Finger pokes during sc/rp. Help!

[Classone]

Does anyone know what the statistics are of contracting HIV/Hepatitis from an instrument poke during scaling and root planing?

I'm really depressed tonight. I had a patient earlier today. I was doing some really deep scaling and root planing. My scaler (SH6/7) has a really sharp and pointy end. It went through my glove and about 1mm into my right ring finger. The instrument had been contaminated with blood. It doesn't help that the patient appears to be in the high risk category (poor oral and personal hygiene plus questionable life-style). I went to the ER. They can't take any preventive measures unless my patient agrees to go in for testing tomorrow. I somehow doubt he will.

If anyone has any good advice, please make a quick response. I'm REALLY bummed out. =(
Thanks.

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[Big_Poppa DDS]

The risk for HIV is very low. I also had an exposure and went through the standard protocol. Fortunately everything turned out ok.

I'm not sure what the protocol is but if the patient is high risk and refuses testing I thought they put you on prophylactic anti - virals within 2 hours of the exposure. Check with your school to make sure everything was done per OSHA regulations.

 

[tulanestudent]

An open-bore needle-stick carries a 4% HepC risk and a 0.5% HIV risk IF the patient has one of those. You should get tested for both, even if your patient can't be tested. Also, they should have offered you HIV prophylactic drugs. These drugs do have side effects, of course, but they have been shown to reduce the risk of contracting HIV even more than the 0.5% if started immediately.
I got this info from the CDC website when I got stuck with a suture needle from a HepC+/HIV- patient. I worried too, so I know how you feel. Check out the CDC and their links for some reassurance.

 

[DrJeff]

Rest assured, I'm 0 for 2 in my exposure situations. On of them was a suture needle on an HIV positive patient with a viral load as I remember that was over 150. The other was a bur stick on an at risk patient. Both times I followed the protocols and took the meds. Fortunately the GI side effects weren't too bad in my case.

I have two other friends with high risk exposures with no problems. One of them was when she punctured her finger with an east/west elevator during an extraction on an HIV+ patient. No problems. The biggest scare was from a friend of mine who was an ER tech. He was stuck with a large bore needle that had just been used to draw blood from the patients femoral artery. The patient died of HIV related complications 4 days later 😱 These may help provide some piece of mind. I can though relate to the anxiety. Even when people read you the statistics that that the chance of conversion with an arterial blood contamination of an HIV+ patient are something like two tenths of 1 percent, the mind will always think what if I'm that two tenths of 1 percent. Anybody who has had a potential exposure has these thoughts, so they are normal. In all likelyhood when you look back on this day in a few months, it will just be one of those lessons about the importance of finger rests. I will almost guarentee you though, this will not be the last time in your career that you accidently stick yourself. Fortunately most of the times that it will happen will be on a clean needle before an injection or on a bur when the handpiece isn't turned away from you. Also you've now had one of those experiences that basicallly everyone who calls themself a dentist has had, so in a wierd way you can say that you completed one more graduation requirement today 😉

 

[Classone]

Hi everyone. I wanted to thank you for replying.

I'm upset that the emergency room wouldn't give me a prophylaxis last night when I really stressed that I wanted one. The handbook that they whipped out categorized me into the low risk range and 'recommends' that a prophy not be given. With regret, I trusted their decision. I really wish they had given me one, but because my health center (i'm a student) and the company care that my school has us call for these incidents was closed, I had no other options. Of course, I called the company care in the morning and they had me come in right away to start a prophy. They thought that the ER should have given me one, especially with an unknown source. Now, I still feel uneasy because I waited 19 hours before taking the first pill. The first 1-2 hours after exposure is most effective. After 24-36 hours, the effects are questionable.

Does any one know any statistics or info on waiting as long as I did to start a prophy in cases of a positive patient. Also, does anyone know any statistics on long term effects of the antivirals (ex. liver damage). So far, the nurses haven't been able to contact my patient, although he has received the message. I may have to remain on the antivirals for 4 weeks if the health status of my source remains unknown.

Again, thanks for your replies and if you can give any more information, it's much appreciated.

 

[T.K.]

Hi There,

I can see your concern. A few years ago, the same thing happened to me - I stuck myself with an anterior sickle while doing s&rp on a high risk patient. I have tested neg for any dz. Rest assure because in the literature I've read, there has never been an HIV contraction from a solid instrument stick only a hollow one. As far as hep, I can only say try not to worry too much, there isn't much you can do right now.

I've had a couple of accidents like this. I tend to bleed my wound and use iodine. Don't know if this is any help.

 

[DrJeff]

I can say that if your worried about any long term effect on your liver functions based on taking the prohylactic cocktail, my LFT's are the same almost 4 years after I took my 1st cocktail for a month. Since then my liver has seen another month of the cocktail and quite a few alcoholic beverages 😀

 

[Classone]

Thanks for the response Dr. Jeff.

My doctor called me late Friday night to let me know they contacted my source. He is HIV negative, so that is a relief. However, the Hep test takes longer for results, so it won't be until Monday or Tuesday before I know. Just glad I don't have to continue with the antivirals, as I was starting to feel some of the side effects.

Now I'm just crossing my fingers =)