Quick question about transmission of HIV and/or Hep C!!

[dmitrinyr]

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I don't mean to ask for medical advice but a friend of mine asked me a question and I am still only a medical student and so wasn't sure.

If a person is scratched by a patient with HIV and Hep C can he get the disease from a simple scratch or it would have to be a pretty deep scratch (one that gets bloody). He is an EMT and was concerned after a patient scratched him a couple of days ago. He says it wasn't a major scratch and there was no blood. He didn't think much of it, but yesterday got paranoid and called me. I used to be an EMT and he was wondering if I ever experienced anything like this or if I knew how serious this situation could be. I told him NO and that I wasn't sure if these diseases could be transmitted in such a way. I told him that I heard the chances of getting HIV from a needle-stick, was something like 1/250 and so I thought that in his situation, the chances of contracting the disease were better than that.

I thought that ER physicians would probably have more experience and would know more about such a situation. Thanks for any advice you may offer.

dmitri

 

[southerndoc]

The chances of getting HIV from a hollow-bore needle stick are 1:280. I don't recall numbers for solid-bore needles (i.e., suture needles), but it's really remote. The idea of getting HIV from a non-bloody scratch when the patient him/herself doesn't have a bloody injury is ridiculous. HIV is a bloodborne pathogen. If the patient doesn't have bloody fingernails (from a trauma or something), then the chances of getting HIV from this are almost nil. I say almost because there is always some weird chance it could be transmitted, but I bet you probably have better chances of winning the lottery AND getting struck by lightening... simultaneously.

HCV is a higher transmission risk, but again, as long as blood wasn't transmitted, it's unlikely. In the case of HCV, this also involves not only blood, but bodily fluids as well.

If in doubt, have him/her see the occupational health officer and file a report. It's better to go through testing and come up negative than to find out 20 years from now you contracted HCV or HIV (however remote) and be stuck with the medical bills yourself.

 

[ThinkFast007]

The chances of getting HIV from a hollow-bore needle stick are 1:280. I don't recall numbers for solid-bore needles (i.e., suture needles), but it's really remote. The idea of getting HIV from a non-bloody scratch when the patient him/herself doesn't have a bloody injury is ridiculous. HIV is a bloodborne pathogen. If the patient doesn't have bloody fingernails (from a trauma or something), then the chances of getting HIV from this are almost nil. I say almost because there is always some weird chance it could be transmitted, but I bet you probably have better chances of winning the lottery AND getting struck by lightening... simultaneously.

HCV is a higher transmission risk, but again, as long as blood wasn't transmitted, it's unlikely. In the case of HCV, this also involves not only blood, but bodily fluids as well.

If in doubt, have him/her see the occupational health officer and file a report. It's better to go through testing and come up negative than to find out 20 years from now you contracted HCV or HIV (however remote) and be stuck with the medical bills yourself.

man ol man.....i must admit this 'occupational health officer' business is soooooo whack. I remember something similar happend to me when I was doing doing a trauma check in the EM. I didnt get stuck but i was very paranoid. i mean i feel the OPs pt just because when I was in that similar situation the freakin EM dept nurses etc still made me have to sit and wait to get paperwork done. i mean jeez we're here helping ppl and doing the best we can . there should be a line or 'fast lane for MDs/MSIII's "
ok done venting

hehhe bottom line....if ur in med school DONT get stuck...u'll be treated like the joe blow that's been waiting in the EM since 6am the previous day

 

[southerndoc]

We give "express checkout" treatment to medical students, residents, nurses, etc.

 

[skeezixdoc]

I don't mean to ask for medical advice but a friend of mine asked me a question and I am still only a medical student and so wasn't sure.

If a person is scratched by a patient with HIV and Hep C can he get the disease from a simple scratch or it would have to be a pretty deep scratch (one that gets bloody). He is an EMT and was concerned after a patient scratched him a couple of days ago. He says it wasn't a major scratch and there was no blood. He didn't think much of it, but yesterday got paranoid and called me. I used to be an EMT and he was wondering if I ever experienced anything like this or if I knew how serious this situation could be. I told him NO and that I wasn't sure if these diseases could be transmitted in such a way. I told him that I heard the chances of getting HIV from a needle-stick, was something like 1/250 and so I thought that in his situation, the chances of contracting the disease were better than that.

I thought that ER physicians would probably have more experience and would know more about such a situation. Thanks for any advice you may offer.

dmitri

Unless the patient who scratched your friend was bleeding from somewhere, and the patient's blood then was in contact with your friend's skin, there is virtually no chance of transmission of HIV, and the Hep C is even lower than that.

The psychological fear is usually way out of proportion to any risk. I was bitten by a psych patient who broke the skin around my MP joint and then refused HIV testing. I was tested at that point for a baseline and then again at 3 months and at 6 months, even though it wasn't indicated by current guidelines for Health Care worker exposure. Even though my rational mind told me I was at virtually no risk (saliva is not one of the body fluids that is on the list of transmission fluids for HIV, and the guy was not bleeding from the mouth) the emotional mind worked on me from time to time until the 6 mo. test was also negative. But I must say, I was never really scared having read up on the risk. Being in the business, so to speak, I could have taken Post Exposure Prophylaxis (PEP) if I really insisted, but the risk of toxicity to those powerful drugs was not worth it to me, not even remotely.

So, tell your friend that he/she's not really at any risk, but if they need peace of mind just get tested so they're sure. You can read up on this at the following link:

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm#box2