It was the end of a busy afternoon endoscopy list, nearing 5pm. My next patient was ‘fitted in’ at the end of the list. Despite being a prerequisite on the endoscopy checklist, the patient had no IV access. I inserted a flexible cannula (as per British Society of Gastroenterology guidelines) into the patient’s right hand. As I withdrew the hollow bore needle, the patient moved and the needle penetrated my left index finger. This was my first needlestick injury in 36 years of practice.
As I took off my gloves to squeeze and irrigate my finger under the tap, the nurse informed me that the patient was known to have Hepatitis C. My heart sank and my legs felt weak as a survey of the patient’s notes confirmed this.
I immediately went to A&E as per hospital protocol for a sample of serum to be taken. While I was there, I received a Hepatitis B booster and counselling. Meanwhile, as per protocol the source patient was approached to seek consent for further testing for other blood borne viruses. I was informed that two other needlestick injury cases had been seen in A&E earlier that day, one of which was a Consultant Anaesthetist.
In retrospect, this was undoubtedly the worst time for anxiety, as I searched for information on my prospects of contracting Hepatitis C. Where else to look but on the internet which revealed risks ranging from an acceptable 3 or 4% to an alarming 10%. The relevant point being that hollow bore needles present an increased risk factor enabling fresh blood to reach subcutaneous tissues. The 10% risk seemed depressingly more applicable to my situation.
The next morning I was informed that no other virus had been found in the source patient. I then visited the Occupational Health Sister who explained the post exposure protocol; blood tests at 6, 12, 24 and 52 weeks. Counselling was offered.
Over the next few days, the anxiety resolved a little as the ‘this can’t be happening to me’ factor won the day. However, I was still looking out for flu like symptoms to strike. Thirteen days later I had a slight sweat on one evening but not really like flu.
I now knew I had acute Hepatitis C
On day sixteen whilst packing a roof rack on our car prior to a holiday, I fell backwards on to our gravel forecourt and was rendered momentarily unconscious and subsequently concussed. A CT scan and cerebral angiography confirmed a traumatic subarachnoid haemorrhage requiring three days in hospital and six weeks off work. On day 42, I went to Occupational Health for my first set of blood tests and that very morning noticed transient nausea. Over the next few days the nausea reoccurred without a headache and on day 46, I vomited twice producing clear sweet vomit (no bile). The following day I noticed my urine was dark brown and that drinking extra fluids failed to clear this. On day 50 a visit to my GP confirmed bile in my urine.
I now knew that I had acute Hepatitis C.
I started combination therapy of peginterferon and ribavirin which is a demanding therapy, so much so that about 20% of patients have severe side effects which requires cessation or reduction of therapy. I feared the development of significant depression, crippling fatigue and neutropenia as well as pancreatitis, colitis and eye complications. My injections led to flu like reactions, aches, pains and tiredness. I also lost weight and had a few nights of insomnia. I cleared the virus by week 10 and this was sustained at the end of the treatment and 6 months after stopping treatment.
The therapy had been a success.
Dr Mike Ashton, MbChb, FRCP
Chesterfield Royal Hospital NHS Foundation Trust