How safe is HIV research?

[deleted103644]

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Double gloving makes gloves more likely to break doesn't it?

Yes and no.

If there's a lot of friction between the layers (eg doubling up on a condom), then yes.

With gloves, there's some risk, but there's a higher risk of the glove having an imperfection in it already. Most gloves don't go through the same QC condoms do, and most aren't individually packaged.

 

[MemberName345]

Yes and no.

If there's a lot of friction between the layers (eg doubling up on a condom), then yes.

With gloves, there's some risk, but there's a higher risk of the glove having an imperfection in it already. Most gloves don't go through the same QC condoms do, and most aren't individually packaged.

Well that makes sense thanks. but I personally would still think that because sooner or later you'll probably have a patient with an infectious disease without knowing it, you should either double glove all the time or not worry about it. If double gloving was really helpful they would require it all the time, hence the "universal" in universal precautions. Seems unnecessary

 

[STAT EKG]

Pokemon will give you HIV.

i see what you did there.

 

[deleted103644]

Well that makes sense thanks. but I personally would still think that because sooner or later you'll probably have a patient with an infectious disease without knowing it, you should either double glove all the time or not worry about it. If double gloving was really helpful they would require it all the time, hence the "universal" in universal precautions. Seems unnecessary

Sometimes it's useful to be able to change the outer glove while still having a glove underneath. For example, can be very helpful when maintaining a sterile field.

 

[MemberName345]

Sometimes it's useful to be able to change the outer glove while still having a glove underneath. For example, can be very helpful when maintaining a sterile field.

So do they actually teach or recommend this? that's cool. I used to like using an over glove, like a food handler's glove, for thing like that when I was a dental assistant.

 

[Gut Shot]

- HIV cannot survive in open air (blood, semen, etc.)
- HIV is not found in feces (rectal exams)

I take it you haven't reached the chapter on BRBPR.

 

[sportsperson]

Ok, then you do your next DRE on an HIV patient bare gloved. If you're truly a medical student, you should realize not everything is seen by the naked eye. Are hemoccult tests done just for fun? Maybe we shouldn't use gloves either for vaginal exams.

The point is, until the virus is dessicated you are at risk. Even so, I'm not going to play with dried blood or other secretions.

This discussion isn't about how I feel safe mentally, it's just about facts and presenting reality.
You could do all the vaginal/rectal exams you want on HIV patients with your bare hand, you'll never get it unless you have an open wound that's going to come in direct contact with infected body fluids. There is no risk in touching up body fluid with your hands (I'm not! saying you should do that, im just talking about the reality of it) if there's no OPEN cuts/wounds.

His point was, in his words, you do not have to worry about it beyond surgery when there are regular office procedures where you can potentially be exposed: DRE, pelvic exams, glucose checks, immunizations, venipuncture. He is being too lighthearted about the wholw thing claiming you only have to worry if you are doing surgery.

And it is the truth. lol.

 

[sportsperson]

I take it you haven't reached the chapter on BRBPR.

Everything I'm saying is based off my discussion with 2 infectious disease doctors and personal research/reading up what HIV experts have to say.

 

[Bacchus]

Everything I'm saying is based off my discussion with 2 infectious disease doctors and personal research/reading up what HIV experts have to say.

Blood is blood, whether it comes from your rectum, your mouth, an open sore, a cut. There is the potential for viral load. You suggested you only have to worry about surgery which is wrong.

 

[sportsperson]

Blood is blood, whether it comes from your rectum, your mouth, an open sore, a cut. There is the potential for viral load. You suggested you only have to worry about surgery which is wrong.

No those sources of blood are not all equal. Blood from in the mouth would have a lower risk of transmission for example as your saliva will slowly render the virus inactive (risk exists but is reduced). The rectum presents a greater risk but is still less than an exposure to a direct wound.

The point of all this, is that you cannot contract HIV just by touching blood with your hands. There must be an open entry way (an open cut) for the virus to enter your body before being rendered inactive. Your skin prevents this with a success rate of 100%. So I dont know what the issue is...

 

[deleted103644]

Blood is blood, whether it comes from your rectum, your mouth, an open sore, a cut. There is the potential for viral load. You suggested you only have to worry about surgery which is wrong.

The reason you worry about HIV during surgery is not because of the fluids - its because of the scalpels and needles.

There are no sharps involved in a DRE.

No ones claiming there's no HIV in anyone's rectum, that is after all a major mode of transmission. Unless you have a cut on your hand or perform rectal exams with your unprotected penis (would probably be an HR issue), you aren't going to get HIV that way.

 

[Bacchus]

No those sources of blood are not all equal. Blood from in the mouth would have a lower risk of transmission for example as your saliva will slowly render the virus inactive (risk exists but is reduced). The rectum presents a greater risk but is still less than an exposure to a direct wound.

The point of all this, is that you cannot contract HIV just by touching blood with your hands. There must be an open entry way (an open cut) for the virus to enter your body before being rendered inactive. Your skin prevents this with a success rate of 100%. So I dont know what the issue is...

Obviously. Your initial semantics are which got me on a roll, to be honest.

 

[sportsperson]

The reason you worry about HIV during surgery is not because of the fluids - its because of the scalpels and needles.

There are no sharps involved in a DRE.

No ones claiming there's no HIV in anyone's rectum, that is after all a major mode of transmission. Unless you have a cut on your hand or perform rectal exams with your unprotected penis (would probably be an HR issue), you aren't going to get HIV that way.

 

[tantacles]

No ones claiming there's no HIV in anyone's rectum, that is after all a major mode of transmission. Unless you have a cut on your hand or perform rectal exams with your unprotected penis (would probably be an HR issue), you aren't going to get HIV that way.

I'm pretty sure they're just jealous.

 

[Caesar]

In medicine you are going to assume every patient has HIV and Hep C. Many do. In some specialties and populations they all do. Not sure this is any different. You take precautions. If you fear work involving HIV and other bloodborne viruses, I'm not sure how you are going to make it through med school and residency.

I know to assume all patients are positive for everything, I spend a lot of time in the ED.

But we both know that when you assume everyone has it, people get used to it and stop being on their toes and proactive.

Also, 100% agree to double gloving on an HIV pt. No matter how hard you think it is to contract the disease, it is much easier to do when you aren't trying to prevent it.

 

[Gut Shot]

Everything I'm saying is based off my discussion with 2 infectious disease doctors and personal research/reading up what HIV experts have to say.

And these sources have told you that it's impossible for there to be a large quantity of fresh blood in the rectum?

 

[tenndoc]

Been waiting on a magic Johnson joke to be posted. Lil bit upset right now 🙁

 

[deleted103644]

I will say one thing: the exception is if you will be concentrating the virus.

That can be dangerous, but they shouldn't be making a novice lab tech do it.

 

[sportsperson]

And these sources have told you that it's impossible for there to be a large quantity of fresh blood in the rectum?

I was speaking directly about feces and not the rectum. But this doesn't change anything at all... you can put your hand into HIV infected blood and still have no chance of catching it. The virus cannot enter your body therefore you cannot get it. It's as simple as that.

 

[CoolWhipp]

I was speaking directly about feces and not the rectum. But this doesn't change anything at all... you can put your hand into HIV infected blood and still have no chance of catching it. The virus cannot enter your body therefore you cannot get it. It's as simple as that.

No one is going to touch blood, why is this even an argument?

 

[sportsperson]

No one is going to touch blood, why is this even an argument?

It's all theoretical discussion.

 

[Gut Shot]

I was speaking directly about feces and not the rectum.

It's rather difficult to separate the two in this context. You said so yourself:

- HIV is not found in feces (rectal exams)

But this doesn't change anything at all... you can put your hand into HIV infected blood and still have no chance of catching it. The virus cannot enter your body therefore you cannot get it. It's as simple as that.

Except the one time you're performing a DRE in the ED and you single glove because it's the last pair in the bay, and you tear the glove doing the exam because the patient really came in because he had inserted a screwdriver into his rectum (that he forgot to mention), which has been scraping along the mucosa and causing a fair amount of bleeding. Oh, and you happened to have a small wound on that finger from chopping onions before starting the shift.

Medicine is a study in low probability events aligning in ways you never could have imagined.

 

[Morsetlis]

Except the one time you're performing a DRE in the ED and you single glove because it's the last pair in the bay, and you tear the glove doing the exam because the patient really came in because he had inserted a screwdriver into his rectum (that he forgot to mention), which has been scraping along the mucosa and causing a fair amount of bleeding. Oh, and you happened to have a small wound on that finger from chopping onions before starting the shift.

Medicine is a study in low probability events aligning in ways you never could have imagined.

Clearly the only thing within your control is to not chop the stupid onions 😡

 

[sportsperson]

It's rather difficult to separate the two in this context. You said so yourself:





Except the one time you're performing a DRE in the ED and you single glove because it's the last pair in the bay, and you tear the glove doing the exam because the patient really came in because he had inserted a screwdriver into his rectum (that he forgot to mention), which has been scraping along the mucosa and causing a fair amount of bleeding. Oh, and you happened to have a small wound on that finger from chopping onions before starting the shift.

Medicine is a study in low probability events aligning in ways you never could have imagined.

This was all theoretical and not putting together fully realistic/real life situations.

If the small wound is an open cut, why isn't there a band-aid on it?

 

[deleted103644]

Medicine is a study in low probability events aligning in ways you never could have imagined.

There are many low probabilities out there to worry about...

The risk of transmission from a single exposure with broken skin is less than 1 in 1000. And that probably refers mainly to direct contact with blood.

As long as you aren't going out of your way to perform bare handed DREs on HIV infected patients (with high viral titers) after giving yourself paper cuts, this is a silly thing to be worried about. Personally, I'm always painfully aware when I have any minor cut or abrasion on my hand, and I usually take extra care to keep my hand protected on those cases. Rub salt on your hand if you aren't sure.

You are far more likely to die on the way to or from work.

 

[pfaction]

Personally, I'm always painfully aware when I have any minor cut or abrasion on my hand, and I usually take extra care to keep my hand protected on those cases. Rub salt on your hand if you aren't sure.

Why not just hand sanitizing alcohol, a two-fer. Tells you where the cut is, and also disinfects.

Also smh @ some of you. I'm a pharmacy student and I'm still scared out of my ****ing mind when someone comes up to me with all scripts for tuberculosis, and starts coughing. Some of you guys are ridiculous. "If you're this scared around HIV now, how will you be as a doctor?" Not even the same ****ing thing. At all. This is like saying "Oh, you don't like driving, what happens when you take a bus?"

 

[sportsperson]

Why not just hand sanitizing alcohol, a two-fer. Tells you where the cut is, and also disinfects.

Also smh @ some of you. I'm a pharmacy student and I'm still scared out of my ****ing mind when someone comes up to me with all scripts for tuberculosis, and starts coughing. Some of you guys are ridiculous. "If you're this scared around HIV now, how will you be as a doctor?" Not even the same ****ing thing. At all. This is like saying "Oh, you don't like driving, what happens when you take a bus?"

Unfortunately people should be more concerned about more serious health risks. Like being struck by lightning.

 

[Arbor Vitae]

at GenY'ers believing this with the current state of the economy and boomers getting ready to hoard all the resources and money. The best part of your life was spent playing GoldenEye and trading baseball cards in the glorious 90's.

u sad bro?

 

[deleted103644]

Why not just hand sanitizing alcohol, a two-fer. Tells you where the cut is, and also disinfects.

Haha, forgot about that - yeah, that's the reason I always know if I have a cut on my hand.

That's what I get for taking non-wards electives the past few months. 🙂

I'm not sure what your point was about TB. That's something you have a legitimate reason to be worried about, but that's true on the subway almost as much as in the hospital.

 

[Gut Shot]

This was all theoretical and not putting together fully realistic/real life situations.

You sure? How many years have you been in practice, again?

I notice you don't want to talk about rectal contents anymore.

If the small wound is an open cut, why isn't there a band-aid on it?

Running late, out of band-aids, band-aid partially dislodged when finger crossed the anal verge, resident prefers to let things heal by secondary intention, etc.

 

[Law2Doc]

Double gloving makes gloves more likely to break doesn't it?

No, not really. If you are having problems you probably are using the wrong sizes. It decreases sensitivity/dexterity, which is why some surgeons prefer to risk the single glove. But it's harder to break through two gloves than one, which is the whole point of double gloving.

 

[Gut Shot]

There are many low probabilities out there to worry about...

The risk of transmission from a single exposure with broken skin is less than 1 in 1000. And that probably refers mainly to direct contact with blood.

As long as you aren't going out of your way to perform bare handed DREs on HIV infected patients (with high viral titers) after giving yourself paper cuts, this is a silly thing to be worried about.

I'm not trying to instil any anxiety, just some common sense that shoving your finger blindly into a body cavity can yield some unexpected surprises. On top of foreign objects just consider the broader spectrum of lower digestive pathology: cancer, vascular malformations, ulcerative colitis, pseudomembranous colitis, solitary rectal ulcer, on and on.

I hope everyone here can someday have the pleasure of serving on QA/QC committees. The things that go on inside hospitals are truly amazing.

 

[Law2Doc]

...
There are no sharps involved in a DRE. ...

never underestimate what folks are willing to shove up there.

 

[Law2Doc]

... you can put your hand into HIV infected blood and still have no chance of catching it. The virus cannot enter your body therefore you cannot get it. It's as simple as that.

you never really know what nicks and scratches and minute paper cuts you might have that aren't visually appreciable but might still be permeable. You still need gloves.

 

[deleted103644]

you never really know what nicks and scratches and minute paper cuts you might have that aren't visually appreciable but might still be permeable. You still need gloves.

If you have an open cut, your odds of getting HIV from sticking your hand in a bucket of infected blood are around 1/1000. It just goes down from there (eg old blood in the rectum, pt on HAART, etc).

I'm not saying not to use PPE, I'm just saying that HIV is the least of your worries. (There are plenty of other things you could catch, many without direct contact with blood.)

Although I suppose you do have a point about the possibility of someone sticking sharps up their rectum, but a glove wouldn't offer much protection there either.

 

[Itwashambone]

..

 

[sportsperson]

You sure? How many years have you been in practice, again?

I notice you don't want to talk about rectal contents anymore.



Running late, out of band-aids, band-aid partially dislodged when finger crossed the anal verge, resident prefers to let things heal by secondary intention, etc.

And what is the percentage of dying in a car accident when you're not at fault?

I'm sure if your hand was cut bad enough, you would acquire a band aid... you are looking at things with the tiniest possibilities of causing you harm where many other things in everyday life present greater risks.

Also, my year in practice aren't relevant. I read how an MD gave some guy PEP cause he got cut by a razor at a barbershop that he suspected wasn't clean.....ridiculous.

 

[sportsperson]

you never really know what nicks and scratches and minute paper cuts you might have that aren't visually appreciable but might still be permeable. You still need gloves.

And those cuts do not present any sort of practical risk. Maybe if the cut just happened before it was covered in the patient's blood.

 

[Roguelyn]

Just ask about what precautions are taken and how many staff have contracted HIV during their work with the lab. There are bigger things to worry about, but if you know you're just going to agonize about it every day this is not the job for you.

 

[deleted103644]

Just ask about what precautions are taken and how many staff have contracted HIV during their work with the lab. There are bigger things to worry about, but if you know you're just going to agonize about it every day this is not the job for you.

Bad question to ask.

Even suggesting someone has contracted HIV in the lab would be horribly offensive to your employer. That's the type of accident that gets a lab shutdown, so asking if that's ever happened would be unwise.

Asking about safety, saying you're nervous about working with HIV, etc, those things are all fine.

 

[Gut Shot]

And what is the percentage of dying in a car accident when you're not at fault?

Care to phrase that in a way that makes sense?

I'm sure if your hand was cut bad enough, you would acquire a band aid... you are looking at things with the tiniest possibilities of causing you harm where many other things in everyday life present greater risks.

The risk of harm is low because people take adequate precautions, not in spite of them. Don't forget that HIV likely emerged from a SIV which made the jump to humans through the slaughter of bushmeat. Dead primate + cutting table = transmission. Given the multiplicity of major HIV strains it probably happened more than once.

What are the odds of that?

Also, my year in practice aren't relevant.

Like Alexander Pope said, "A little learning is a dangerous thing".

 

[Gut Shot]

And what is the percentage of dying in a car accident when you're not at fault?

I'm sure if your hand was cut bad enough, you would acquire a band aid... you are looking at things with the tiniest possibilities of causing you harm where many other things in everyday life present greater risks.

P.S. Why don't you take your bravado into the Emergency Medicine forum? I'm sure they'd love you.

 

[sportsperson]

Care to phrase that in a way that makes sense?

The odds of dying on your way to work are significantly higher than contracting HIV if your specialty does not involve working with sharps.
Very rare things happen, but they're called "very rare" for a reason.

The risk of harm is low because people take adequate precautions, not in spite of them. Don't forget that HIV likely emerged from a SIV which made the jump to humans through the slaughter of bushmeat. Dead primate + cutting table = transmission. Given the multiplicity of major HIV strains it probably happened more than once.

What are the odds of that?

I havent looked into the transition of HIV to humans, do you have any legitimate studies which verify this with significant evidence?

 

[sportsperson]

P.S. Why don't you take your bravado into the Emergency Medicine forum? I'm sure they'd love you.

I didnt see where I ever mentioned in this thread precautions should not be taken. There's many more things to worry about in the health care setting. My point was that given all these facts, HIV is not something to WORRY ABOUT on a daily basis doing your job (unless you're a surgeon in a high-risk geographic area, ex. washington dc).

 

[Gut Shot]

The odds of dying on your way to work are significantly higher than contracting HIV if your specialty does not involve working with sharps.
Very rare things happen, but they're called "very rare" for a reason.

My argument isn't over commonality. It's over you flapping your gums about topics in which you are, to date, poorly learned.

I havent looked into the transition of HIV to humans, do you have any legitimate studies which verify this with significant evidence?

In the age of Google and Pubmed you're asking someone else to do a lit search for you. Jesus wept.

 

[sportsperson]

My argument isn't over commonality. It's over you flapping your gums about topics in which you are, to date, poorly learned.



In the age of Google and Pubmed you're asking someone else to do a lit search for you. Jesus wept.

Everything I presented was based off of facts and everything was theoretically discussed. Theoretical discussions are not fully applicable to real-life situations due to the fact that real-life situations present a combination of things (sometimes unexpected). But none of the things you suggested really present real-life risks anyway... first you talk about blood as if your finger touching blood actual is an exposure. Next you talk about hidden cuts, etc. which are not realistic risks at all, especially when precautionary tactics are made.

 

[sportsperson]

Also, I looked up the bush meat theory. Someone got infected with an SIV virus, which later formed into a strain of HIV. This doens't make for good comparison unless you know exactly how infectious the SIV virus is compared to HIV.

 

[CoolWhipp]

Everything I presented was based off of facts and everything was theoretically discussed. Theoretical discussions are not fully applicable to real-life situations due to the fact that real-life situations present a combination of things (sometimes unexpected). But none of the things you suggested really present real-life risks anyway... first you talk about blood as if your finger touching blood actual is an exposure. Next you talk about hidden cuts, etc. which are not realistic risks at all, especially when precautionary tactics are made.

When you are working in a lab, you are using HIV that is at really high concentrations, not physiological concentrations. This is because HIV, as you said, is not very infectious and as a scientist you want to be able to infect things to study pathogenesis. If the blood that you touch is infected with HIV made in the lab, then you should be worried. If you physically contact blood from an HIV+ donor, then most likely they are on HAART, and the concentrations are undetectable. You can be less worried in that instance, however everyone is going to take full precaution and get the exposure treatment.

It is required by the BUA that you take the appropriate precautions when dealing with blood and that you respond accordingly to the level of infectious threat, which if you work with HIV you'll know.

I know people have personally pricked themselves and have not gotten HIV. HIV research is not that scary compared to other infectious diseases.

The bushmeat theory is the most believed story of the zoonosis of HIV.

Also, if you cut yourself and believe that there is a chance that it was infected with HIV... why would you not get PEP? You can take your chances if you want, but I'll get PEP anyday in that situation.

The reason why this thread is getting so much attention is not because of the subject, it's because you are a gunner and no one likes your tone. You might have done a little bit a research on HIV and you feel like you know something, but SDN isn't the general population. Realize that on these forums there are actually people that have done the same, some of whom actually know more than you do.

 

[sportsperson]

When you are working in a lab, you are using HIV that is at really high concentrations, not physiological concentrations. This is because HIV, as you said, is not very infectious and as a scientist you want to be able to infect things to study pathogenesis. If the blood that you touch is infected with HIV made in the lab, then you should be worried. If you physically contact blood from an HIV+ donor, then most likely they are on HAART, and the concentrations are undetectable. You can be less worried in that instance, however everyone is going to take full precaution and get the exposure treatment.

It is required by the BUA that you take the appropriate precautions when dealing with blood and that you respond accordingly to the level of infectious threat, which if you work with HIV you'll know.

I know people have personally pricked themselves and have not gotten HIV. HIV research is not that scary compared to other infectious diseases.

The bushmeat theory is the most believed story of the zoonosis of HIV.

Also, if you cut yourself and believe that there is a chance that it was infected with HIV... why would you not get PEP? You can take your chances if you want, but I'll get PEP anyday in that situation.

The reason why this thread is getting so much attention is not because of the subject, it's because you are a gunner and no one likes your tone. You might have done a little bit a research on HIV and you feel like you know something, but SDN isn't the general population. Realize that on these forums there are actually people that have done the same, some of whom actually know more than you do.

Yes and if you were to cut yourself with a sharp tool you would be at risk. That's an absolute given. And yes greater concentrations present a greater risk. But how much greater? The risk runs linear with that as well. But yes I'm sure if the concentration is at >100,000x and you have some microwound on your hand and touch the blood, maybe you're at some risk....

And yes a cut to somewhere would require PEP. But if you're talking about my barbershop thing I mentioned before... in no way would that ever require PEP unless the barber is running back and forth cutting people with the same razor.

 

[Cambino]

I just got a job interview for a research tech position in HIV research. However, im a little worried for obvious reasons. This lab works with live HIV viruses, an in the email she said "We will be doing blood assays" Im 24 and have my entire life ahead of me.

At least it's not AIDS research.