Blood exposure question ...

[DD214_DOC]

Hey,

I was exposed to what I presume was a "flick" of blood that came from a needle-driver when it popped open (they suck where I'm at) and into my eye; it was very, very small from what I could feel.

I finished what I was doing and went to rinse and mentioned it to the doc, who said the risk is extremely low and I shouldn't worry about it. After a few minutes I decided to worry about it and filed a report.

Unfortunately, the patient had already left so no blood could be drawn on them. Baseline labs were drawn for me and that was pretty much it -- no offer for PEP or anything.

Should I be concerned? I've looked at seroconversion rates for mucous membrane exposure and they're pretty darn low. They were trying to convince the pt to come back to get drawn and checked. I was a bit surprised that nothing was really offered to me. I'm a bit concerned.

---

Members don't see this ad.

 

[FutureInternist]

All the places I rotated at had a service in place for needlesticks or any other kind of exposure for that matter. If pt's blood is not available then it really is up to you as far as taking HIV meds. I guess depending on pt history etc you could assess their risk of it but no matter how small the risk, I would start the meds soon.

Good Luck.

 

[BobBarker]

If the patient was HIV+ you have a .09% chance of contracting HIV.

 

[Smurfette]

I had a significant eye exposure once (blood all over my face, pt HepC+). Basically I had to throw out my contacts and get my eyes irrigated and they gave me antibiotic eye drops to prevent an eye infection, which they told me was the most likely "bad thing" I would get from the exposure. (The patient also was bacteremic/septic from pseudomonas...). The patient ultimately died, and I just made sure to keep all my followup blood draws to make sure I stayed HepC negative. Likelihood of HIV infection from eye exposure is minimal, I was told....definitely many times less likely than hollow-bore ('biggest' risk) or solid needlestick injury (less risk).

It is very rare to get offered prophylaxis for HIV...only if the patient is HIV+ with significant viral load or extremely high risk (like an IVDU hooker) do they ever seem to offer it... Seriously, the transmission rate is so low it is not worth taking those meds in the also low likelihood of your patient having HIV (which make you feel physically awful from what I've seen from my colleagues, need regular LFT draws, can't drink EtOH, etc.).

Just get proper followup blood draws to make yourself feel better that you haven't seroconverted. HIV usually seroconverts by 6 weeks, but they retest at 3 months to get the "late" converters. HepC can be more insidious.

 

[Law2Doc]

...
It is very rare to get offered prophylaxis for HIV...only if the patient is HIV+ with significant viral load or extremely high risk (like an IVDU hooker) do they ever seem to offer it... ...

Very rare depends on where your med school is. In certain US cities with high IV drug usage and rampant STDs, a very large proportion of the people you will work on would will fit the extremely high risk definition.

 

[DD214_DOC]

I was in the rural south, which isn't really known for IVDU. Most drug abuse around here is related to meth and cannabis. As far as we know, the pt had no hx of IVDU and wasn't a hooker. He was just a low SES unemployed older guy (mid-late 30s) who got drunk and tried to fight a window.

I'm not as concerned with the possibility of HIV as I am HepC. Apparently form my readings with the CDC guidelines, the possibility of HepC transmission through a "microsplash" into the eye is so low it's not even documented. BEsides that, there does nto exist any PEP for HepC anyway so I guess I play the waiting game.

Given my case, do you guys not think HIV PEP is necessary?

 

[Gallix23]

Even though I'm not a med student (yet...I hope =P ) I can share a story that may make you feel better.

My mother is a nurse, and when she was first starting out in the 80s when AIDS was getting big, one of her fellow nursing classmates was drawing blood from a full blown AIDS patient. Somehow she got fully stuck with the needle, and she never contracted anything from it.

If anything I hope it just eases your nerves, sorry I couldn't be of more help =/

 

[Droopy Snoopy]

Given my case, do you guys not think HIV PEP is necessary?

One of my classmates got a needlestick (from a known high-fiver), and I can tell you that HIV PEP is no fun at all. I mean it's better than getting AIDS obviously, but you know what I'm saying. Anyway, although it's easy to say don't worry about it you'll be fine, I think it'd be different if any one of us were actually in that situation. Sorry but I think you just gotta make this call on your own.

 

[Smurfette]

I was in the rural south, which isn't really known for IVDU. Most drug abuse around here is related to meth and cannabis. As far as we know, the pt had no hx of IVDU and wasn't a hooker. He was just a low SES unemployed older guy (mid-late 30s) who got drunk and tried to fight a window.

I'm not as concerned with the possibility of HIV as I am HepC. Apparently form my readings with the CDC guidelines, the possibility of HepC transmission through a "microsplash" into the eye is so low it's not even documented. BEsides that, there does nto exist any PEP for HepC anyway so I guess I play the waiting game.

Given my case, do you guys not think HIV PEP is necessary?

No, it doesn't sound necessary. Do the math...if the above poster was correct (I don't know the odds myself) and you have a 0.09% chance of getting HIV if the patient was HIV+, and the odds that the patient was HIV+ was, 2% (estimating high here), that gives you a 0.0018% (0.02*0.0009*100) chance of contracting HIV.

 

[BobBarker]

No, it doesn't sound necessary. Do the math...if the above poster was correct (I don't know the odds myself) and you have a 0.09% chance of getting HIV if the patient was HIV+, and the odds that the patient was HIV+ was, 2% (estimating high here), that gives you a 0.0018% (0.02*0.0009*100) chance of contracting HIV.

My info is from Harrison's. That is for transmission via mucous membranes from a knwon HIV infected source. Needle stick is .3%.

 

[DD214_DOC]

My info is from Harrison's. That is for transmission via mucous membranes from a knwon HIV infected source. Needle stick is .3%.

These same numbers were in the current CDC guidelines

 

[Rendar5]

No, it doesn't sound necessary. Do the math...if the above poster was correct (I don't know the odds myself) and you have a 0.09% chance of getting HIV if the patient was HIV+, and the odds that the patient was HIV+ was, 2% (estimating high here), that gives you a 0.0018% (0.02*0.0009*100) chance of contracting HIV.

HIV prevalence in NYC ED patients is a bit higher than 2%, so you're not far off with that estimate

 

[dpmd]

I couldn't find the info this time, but I stabbed myself with a scalpel when I was an intern and I looked up some guidelines. I found a chart that classified the types of injuries with hollow bore obviously the high risk type of injury. It then classified the patient into highest risk (HIV pos with high viral load) to lowest (HIV neg). It then gave recommendations based on the type of injury, how much blood exposure there was, and the type of patient. It was a little more specific than the CDC link shown, but I can't remember where it was from (must have been some reputable govt source if I paid attention to it when I got stuck). Basically, if you have a low risk injury and not a high risk patient the risks of PEP outweigh the benefits. Just goes to show that you should always follow the hospital protocol when a blood or body fluid exposure occurs, not just what some attending says (they aren't going to know, you usually have to tell an administrative type person-in our facility its the house supervisor). That way the patient can get tested before they leave (or die as was the case with mine).

Also goes to show that you should always wear appropriate protective gear. I never let my students scrub or do bedside procedures without eye protection.

Don't let it freak you out too much for too long. Besides deciding about the PEP (which doesn't seem necessary in your situation) what is going to happen is just going to happen. Learn from it and tell your friends not to make a similar mistake, then move on with your training. Dwelling on it won't do anything.

 

[reedman]

I know an ER tech that got stuck . He did antiretroviral therapy because the patient left before they could draw blood. According to him, the drugs make you feel awful. He didn't finish the therapy. From what he said, I don't think I would take the drugs for a .09% chance of transmission.

 

[DD214_DOC]

I got re-tested about 2.5 - 3 mos afterwards and everything was negative. Will probably get more drawn at 6 mos.

I ended up getting exposed to bacterial meningitis during an autopsy as well. It was neat to have orange pee for a few days though.

 

[Pinkertinkle]

Sucks that your attending didn't just have needlestick panel ordered when you first brought it up, i think there's a lotta pressure just to hush hush these incidents and that's definitely not what's best for students or patients.

 

[The Angriest Bird]

If the patient was HIV+ you have a .09% chance of contracting HIV.

Which is the same chance of getting HIV from your next girlfriend/boyfriend

 

[Rendar5]

Which is the same chance of getting HIV from your next girlfriend/boyfriend

well, bit higher depending on your practices. To the OP: why are you getting tested at 6 months? If your'e that worried that you won't seroconvert at 3-4 months, why not have requested a PCR in addition to the rapid test or Western Blot one that you got? That way you'll ahve peace of mind sooner (although personally I would trust a western blot at 3 months duration, but that's just me).

On another note, i just stuck myself suturing a 15 month old today, I think I"ll go without seeking HAART or confirmation

EDIT: and orange pee? what bacteria were you prophylactically taking Rifampin for? I"m actually curious, since I had to take cipro as prophylaxis for close contact with an encephalitis patient last month.

 

[Boba Q Fett]

well, bit higher depending on your practices. To the OP: why are you getting tested at 6 months? If your'e that worried that you won't seroconvert at 3-4 months, why not have requested a PCR in addition to the rapid test or Western Blot one that you got? That way you'll ahve peace of mind sooner (although personally I would trust a western blot at 3 months duration, but that's just me).

My understanding was that they only do the western blot if the ELISA is positive since it has such high sensitivity.

 

[Rendar5]

My understanding was that they only do the western blot if the ELISA is positive since it has such high sensitivity.

yeah, either one is a diagnostic test (though ELISA requires confirmation). But PCR can be done, or a viral load can be done, for the first month or two before antibodies are produced.

 

[emily487]

I believe my dad (a surgeon) was once exposed to the bodily fluids of an HIV+ patient through eye contact (somehow bodily fluids squirted or splashed into his eyes)... this was in the 80s when HIV first started to become known and they didn't know at the time that this pt had HIV but found out later... he was fine (no prophylaxis or anything like that, obviously), tested multiple times and still HIV-, so you should be fine.

 

[SouthernSurgeon]

I believe my dad (a surgeon) was once exposed to the bodily fluids of an HIV+ patient through eye contact (somehow bodily fluids squirted or splashed into his eyes)... this was in the 80s when HIV first started to become known and they didn't know at the time that this pt had HIV but found out later... he was fine (no prophylaxis or anything like that, obviously), tested multiple times and still HIV-, so you should be fine.

Hooray for anecdotes.

I'm glad your dad was ok, but his experience doesn't mean everyone who gets splashed in the eye will be "fine." There is a real and quantifiable risk to blood exposure cases.

 

[goodoldalky]

The best thing to do in these situations is to handle it immediately through your institution's exposure protocol. I always sat in those lectures and hoped to God I'd never have to deal with it, but sure enough, 1st week on my ER rotation, splashed in the face with blood from a non-citizen pt. with no available medical history.

It's nervewracking. And it's true that your odds are extremely low of contracting something. The time to be most worried is if you get stabbed with a hollowpoint on a viral positive patient, but even then the odds are in your favor. But the bottom line is that you will likely waste a lot of time thinking about it unless you call the exposure hotline and get your and the patient's labs drawn.

 

[FractureFixer]

I would talk to your need-stick office!

 

[DonHovaMD]

Hey ,
I feel your pain. Last week I was exposed. I had a perianal abscess burst in my face. Hours earlier the surgical intern showed me how to do do the I&D on another perianal abscess. It was the first time I had to do this so I followed his lead (which basically means I was holding the guy's buttcheeks open). None of us were wearing masks. When it came to the second one, they told me I could do it. I proceeded to inject lidocane all around the border and into the abscess. At all times I was having the abscess and his anal wink reflex pointing away from me. Then, the surgical senior came into the room, asked me for the syringe (in a very demanding tone of voice) and totally changed the angle at which I was injecting and at her first site of injection...a squirt of pus came from this guy's butt and splashed my face and eyes. I walked out, rinsed my face, but was unsure if it had gone into my eye. I went back to the room (with a mask on) and packed the wound. When I got out I told my attending what had happened. She told me got go get tested and to get the guy tested. Thankfully, His HIV and hepatitis panel both came back negative. I want to go into EM, so I was trying to make an impression on that attending (residency director). Am sure she is not going to forget me anytime soon. Moral of the story : don't give up the syringe to the surgical senior...and wear a mask.

 

[samyred]

I wanted to resurrect the thread for a friend of mine had a splash on her eye and patient was positive for HIV. She washed her eye and is taking PEP right now.

Are you guys all fine after your exposures?


Personal story, I once stuck myself with an explorer that was used inside the mouth of a hep C patient, I got so freaked out at that time and ordered a PCR 3 weeks post exposure, it came out negative of course, I love those PCR tests, they are very sensitive and accurate. And here I am a year later negative.