An ounce of prevention is said to be worth a pound of cure — but it’s not always enough when the unexpected happens. That’s what one surgeon discovered when he was accidentally stuck with a needle containing blood from an HIV-positive patient during a complicated 12-hour procedure in late 2023.
He completed the surgery late at night, then found that the steps for preventing transmission were harder to take than anticipated. With pharmacies closed for the night, and then understocked the following day, it took a runaround for him to access antiviral drugs for postexposure prophylaxis, or PEP. While he received his initial PEP course within the recommended 72-hour window after exposure, treatment arrived perhaps too close for comfort, and after too much confusion.
“It shouldn’t have been that difficult,” said Earl Strum, MD, medical director of Employee Health at Keck Medicine of USC and interim chair and clinical professor of anesthesiology at the Keck School of Medicine of USC. “We keep track of data on needlesticks, but the story of the surgeon made the issue bubble up. It was personal, and it was scary. We didn’t want anyone to go through that again.”
Spurred to action, Strum and Employee Health nursing director Yolee Casagrande, DPN, RN, spearheaded an initiative to improve needlestick protocols at Keck Medical Center of USC. They collaborated with a wider group including leaders at the on-campus pharmacy and the Keck Medicine administration to ensure there wouldn’t be a repeat of the travails the surgeon had gone through. The result of these efforts is a system for fast response whenever anyone working at the medical center is exposed, along with an ongoing training component.
“This program has empowered our people to do the right thing, and do it quickly.”
~Yolee Casagrande, DPN, RN
One crucial difference, making PEP readily available on the fly, was implemented in fall 2024. During business hours, Employee Health provides a kit on hand with three days’ worth of medication. After hours, PEP can be obtained at the Evaluation and Treatment Clinic in Keck Hospital of USC.
“Getting medication to someone on the spur of the moment — any time of day or night — is not an easy thing,” said Strum, who is also affiliated with the Department of Population and Public Health Science. “It had to be a 24/7 program. ‘Come back the next day’ just wasn’t good enough.”
In addition to PEP, the protocols for an exposure include a battery of lab tests. The Employee Health initiative speeds up the response with a power plan now preloaded into the medical center’s computer system. With ease, physicians can pull up every step needed for testing and treatment.
“This program has empowered our people to do the right thing, and do it quickly,” said Casagrande, associate administrator for nursing at Keck Medical Center and an adjunct clinical assistant professor of population and public health sciences at the Keck School of Medicine. “It’s removed any confusion from the process.”
Meanwhile, Employee Health offers training sessions on needlestick reduction. The four-minute video covers risk factors for needlesticks, best practices for avoiding needlesticks, and instructions for how to handle them when they occur. The first sessions took place in spring 2025, and the goal is for everyone with a patient-facing role to complete it.
The entire endeavor is motivated by concern for the health and wellbeing of every staff member at Keck Medical Center. After all, while infection from a needlestick is unlikely, the stress that someone experiences can be overwhelming.
“We have good HIV medications, but still, no one wants to be infected with a serious disease while treating their patients,” Strum said. “Exposures are nerve-racking. You don’t know whether your life will change. It’s watching, waiting, getting blood tests to ensure you’re free and clear. So it was important to make it a simpler process here.”
Casagrande added, “I think most of us have suffered a needlestick at some point. This program is just us taking care of our own Trojan Family in a better way.”
For more information about needlestick reduction training, please contact Maria Saballos, RN, at (323) 442-8509.