Grossing scalpel injury

[path doc]

I had a scalpel injury while grossing a Uterine Fibroid specimen. The scalpel cut through the glove and there was visible blood on my opposite index finger. Washed and cleaned it but I did not think much of it at that time but now worried about HIV and Hep C as the scalpel blade was not new and may have been used by others for grossing other specimens.

As this specimen (and others grossed by the scalpel) were formalin fixed, does it mean the risk is very low/ absent.

I was given a choice of starting PEP, but at that time I was not much worried but freaking out now. Are my concerns justified or am I just being paranoid?

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[tiredguy]

Perhaps this has more to do with the fact that you are concerned rather than logically justifying your concerns. If you are "freaking out" then maybe taking PEP will make you feel better even if the risk happens to be miniscule. No one can give you the exact odds given the uncertainty regarding the scalpel blade.

 

[icpshootyz]

I had a scalpel injury while grossing a Uterine Fibroid specimen. The scalpel cut through the glove and there was visible blood on my opposite index finger. Washed and cleaned it but I did not think much of it at that time but now worried about HIV and Hep C as the scalpel blade was not new and may have been used by others for grossing other specimens.

As this specimen (and others grossed by the scalpel) were formalin fixed, does it mean the risk is very low/ absent.

I was given a choice of starting PEP, but at that time I was not much worried but freaking out now. Are my concerns justified or am I just being paranoid?

So how was the scalpel blade not new? When I was a resident no one left blades on scalpel handles for the next person to use. I personally would use the same blade for multiple of my own cases, but I'd never leave a blade for the next person to use my bench. Seems like basic safety to throw away the blade when you leave the bench.

 

[gbwillner]

Maybe path doc is a resident in Soviet Russia. In Soviet Russia residency, you don't cut specimens, specimens cut you.

 

[Ishie]

The risk would be low, particularly on formalin fixed specimens (though remember that formalin penetrates slowly, so if if a fibroid uterus hasn't been in that long, the interior isn't necessarily formalin fixed).

I would think having it sit around would reduce risk of HIV/HepC though the latter is heartier, so if there was visible matter on the scalpel, that would increase the chances. I would echo the others though about it being weird to have multiple people use a scalpel. This might be a good time to bring up changing scalpel blades between specimens at your hospital. I caught myself with one during residency and only had to worry about the patient I was grossing (negative for disease). Blades are cheap (unless they're the long placenta or brain knives), dull quickly, and leaving them through multiple specimens increases infection risk and likely affects quality (dull sections). If you must reuse blades, soak them in bleach between uses. This will prevent future issues and you have a good reason to bring it up since you're having to worry about it.

As far as whether to start PEP, that depends on you. The risk is quite low (even if you had an infected patient), but if you did wind up getting something, how would you feel about it? I'd probably err on the side of no PEP, but it's a completely personal decision.

 

[Torsed]

I wouldn't worry, been there done that, more cautious now.

I take my time grossing, it isn't the indy 500. I keep all my blades in the top left hand corner so I know where they are. I change my blades between each case.