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by Lois Pilant
For many officers the greatest fear is not some punk''s bullet, it''s
the business end of a junkie''s dirty needle.
You might think that getting stuck by a needle in the course of a
shift would be the least of an officer''s worries, especially when
there are so many other things to worry about: like how fast a
traffic stop can go bad; the irrational behavior of the players in a
domestic violence call; the stupidity of the guy who flees the police
and the risks inherent in a chase.
But talk to Officer Don Gause, an eight-year veteran of the Myrtle
Beach, S.C. Police Department, and he''ll tell you that a needle stick
or accidental exposure to HIV, hepatitis, or any other bloodborne
pathogen is absolutely his greatest fear.
"On a traffic stop, you know the potential is there to be shot. On a
domestic violence call, you know how fast a complainant can become a
defendant. But to be stuck by a needle on a pat down, that''s
something else. If you get shot, you know right away if you''re going
to be all right or not. With a needle stick, you won''t know for six
months. That''s scary."
How scary? Just ask Cpl. Darryl Bolke, a 14-year veteran of the
Ontario, Calif. Police Department. He says getting stuck by a needle
"ranks right up there with the worst thing I''ve had to go through in
my life."
Bolke was stuck on the index finger while searching a man he''d
arrested for solicitation of a prostitute. Although he asked if the
man had any sharp objects in his pocket, and although he noticed an
object on the initial pat down, the object didn''t feel like a
syringe. It felt, he said, like a crack pipe. Bolke put his hand in
the man''s pocket and was immediately jabbed by a needle sticking out
of a small, 2-inch piece of plastic that had been fashioned into a
homemade syringe. What made Bolke''s situation worse was that it
happened 10 years ago, when there was less information about HIV and
other bloodborne diseases, when there were no prophylactic drugs
given post exposure, and when getting a blood sample from the source
meant fighting your way through a battery of privacy laws, the
courts, and the medical community.
"I had no intimate contact with anyone in my family for three months
following the first blood test. The crook was treated like the victim
by the courts and the medical community, and I had no rights at all.
I felt like I''d been victimized twice," Bolke says.
Times have changed. Today''s officers are offered immunization with
drugs like GlaxoSmithKline''s Twinrix for Hepatitis A and B; education
in the prevention of and protection from exposure to bloodborne
pathogens and tuberculosis; personal protective equipment; training
in search techniques that use a baton or the blade of the hand; and
post-exposure counseling and medical care. In addition, there are now
laws that require the source to provide a blood sample on request or
through a court order. Finally, today''s officers have available an
abundance of reassuring statistics that detail exposure rates and the
rarity of exposure converting to a disease.
High Frequency, High Risk
Such precautions have not dispelled many officers'' continuing fears
of exposure to HIV, hepatitis, or tuberculosis. One reason is that in
the context of risk management, exposure comes from job duties that
are considered high frequency: arrests and physical searches; vehicle
searches; blood and body fluids at accidents and crime scenes, just
to name a few. Because exposure and subsequent conversion can be
fatal, these activities are also considered high risk.
Added to this deadly mix is the fact that an officer probably will,
during the course of a shift, come into contact with an infected
person.
In 1996, an estimated 98,000 to 145,000 HIV-positive inmates were
released from prisons and jails. Also in 1996, between 1.3 million
and 1.4 million inmates released from prison or jail were infected
with hepatitis C. That same year, approximately 155,000 released
prisoners had current or chronic hepatitis B, while 566,000 were
released with latent TB infection. In addition, between 12 and 35
percent of the total number of people in the United States with some
sort of communicable diseases passed through a correctional facility.
And the one thing many of these disease carriers have in common is
further contact with police. According to a report from the Bureau of
Justice Statistics, 67 percent of the nearly 300,000 people released
(from 15 test states) in 1994 were rearrested for a new offense,
almost exclusively a felony or serious misdemeanor. They had
accumulated 4.1 million arrest charges prior to their most recent
imprisonment and another 744,000 charges within three years of their
release (an average of four new crimes each).
Given these figures, it doesn''t take a rocket scientist to calculate
that the inordinate number of infected releasees and the high rate of
recidivism almost guarantees contact between an infected person and a
police officer. Those numbers do not include contact with illegal
aliens and the homeless, who often spend time in crowded,
unventilated shelters that can be breeding grounds for diseases like
tuberculosis and bacterial meningitis. It also doesn''t include the
drug addicted, a group that typically has little concern for health
care or personal cleanliness, and even less concern for those who
arrest them.
Lying in Wait
For years, the scariest of infectious diseases was HIV. Today''s
nemesis, however, is hepatitis C (hep C), a virus that is spread by
contact with the blood of an infected person and eventually causes
liver disease. While health officials estimate that about 1 million
people in the United States are HIV infected, about 3 million to 4
million Americans are infected with hep C.
At least 75 percent of the people infected with hep C don''t even know
it, according to Debbie Borst, a registered nurse who does in-service
health care training for South Carolina police agencies. Those
numbers held true in a recent statewide study that required a hep C
test for tattoo artists renewing their licenses. The study revealed
that more than 60 percent of those tested were infected with hep C
and completely unaware.
"I call it the stealth virus," Borst says. "It can lie dormant for
five to 20 years, and while it''s doing that it''s eating the liver
cells. You may have some flu-like symptoms in the beginning, but when
those go away, you are generally symptom free. Then one day you wake
up with jaundiced skin, orange urine, and yellow eyeballs, or you may
have liver cancer."
Hepatitis C was a stealth virus for health care professionals as
well. The disease has been around for 50 years, since its first
transmission was documented through blood transfusions during World
War II. But the virus was only clinically identified in the late ''80s
when technology finally caught up with it.
Several factors make hep C a deadlier adversary than HIV. For
example, HIV cannot live outside the body, whereas the hep C virus
can live outside the body for up to seven days. One drop of
HIV-positive blood contains about eight live viral particles, while
one drop of hep C-infected blood contains about 100, making
transmission of the virus that much more likely.
Hepatitis A and B are equally virulent, but less likely to be
transmitted. Although both can live for longer periods outside the
body, public safety and health care employers are now required to
offer immunization against hepatitis B. Hepatitis A, the oldest form
of the virus, is spread by ingesting contaminated food or water.
Although police officers are certainly not immune, their chances of
exposure to hep A or hep B are smaller than those with hep C and HIV.
Tuberculosis and bacterial meningitis also have been pinpointed as
problems for law enforcement officers. These are airborne diseases
that are transmitted by breathing or coughing on someone. Among law
enforcement officers, the most susceptible to these diseases are
those who work in prisons and jails, since transmission generally
requires that the bacterial count build to a certain level before
infection.
According to Laura Herring, the occupational infectious disease nurse
for the city of Portland, it would take longer than a ride to the
stationhouse for someone to become infected with TB or bacterial
meningitis. "The people who might be vulnerable would be those who
have to have face-to-face interaction with an infected individual
over a period of several hours," she says.
Fear vs. Reality
Which brings us to the real question: Exactly how vulnerable are you
as police officers to contracting disease from a needle stick, a
blood splash, or convict spit?
"The most important thing is to keep it in perspective," Herring
says. "The way to do that is to be sure you have all the information
about the diseases, how they are transmitted, and the rate of
conversion or the likelihood of actually contracting the disease
after exposure."
Conversion rates are actually strikingly low. According to the
Centers for Disease Control, those exposed to HIV have a 0.3 percent
chance (1 in 300) of becoming HIV positive. The risk after exposure
from contact to the eye, nose, or mouth is approximately 0.1 percent,
or 1 in 1,000. The risk after exposure of the skin to HIV-infected
blood is estimated to be less than 0.1 percent. And a small amount of
blood on intact skin probably poses no risk at all. In fact, there
has been no documented case of HIV transmission due to an exposure
involving a small amount of blood on intact skin. The risk may be
higher if the skin is damaged-for example, by a recent cut-or if the
contact involves a large area of skin or is prolonged (for example,
being covered in blood for hours).
The risk of conversion to hepatitis is slightly higher. Those who
received hepatitis B vaccine and developed immunity to the virus are
at virtually no risk for infection. For the unvaccinated person, the
risk from a single needle stick or a cut exposure to hep B-infected
blood ranges from 6 to 30 percent, and depends on the level of the
virus and its antigens in the source''s blood. Of those exposed to hep
C from a needle stick or cut, the risk of infection is approximately
1.8 percent. The risk following a blood splash is unknown, but is
believed to be very small.
But just because the conversion rates are low does not mean you
shouldn''t be cautious. Diseases like HIV, AIDS, and hepatitis are
deadly and therefore should engender a certain amount of fear. "Fear
is good. It keeps you alive," one officer said. "Panic is bad because
you''ll blow it."
"I know I have to be careful," adds Officer Skip Chatford, a patrol
officer with the Corona (Calif.) Police Department. "But I don''t
worry about it every day. When I do a search, I don''t stick my hands
in people''s pockets if I can help it. I pull at the top of the pocket
and roll the liner out. I just keep rolling until the stuff inside
comes out. If I know I''m going to a stabbing or a shooting, I stop
and put on gloves before I get there. I stop and think before I do
anything. I try to stay aware of what is happening and not rush in
without thinking. I feel like I have the education and the equipment
I need to protect myself. That''s what has dispelled any initial fear
I may have."
Lois Pilant is the former editor of a law enforcement magazine, a
writer for the National Institute of Justice, and a frequent
contributor to POLICE.
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This article is reprinted with permission from Police Magazine,
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