Sharps injury during a high-risk procedure
A radiographer is assisting with an ultrasound-guided biopsy on a patient whose infectious status is unknown. During disposal, a needle protrudes from an overfilled sharps container and punctures her glove and thumb, drawing blood. She rinses the wound, reports to the nurse in charge, and is told 'the container was changed yesterday, it should be fine - finish the list first, we're already 20 minutes behind'. The patient's serology is not on file. The department has no posted post-exposure protocol and the occupational health clinic closed at 15:00; it is now 16:40.
1. What is the correct immediate sequence of actions?
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Immediate care comes before the list. The radiographer should wash the wound with soap and water (not scrub, not squeeze), allow it to bleed, and rinse - she has already done the first step correctly. She should then leave clinical duties and attend the emergency department, because post-exposure prophylaxis for HIV is time-critical and the occupational health clinic is closed; ED is the correct escalation route, not 'tomorrow morning'.
The nurse in charge's instruction to finish the list is not a defensible basis for delay. Source patient testing should be requested through the correct consent and confidentiality pathway so that risk can be stratified, but prophylaxis decisions should not wait on it - national guidance allows starting prophylaxis while source status is pending. The overfilled container must be taken out of service immediately and the event reported.
2. How should the incident be reported and what system failures should the review address?
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Report through the incident reporting system the same day, with factual detail: time, procedure, container condition, PPE worn, immediate actions, time of ED arrival. Report to occupational health for follow-up serology and counselling. Maintain confidentiality of both the injured worker and the source patient.
The review should treat this as a system failure, not an individual error. Contributing factors visible in the scenario: a container filled beyond its safe capacity, no posted post-exposure protocol, occupational health hours that do not cover the service's operating hours, and a culture in which a manager deprioritised a bloodborne exposure. Actions: audit sharps container replacement frequency against fill level, display the post-exposure pathway at every point of use, extend or contract out 24-hour occupational health cover, and feed the case through clinical governance with a named owner and a re-audit date.