Review needlestick training after ER nurse acquires monkeypox

Remind clinical staff and others about sharps safety now that the CDC has confirmed an emergency department nurse contracted monkeypox in Florida from a needlestick. It is the first healthcare-acquired monkeypox case in the United States since a public health emergency was declared earlier this year.

According to a recent CDC Morbidity and Mortality Weekly Report, the nurse was exposed through a needlestick while obtaining swabs from a patient with suspected monkeypox.

“The nurse used a needle to create an opening in the vesicular lesion to facilitate direct contact of the swab with fluid in the lesion. The needlestick occurred when recapping the used needle by hand before disposal; it caused a break in the skin on the index finger through the nurse’s gloved hand, accompanied by a small amount of bleeding. The wound was immediately washed with soap and water and drenched with Betadine antiseptic solution (10% povidone-iodine),” according to the CDC report.

The incident was promptly reported to the hospital’s infection control practitioner and occupational health department, and to county health department (HD).

After the specimen was tested and found positive for the virus using two separate methods, the nurse was given the first dose of a vaccine.

“In accordance with CDC guidance, the nurse continued to work while asymptomatic and was actively monitored by the hospital infectious disease specialist and the county HD. The nurse wore a surgical mask, consistent with CDC COVID-19 guidance, and chose to wear medical gloves when interacting with patients.”

“Ten days after the exposure, a single skin lesion formed at the site of the needlestick. The nurse immediately began isolating at home and kept the lesion covered until it had crusted over, the scab had fallen off, and a new layer of skin had formed beneath the lesion 19 days later.”

Apart from the lesion, no other lesions or clinical signs or symptoms of monkeypox were reported.

CDC recommends reviewing training for healthcare personnel (HCP).

“Employers should ensure that HCP are trained in proper specimen collection methods, follow recommended infection prevention and control precautions for the care of patients with monkeypox, and implement safety practices for managing sharps if they are used during other aspects of patient care. HCP with exposures should be evaluated promptly to ensure postexposure recommendations are implemented.”

The safe use of sharps, including regular staff training, is required under the OSHA Bloodborne Pathogens standard and the CDC’s The National Institute for Occupational Safety and Health (NIOSH) offers these tips for preventing and dealing with needlestick injuries:

• Avoid the use of needles where safe and effective alternatives are available
• Select and evaluate devices with safety features that reduce the risk of needlestick injury
• Ensure use of devices with safety features provided by the employer
• Avoid recapping needles
• Plan for safe handling and disposal of needles before using them
• Promptly dispose of used needles in conveniently placed and appropriate sharps disposal containers
• Report all needlestick and sharps-related injuries promptly to ensure that there is appropriate follow-up care
• Encourage employees to report needlestick hazards and promptly report any needlesticks and near-misses
• Offer and participate in training related to infection prevention
• Employees should get a hepatitis B vaccination

In the event of a needlestick injury, immediately follow these steps:

• Wash needlesticks and cuts with soap and water
• Flush splashes to the nose, mouth, or skin with water
• Irrigate eyes with clean water, saline, or sterile irrigants
• Report the incident to a supervisor
• Immediately seek medical treatment