Rare accident exposes little B.C. girl to HIV during vaccination

A lot of children, and adults, for that matter, are afraid of needles. But a little B.C. girl’s flinch as she was getting a routine vaccination is proving scarier than the shot itself.

The six-year-old was getting a booster shot at the Fort St. James health unit in northern B.C. in early October. The child’s father told 250News she flinched as the nurse was giving the injection, causing the needle to go through the child’s skin and into the nurse’s hand.

In drawing the needle back, the nurse’s blood mixed with the little girl’s blood.

The father, who was not identified, said he subsequently learned the nurse was undergoing treatment for HIV, 250News said.

The incident means the child now must have followup blood tests – more needles – for months to determine if she contacted the virus.

It also raised the question of how much patients should know about their health-care providers’ potentially threatening medical conditions.

The B.C. Northern Health Authority’s chief medical health officer said the agency has apologized to the girl’s family and started an investigation.

“We immediately contacted our partners at the provincial government and the B.C. Centre for Disease Control to understand what next actions were needed,” Dr. Sandra Allison said in an interview Wednesday with Yahoo Canada News.

The health authority has a procedure to follow up any needle-stick injury and to deal with for exposure to blood-borne pathogens, which are more commonly carried by patients than by health workers.

“Depending on the pathogen we have protocols in place for following up, so routine baseline testing is done and subsequent testing for up to six months later is required,” said Allison, who called such incidents “extremely rare.”

Like most professional health-care organizations, the 40,000-member B.C. College of Registered Nurses’ practice standards lay out the guidelines for preventing nurse-to-client transmission of communicable diseases, said Cynthia Johansen, registrar and chief executive officer.

“Our requirement is that a nurse makes public safety the absolute priority and we appreciate that also needs to be balanced with their own right to keep their own medical information private,” she said in an interview.

“We absolutely encourage disclosure. However, in terms of a requirement around it, our expectation is the nurse puts the safety of the patient first and foremost.”

Employment law would require nurses to disclose their status for diseases such as HIV or hepatitis C to the institutions they work for, said Johansen, adding the college is conducting its own investigation of the incident.

[ Related: Top HIV/AIDS researcher Dr. Julio Montaner slams Ottawa for ignoring B.C.’s successful treatment ]

The college’s policy requires nurses who test positive for a blood-borne pathogen to consult an expert in infectious diseases for advice on how it might affect their work, which might include withdrawing from medical procedures where there’s a risk of passing on the disease.

“They are expected to follow that advice and put in place those restrictions on their nursing practice,” said Johansen.

The Canadian Medical Association (CMA), which speaks for the country’s physicians, takes much the same approach. But its policy also spells out a doctor’s responsibility to disclose their medical condition to their patients if a procedure presents a “material risk” of infection.

“Basically what it says is the disclosure of seropositive status should be consistent with the standard of informed consent,” Dr. Jeff Blackmer, the CMA’s executive director of the office of ethics, professionalism and international affairs.

“That generally involves putting your hands in a body cavity when there are sharp objects in the area – usually things like open surgery with scalpels, retractors and that type of thing – where there’s a reasonable risk of health-care provider blood being spilled.”

When it comes to employers, such as hospitals, requirements for disclosure differ from place to place, said Blackmer, also a professor at the University of Ottawa’s Faculty of Medicine.

“Increasingly what we’re seeing is these types of questions are coming up,” he said.

Hospitals usually require doctors to renew their privileges annually, which includes disclosing things like whether they’ve been sued or lost their licence.

[ Related: HIV vaccine reported to be successful in trials by Canadian university ]

“But we’re seeing more and more people asking about serological status and for the regulatory colleges as well when you go to renew your licence,” Blackmer said.

Each province’s college of physicians is responsible for monitoring the guidelines and the general principles are largely the same across the country, he said.

“What we’ve done is recommended that there be an independent expert review committee and in most provinces that is operated through the regulatory college,” said Blackmer.

“You would need to essentially report your status there, where it would be maintained in privacy and confidence, but you would also have to disclose to them what you are doing in terms of your medical practice.

“They would have the ability to limit that practice to make sure that you’re not unduly exposing patients or that you’re getting their consent.”

Both nurses and doctors are encouraged to report colleagues they believe are not following the rules.

In the event the little girl does contract HIV, insurance should cover the liability.

Northern Health’s Dr. Allison said she could not comment on the matter but Johansen said registered nurses, like doctors, carry liability insurance and may also be covered by their employers’ insurance.

Blackmer said doctors are covered by insurance provided through the Canadian Medical Protective Association but cases can become complicated if a doctor has not been candid about his or her seropositive status.