barely know beyond a habitual polite nod of acknowledgement, were coming up to me with a slightly flushed and nervous facial expressions, to ‘see if I was OK’. I don't know; am I OK? Other reminders come along twice a day, morning and evening, in the form of my consuming seven tablets, five of which are the size of two paracetamol tablets rolled into a sausage – nauseating. For one careless error, it seems like harsh punishment to twice a day be made to feel as if I am taking an overdose. and these are not smarties. They can compromise liver and kidney function, cause gastrointestinal disturbance, hyperlipidaemia, anaemia, peripheral neuropathy, severe rash and, in my case to date, a general sense of nausea and malaise. I know I have made several lucky escapes already in my life and, fingers crossed, mother probability will see me through this time once more. But my message to my fellow clinicians is clear and simple. Such is the psychological impact which I have tried to convey that taking too much care with sharps and body fluids of patients (irrespective of known or unknown infective status) is not possible. An accident is complete in a split second, yet the consequences cause months of worry on the scale of life, loved ones and the future. and it is this psychological angle of accidental needlestick injury that I wish to emphasise with respect to the original review article. Anxiety, sleep disturbance and low mood are added stresses to an already pressurised working role, and I feel could significantly compromise the everyday level of functioning of the anaesthetist – a potentially hazardous development (in a similar way to the over tired anaesthetist who has been awake working for too long). I was fortunate in at least one respect to be referred to a supportive and sympathetic HIV consultant who guided me skilfully. Perhaps these issues (including the option of supportive counselling) should also be considered and maybe even included in a further updated new post-exposure protocol design. I do believe that in six months time my HIV test result will be negative. I wish I could be as sure that these next six months will fly by.
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Jan 28, 2015
Barbara Castro-Pimentel Figueiredo + 5
Open Access
