HIV or other pathogen transmission in OR

[tkatchev]

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Here's a hypothetical question. Say you, a medical student, were assisting in the OR on an orthopedic surgery case, your eyes were unprotected and while the surgeon is sawing bone you feel some moisture or bone dust hit your eyes. What are the chances of the transmission of HIV or other kinds of pathogens by way of one's eyes?

Further details: The bone being sawed is a skull flap which had been removed for a period of about 5 minutes prior to being worked on again. Also, the patient is a child under the age of 10 if that makes any difference.

Should the person in said hypothetical case get tested for HIV or other infection and if so which ones?

 

[deleted77919]

Any potential body fluid contact should be reported immediately, and if necessary prophilactic treatment initiated.

 

[TexasRose]

Any potential body fluid contact should be reported immediately, and if necessary prophilactic treatment initiated.

Yes, and you should always wear eye protection in the OR.

 

[NCF145]

Here's a hypothetical question. Say you, a medical student, were assisting in the OR on an orthopedic surgery case, your eyes were unprotected and while the surgeon is sawing bone you feel some moisture or bone dust hit your eyes. What are the chances of the transmission of HIV or other kinds of pathogens by way of one's eyes?

Further details: The bone being sawed is a skull flap which had been removed for a period of about 5 minutes prior to being worked on again. Also, the patient is a child under the age of 10 if that makes any difference.

Should the person in said hypothetical case get tested for HIV or other infection and if so which ones?

Yes, you should report it. But here is some info that may help ease your nerves. If you happen to stick yourself with a dirty needle from a patient that you know is infected with HIV. The chances of you becoming infected is 1/300.

 

[smq123]

Here's a hypothetical question. Say you, a medical student, were assisting in the OR on an orthopedic surgery case, your eyes were unprotected and while the surgeon is sawing bone you feel some moisture or bone dust hit your eyes. What are the chances of the transmission of HIV or other kinds of pathogens by way of one's eyes?

Further details: The bone being sawed is a skull flap which had been removed for a period of about 5 minutes prior to being worked on again. Also, the patient is a child under the age of 10 if that makes any difference.

Should the person in said hypothetical case get tested for HIV or other infection and if so which ones?

1) Why were the eyes unprotected? Universal precautions dictate the use of eyewear or a face shield for any procedure in which there may be particles or airborne droplets. It's pretty irresponsible of the student (who, as a med student, should know better), but also of the attending surgeon in charge (who, as the surgeon, should definitely know better).

2) Tested for HIV, probably. Maybe Hep B and Hep C (depending on what the moisture droplets were made of).

 

[tkatchev]

No one else in the OR had eye protection, not a single surgeon, so I didn't think about it until it was too late.

I realize I should get tested and I will first thing this week, however, can anyone give me a realistic idea of how "at risk" I actually am. I understand that's difficult without knowing the true extent of the exposure.

 

[smq123]

No one else in the OR had eye protection, not a single surgeon, so I didn't think about it until it was too late.

Damn. That's terrible. The surgeons should have caught it, and definitely should have been wearing eye gear themselves. Even aside from infection risks, bone fragments in your eye (and the subsequent corneal abrasions) can be very serious.

I realize I should get tested and I will first thing this week, however, can anyone give me a realistic idea of how "at risk" I actually am. I understand that's difficult without knowing the true extent of the exposure.

Your exposure risks are low. You should definitely get treated with prophylaxis, and tested a few weeks from now, but that's just because it's better to be safe than sorry. But, honestly, the chances that you got anything are quite low. As NCF145 pointed out, HIV transmission is more difficult than most people realize. And the chances that a child < 10 years old has Hep B/C are pretty small.

 

[koma]

No one else in the OR had eye protection, not a single surgeon, so I didn't think about it until it was too late.

I realize I should get tested and I will first thing this week, however, can anyone give me a realistic idea of how "at risk" I actually am. I understand that's difficult without knowing the true extent of the exposure.

I am pretty sure there have never been instances of HIV transmitted through eyes, especially since bone is a pretty avascular structure. But I am wondering if you are at risk for CJD.

PS personally, I wouldnt worry about it and I wouldnt report it.

here's a random article:
BACKGROUND: Human immunodeficiency virus (HIV), the pathogen that causes acquired immunodeficiency syndrome (AIDS), has been isolated in the corneal epithelium of some HIV-positive patients. This observation raises concern about the risk of HIV transmission through corneal transplantation surgery (penetrating keratoplasty). METHODS: A comprehensive review of the literature of the ocular transmission of HIV, screening of donor corneas, and the potential of HIV transmission through penetrating keratoplasty was conducted and analyzed to review and interpret the relative risk of HIV infection through corneal transplantation. RESULTS: No cases of HIV transmission were found as a result of routine eye care or ophthalmic surgical procedures, including HIV-serp-negative recipients who inadvertently received HIV-seropositive corneas.

 

[dokota]

During my short stint as a phlebotomist, blood splattered on my face and all over me in the ER. I felt some blood droplets in my eyes and even my mouth. You can imagine how scared I was. The patient was an adult male who was in the ER for chest pain. Anyhow, after cleaning up, I reported the incident to
my supervisor, filled some paper work and faxed it to occupational health. The first course of action was to test the patient's blood for HIV, Hep B and C
(after asking for the patient's consent). I worked in pathology so we got the results in no time. All three tests were negative so I didn't need prophylaxis. That was 5 years ago and I'm O.K.

Being accident prone, while working in the surgical pathology gross room of a major medical institution/center, i cut myself with one of the scalpels. No biggie.That was a very common occurrence in that lab anyway. One resident cut herself really bad and wouldn't even go to Employee health. A 4th year med student cut himself on the cryostat's blade at the end of the day and since the cryostat had not been cleaned, he had to go through the OR schedule for that day to identify all the patients' whose samples had been worked on that day. Bummer!! He ended up getting the prophylactic treatment for HIV and got so sick from it. On the bright side, he is OK now.


I said all this to say, that incidents like these are bound to happen in the environment that you're going to spend the rest of your life in. Don't be stressed out about it. Report the incident if you haven't done so already. Occupational Health or whichever authorities will decide if you need a prophylactic or not. More than likely, you wouldn't. I know HIV and other pathogens aren't respector of persons but the chances that the ten year old is HIV+ is slim (at least in this country, I hope it is)

All the best tkatchev. See you at Retreat.

 

[Tired]

I am pretty sure there have never been instances of HIV transmitted through eyes, especially since bone is a pretty avascular structure. But I am wondering if you are at risk for CJD.

Bone is an avascular structure? You think the 10yr old had CJD? Lord, I don't even know where to start with you.

 

[tkatchev]

I can't thank everyone enough for their replies. I'm proud and honored that many of you will be my future colleagues.

I feel a lot less worried now, but will still get tested to alleviate any doubt. Also, in the future I'll be more proactive in insuring my safety in the OR even if those around me aren't doing the same.

Also I thank the moderators for not closing this thread because I'm kind of seeking medical advice. But I guess the night is still young.

 

[Abilene85]

You guys are brave. If that were me, I would be like "Time out! Don't blink. Bone dust...in the eye. I have bone dust in my eye. Send me where I need to go." I'm surprised so many people get pricked/cut and don't report the incident.

 

[PeepshowJohnny]

Bone is an avascular structure? You think the 10yr old had CJD? Lord, I don't even know where to start with you.

Maybe the kid was British and had been eating hamburgers since birth. 😱

 

[Flopotomist]

Uhm... I would not worry about HIV. As of 1999, the SUM total of known HIV transmission to healthcare workers via mucous membranes was 2. Pretty darned low (grr.. if only I could find the source, I know somebody will jump on me for not quoting it - I just read this in an HIV/AIDS atlas textbook).

More importantly, the kid was 9? Do you have any reason to believe that this CHILD was at risk for HIV? If not... don't worry about HIV.

There may be other things to worry about though (Hep?)

 

[Cirrus83]

Seriously...you think the 10 year old kid has HIV? If you really think so you could probably just check the kid's medical records (if you have access) and stop being so paranoid even without a blood test, since it's extremely unlikely a 10 year old kid would have gotten HIV only recently.

Dunno about hepatitis but still.

I wouldn't be too paranoid, but seriously wear some friggin' goggles from now on. And yes, you should have just told everyone then and there you got some bone in your eye.

 

[tkatchev]

Just in quick response to the age issue. This actually happened several weeks ago and it's just slowly been eating away at me to the point that I finally decided to take action. I said under age 10 just in case I somehow didn't take notice of having an older patient, but most of the cases I scrubbed in on involved children between 9 months and 5 years with the bulk under 3 years.

I know I may come of as ignorant about the OR and the course of action I should have pursued, but I will only be starting medical school this fall and so when I was in the OR I was completely dependent on the surgeons and nurses there to guide me. No one else had eye protection so I didn't have any, I figured if I got some splatter in my eyes then maybe others did too and it was no big deal (although I came to learn the splatter is usually away from the person holding the power tool so it was unlikely that the other surgeons were having this problem).

 

[MSKalltheway]

Seriously...you think the 10 year old kid has HIV?

You'll see crazier things than this in medicine...a 10 year old with HIV is definitely a possibility whether we'd like to believe it or not.

I know I may come of as ignorant about the OR and the course of action I should have pursued, but I will only be starting medical school this fall and so when I was in the OR I was completely dependent on the surgeons and nurses there to guide me. No one else had eye protection so I didn't have any, I figured if I got some splatter in my eyes then maybe others did too and it was no big deal (although I came to learn the splatter is usually away from the person holding the power tool so it was unlikely that the other surgeons were having this problem).

Its always a good idea to get checked for any blood borne disease no matter who the exposure came from, you never know. More likely than not you are fine, but better to be safe than sorry!

And about the safety issue, yeah you should always have eye protection anywhere there is a good chance for any of the patients body fluids to splatter. I have been in the OR several times as well and have seen surgeons without eye protection...its just how it goes. You'll come across improper safety procedure tons while youre in school, its the nature of the beast sometimes. When you do get the chance, find out what proper safety protocol is. I'm sure you'll get a lecture about it before you start your clinical years. But unfortunately, you'll see lots of that in a hospital with your attendings, from eyewear to not using gloves when they should, even not properly washing their hands...

 

[SoCuteMD]

Uhm... I would not worry about HIV. As of 1999, the SUM total of known HIV transmission to healthcare workers via mucous membranes was 2. Pretty darned low (grr.. if only I could find the source, I know somebody will jump on me for not quoting it - I just read this in an HIV/AIDS atlas textbook).

More importantly, the kid was 9? Do you have any reason to believe that this CHILD was at risk for HIV? If not... don't worry about HIV.

There may be other things to worry about though (Hep?)

I heard this number, too, but I think you might be putting it in a bit of a skewed context. There have only been 2 infections for which there have been NO other risk factors (i.e. the infection can be attributed solely to healthcare setting exposure). There have been other HCWs infected, but they have also had other risk factors - the transmission isn't necessarily ONLY attributable to those risk factors.

I can't thank everyone enough for their replies. I'm proud and honored that many of you will be my future colleagues.

I feel a lot less worried now, but will still get tested to alleviate any doubt. Also, in the future I'll be more proactive in insuring my safety in the OR even if those around me aren't doing the same.

Also I thank the moderators for not closing this thread because I'm kind of seeking medical advice. But I guess the night is still young.

I noticed you said above that you would go get tested on Monday. You REALLY should go through your school's established BBF (blood and bodily fluids) exposure protocols. This usually means going through employee health, but it varies from school to school. You should have information in your orientation to third year materials, or just call the dean's office and ask. Don't just go to your private physician - go through the proper, established school channels so that this incident can be documented properly.

I know this is stressful. Try to get through it one step at a time, ok?

Seriously...you think the 10 year old kid has HIV? If you really think so you could probably just check the kid's medical records (if you have access) and stop being so paranoid even without a blood test, since it's extremely unlikely a 10 year old kid would have gotten HIV only recently.

Dunno about hepatitis but still.

I wouldn't be too paranoid, but seriously wear some friggin' goggles from now on. And yes, you should have just told everyone then and there you got some bone in your eye.

Honestly, brushing off proper healthcare setting exposure procedures simply because "the patient is unlikely to be infected" is dangerous and counterproductive. There is always a chance that someone is infected. In addition, part of the process of reviewing what caused an exposure is really important. It's important that those surgeons be reminded that they should be wearing the proper protective gear. The scrub nurse needs to be reminded that making sure everything is done to universal precautions is partly their responsibility. If you just brush off an incident because "no harm, no foul" you are putting other lives at risk in the future.

 

[tkatchev]

I heard this number, too, but I think you might be putting it in a bit of a skewed context. There have only been 2 infections for which there have been NO other risk factors (i.e. the infection can be attributed solely to healthcare setting exposure). There have been other HCWs infected, but they have also had other risk factors - the transmission isn't necessarily ONLY attributable to those risk factors.



I noticed you said above that you would go get tested on Monday. You REALLY should go through your school's established BBF (blood and bodily fluids) exposure protocols. This usually means going through employee health, but it varies from school to school. You should have information in your orientation to third year materials, or just call the dean's office and ask. Don't just go to your private physician - go through the proper, established school channels so that this incident can be documented properly.

I know this is stressful. Try to get through it one step at a time, ok?



Honestly, brushing off proper healthcare setting exposure procedures simply because "the patient is unlikely to be infected" is dangerous and counterproductive. There is always a chance that someone is infected. In addition, part of the process of reviewing what caused an exposure is really important. It's important that those surgeons be reminded that they should be wearing the proper protective gear. The scrub nurse needs to be reminded that making sure everything is done to universal precautions is partly their responsibility. If you just brush off an incident because "no harm, no foul" you are putting other lives at risk in the future.

You're absolutely right about everything. The reason I'm not going through my school, however, is that the school really has nothing to do with it. I don't start medical school until next month and I'm not even working at a hospital associated with the medical school I will be attending. My only options are to either report it to the hospital where it happened or to go through my primary care physician and right now I feel more comfortable with my own physician.

 

[SoCuteMD]

You're absolutely right about everything. The reason I'm not going through my school, however, is that the school really has nothing to do with it. I don't start medical school until next month and I'm not even working at a hospital associated with the medical school I will be attending. My only options are to either report it to the hospital where it happened or to go through my primary care physician and right now I feel more comfortable with my own physician.

Ah, ok. I guess I kinda of assumed that you were a med student - my bad!

Good luck with everything. I know this is stressful.

 

[45408]

I'd talk to your PCP right away if you're still concerned, but my honest opinion is that you're highly unlikely to have gotten anything.

 

[GuzzyRon]

I don't think you should waste your money testing for HIV at the moment because any HIV test you take right now will be negative (if you're not already living with the virus). The incubation period is pretty long and except one's immune system is compromised in some way, I think the recommendation is that you test about 6 months after any (suspected) exposure.

 

[SoCuteMD]

I don't think you should waste your money testing for HIV at the moment because any HIV test you take right now will be negative (if you're not already living with the virus). The incubation period is pretty long and except one's immune system is compromised in some way, I think the recommendation is that you test about 6 months after any (suspected) exposure.

Ok, so this REALLY borders on "medical advice" in my opinion.

With that said, whenever someone is exposed, employee/student health ALWAYS draws a reference sample at the time of exposure.

 

[tkatchev]

I don't think you should waste your money testing for HIV at the moment because any HIV test you take right now will be negative (if you're not already living with the virus). The incubation period is pretty long and except one's immune system is compromised in some way, I think the recommendation is that you test about 6 months after any (suspected) exposure.

Source: http://www.hivtest.org/index.cfm from the CDC

How long after a possible exposure should I wait to get tested for HIV?

Most HIV tests are antibody tests that measure the antibodies your body makes against HIV. It can take some time for the immune system to produce enough antibodies for the antibody test to detect and this time period can vary from person to person. This time period is commonly referred to as the “window period”. Most people will develop detectable antibodies within 2 to 8 weeks (the average is 25 days). Even so, there is a chance that some individuals will take longer to develop detectable antibodies. Therefore, if the initial negative HIV test was conducted within the first 3 months after possible exposure, repeat testing should be considered >3 months after the exposure occurred to account for the possibility of a false-negative result. Ninety seven percent will develop antibodies in the first 3 months following the time of their infection. In very rare cases, it can take up to 6 months to develop antibodies to HIV.
Another type of test is an RNA test, which detects the HIV virus directly. The time between HIV infection and RNA detection is 9-11 days. These tests, which are more costly and used less often than antibody tests, are used in some parts of the United States.
For information on HIV testing, you can talk to your health care provider or you can find the location of the HIV testing site nearest to you by calling CDC-INFO 24 Hours/Day at1-800-CDC-INFO (232-4636), 1-888-232-6348 (TTY), in English, en Español. Both of these resources are confidential.