NEEDLES AND PINS A Case Study in the Management of Occupational Exposure to Percutaneous Injuries by Lynn D. Austin Allied Health and Human Services Western Kentucky University

Part I, The Incident

Jennifer is a 19-year-old college sophomore who has always wanted to be a dentist, like her father, her sister Eileen, and now her brother George, who is currently in dental school. As an entering third-year student, George has just started treating patients. Last Friday, he came home and told Jennifer, "You know, there's a summer program at the dental school for college students who are thinking about becoming dentists and dental hygienists. If you want, you can work in the dental clinics as a dental assistant this summer." Jennifer excitedly signs up for the program.

Jennifer's first day in the clinic begins uneventfully; she had completed a "crash course" in the basics of dental assisting the week before, although she believes she already knows a lot about dentistry because of her exposure to the profession through her family. She is scheduled to help George do a restoration on a fellow student, Ralph. Jennifer picks up the appropriate tray set-up: instruments, gauze, amalgam, some topical anesthetic, a 27-gauge long needle, and some local anesthetic (2% lidocaine with 1:100,000 epinephrine). She places the instruments and materials out on George's tray and sits down, ready to begin.

Ralph is a second-year dental student with decay on a lower molar that was detected when their class took radiographs on each other. He is assigned to be George's patient for the morning. The two dental students only know each other by sight; the classes do not associate much until they are in the clinic. After thoroughly reviewing the medical history and receiving approval to start the procedure from the instructor, Ralph sits down in the chair and George, who has done several amalgam restorations before, prepares to administer the anesthesia to Ralph. After carefully drying the tissue and applying the topical anesthetic, George places the needle at the site of injection, and aspirates the syringe. Blood enters the cartridge, so he repositions the syringe and aspirates a second time -- no blood this time. He completes a perfect mandibular block, followed by a long buccal infiltration. He hands the syringe back to Jennifer, who is paying close attention. Jennifer picks up the needle cap and holds it in her left hand, and attempts to slide the needle back into the cap. She accidentally punctures her glove and sticks her index finger with the needle.

Answer the following questions:

1. What is the significance of the presence of blood during aspiration?
   
2. What are potential consequences of not repositioning the needle if the aspiration is positive?
   
3. What should the students do after the needlestick?
   
4. How could this needlestick have been prevented?
   
5. What diseases have the potential to be transmitted from this needlestick?

Go to Part II -- Jennifer's Dilemma

Date Case Posted: 9/30/99 nas