Prophylaxis or not?

[leviathan]

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When working as a paramedic last year, I felt something poke my finger when I squeezed the shoulder of an unconscious drug addict. He was wearing a bulky jacket at the time. When we got to the hospital I noticed my finger was indeed cut by something, but when security searched him the only needles they found were capped.

Would this be a compelling enough story to recommend prophylactic therapy? I decided it wasn't and didn't bother checking myself in at the ED, but I was curious to hear everyone's thoughts about this if you were approached with this scenario. For what it's worth, I went for testing 6 months later which came back negative for everything.

 

[docB]

I agree that it was probably a pretty low risk exposure. However around here everyone is required to report it and get seen or else they can't get covered by work comp if they do convert.

 

[Rendar5]

well, I don't know what it's like in EDs in your area, but in my area the prevalence rate of HIV is around incidence/prevalence rate is 2%. Even with the drug abuse history, maybe the odds go up to 6%?. It's kind of a tough question because we're talking about taking drugs for a month that do have side effects. I think that unless I could get confirmation that the guy had HIV, I might not do it. But it's still scary even with a .001% risk of infection from a random stick on a random person going to the ED.

 

[emtcsmith]

I stuck myself with the sharp end of a vacutainer barrel while trying to take it apart as a medic student. The ED doc said it was such a low risk exposure being that the patient was clean, etc that he didn't reccomend drungs and I didn't take any.

 

[quinsy]

I definitely would have checked in.

Medical care for any of these diseases is expensive if you have to foot the bill. Get appropriate worker's comp and you don't pay. So it has to be pretty low risk not to justify spending a few minutes getting blood drawn to ensure you don't need to go through that.

Considering this was a blood exposure, possibly with a hollow bore needle and with a known drug addict, I'd say definitely worth getting checked plus then you are able to run the tests in most cases on the patient so you don't lie awake at night not knowing their status (as long as he didn't just contract HIV in the past few weeks and won't test positive yet).

If you said someone spit in your eye and you didn't know their HIV status, who cares, or even a blood exposure on a little housewife somewhere that had never smoked a cigarette, but still in that case you are taking a tiny risk, because you never know who that housewife has been with in the wild days of her youth. Look at it this way, haven't you seen enough in the ED yet not to trust anyone is 'safe' by the way they look?

 

[jbar]

Also they track exposures, so it helps the system overall when you report them. If they see that a lot of people are getting stuck by vacutainer X or in a certain area of the hospital then the infection control people are more likely to address it with training, more sharps containers etc. If no one reports it then no one knows how significant a problem exposures are at your hospital/EMS service. I say in general report it, then make the decision about taking the drugs. Also when you get stuck one tends to be pretty worked up, by reporting it you get to talk through it with another professional who can provide some perspective. It is too hard to sort out your risk on your own while you are still upset.

 

[leviathan]

I agree that it was probably a pretty low risk exposure. However around here everyone is required to report it and get seen or else they can't get covered by work comp if they do convert.

Thanks for the input. I did report the incident to my employer and filed a report, but didn't bother with the hospital part. Actually might have been a good idea to do that so I could have got a blood test right aways, proving that I was negative at that point immediately post-exposure. The point is I never figured out what I got stuck with, but there were no needles found on the guy. I'm thinking I may have injured my finger earlier, not noticed it, and then felt the pain of the prior wound when I used that hand? Even though it was soooo low risk, it was still a really crappy 6 months and a scary visit to the clinic to get my test results. 😳 I'm sure most of us have been through this scenario though.

 

[docB]

Thanks for the input. I did report the incident to my employer and filed a report, but didn't bother with the hospital part. Actually might have been a good idea to do that so I could have got a blood test right aways, proving that I was negative at that point immediately post-exposure. The point is I never figured out what I got stuck with, but there were no needles found on the guy. I'm thinking I may have injured my finger earlier, not noticed it, and then felt the pain of the prior wound when I used that hand? Even though it was soooo low risk, it was still a really crappy 6 months and a scary visit to the clinic to get my test results. 😳 I'm sure most of us have been through this scenario though.

Yeah, we've all been there. I've done it 3 times. Never did the prophylaxis tho.