Risk of HIV transmission in a streetfight

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fedor

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While the risk of HIV transmission w/ a needle stick is quite low, how about in a streetfight?

If a patient presents with abrasions on hands, how likely is it that HIV could be transmitted?

Is there even a protocol for dealing with this?

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In your example, are you saying the person with the hand lac has the HIV, or do they have a hand lac from punching someone (sorry -- 'abrading their hand against a tooth') who has HIV? And are you asking about transmission from puncher to punchee?

In either case, and assuming this is the question, the chances of the healthcare provider contracting HIV seems very low. Except of course if you plan on having unprotected rough sex with patients (which they tell me is considered a no-no). :D

When I work as a tech, my EMT training means I always have gloves on, even if other techs snicker. Which they are welcome to do. I've never touched blood with my bare hands, and therefore don't need to care if it's HIV-infected or not.
 
Febrifuge said:
When I work as a tech, my EMT training means I always have gloves on, even if other techs snicker.

I guess the joke's on them if they get HIV! :p I know when I am treating patients, I always wear gloves as well...even when I'm treating an injury that has no blood (eg. ankle fracture or something like that), I don't want to have my bare hands on their smelly feet.
 
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Word to that. Once, getting ready to move a patient, another tech asked me "where did you get those gloves from?" I told her, "from my pocket."

She looked at me as if to say, "you are a giant nerd." But then what she said was, "uh... you have another pair?"

And that's my story about gloves. The End. +pad+
 
Febrifuge said:
Word to that. Once, getting ready to move a patient, another tech asked me "where did you get those gloves from?" I told her, "from my pocket."

She looked at me as if to say, "you are a giant nerd." But then what she said was, "uh... you have another pair?"

And that's my story about gloves. The End. +pad+
I carry a face shield and pair of gloves in a compartment on my keychain. Nerdy? Perhaps, but I've had to replace those gloves three times in the last year as a bystander witnessing various incidents. One was a fight outside a bar (while I was waiting to get in) when the guy got knocked out and had a nasty blow to the head after falling onto the concrete...minor lac but it was bleeding quite profusely. That's MY story du jour. +pad+
 
I stopped by the roadside for the first time ever last week. The look of relief on the rural volunteer firefighter's face was awesome. Nothing says "it's all under control" like some dude walking over with a crash bag over his shoulder, in the midst of putting on purple nitrile gloves.
 
i wear gloves with every single patient encounter...not b/c they're bleeding but some people are just nasty
 
fedor said:
While the risk of HIV transmission w/ a needle stick is quite low, how about in a streetfight?

If a patient presents with abrasions on hands, how likely is it that HIV could be transmitted?

Is there even a protocol for dealing with this?
I'd say that being the sort of person who gets into street fights is an independent risk factor for HIV regardless of the amount of blood transfer involved.
 
docB said:
I'd say that being the sort of person who gets into street fights is an independent risk factor for HIV regardless of the amount of blood transfer involved.

Hey, gentle now, some of us may have wilder pasts than others... ***looking sheepishly at knuckle scars***

- H
 
Febrifuge said:
I stopped by the roadside for the first time ever last week. The look of relief on the rural volunteer firefighter's face was awesome. Nothing says "it's all under control" like some dude walking over with a crash bag over his shoulder, in the midst of putting on purple nitrile gloves.
What's in your crash bag? If it is what I think it is, we call 'em "jump kits" up here in Canuckada.
 
leviathan said:
What's in your crash bag? If it is what I think it is, we call 'em "jump kits" up here in Canuckada.

Here is what I have in both my wife's and my cars. It is a commercial kit from Dixie EMS and fits into a little case (it is actually a men's dob kit case), but it has everything you need for the first few minutes of any trauma.

"Utilized by various divisions of the US Treasury Department, this custom made kit has everything needed to accommodate emergency needs in a compact easy to carry or wear nylon bag.

Contents 1-each of 80mm, 90mm, 100mm Dixie Berman Airways
1-Dallas Suction Unit
1-Dixie Combo CPR Mask w/ NRV
1-Thumb Dressing 5 1/2" Forceps
1-Dixie Diagnostic Penlight
1-Combisnips Scissors
1-Kelly 5 1/2" Straight Forceps
2-Oval Eye Pads
2-Pairs of Gloves
1-5" x 9" Abdominal Dressing
2-Blood Stopper Bandage
2-Triangular Bandages
1-Cling Stretch Gauze 3"
1-Cling Stretch Gauze 4"
10-1" x 3" Bandaid Strips
1-4" x 4" Sterile Sponge
1-4" x 4" Burn Stop Pad
1-Dermicel Tape
2-Elastogel
5-Antimicrobial Wipes"

I like having the Dallas suction to go along with the mask. It would beat mouth to airway clearance :barf:

- H
 
Here is a case where HIV and Hep C was transmitted after a blow with a fist.

PubMed link
Link to full article


Brief
HIV/AIDS
BRIEF REPORT


Occupational Transmission of Human Immunodeficiency Virus and Hepatitis C Virus after a Punch

Sylvie Abel,1 Raymond Césaire,2 Danielle Cales-Quist,1 Odile Béra,2 Guy Sobesky,1 and André Cabié1

1Center for Information and Care on Human Immunodeficiency, and 2Laboratory of Virology and Cellular Immunology, University Hospital of Fort-de-France, Martinique, French West Indies


Although the simultaneous transmission of either human immunodeficiency virus (HIV) and hepatitis C virus or HIV and hepatitis B virus from a single source has already been described, this is the first case of transmission to occur after a blow with the fist.

Full article
Awareness of the risk of occupational transmission of HIV to health care workers dates back to December 1984, when the first case of needlestick-transmitted HIV infection was reported [1]. From December 1984 through September 1997, a total of 94 documented cases and 170 possible cases of occupational transmission of HIV to health care workers were reported worldwide. However, individuals with other types of jobs also risk occupational exposure to bloodborne infection. We report the case of a policeman in whom both HIV and hepatitis C virus (HCV) seroconversion were clearly documented after he was involved in a bloody fight while making an arrest.

A 52-year-old policeman (patient A) presented with a positive HIV result on EIA. Ten weeks previously, he had developed an acute mononucleosis-like syndrome. Acute HIV-1 infection was confirmed by means of gradual Western blot positivity. His CD4+ lymphocyte count was 399 × 109 cells/L, and his plasma level of HIV type 1 (HIV-1) RNA was 503,200 copies/mL. Alanine aminotransferase activity was slightly elevated. No antibodies to HCV were detected, and the patient was immune to hepatitis B virus (HBV). Three weeks later, HCV seroconversion was diagnosed (by means of EIA, recombinant immunoblot assay, and plasma HCV RNA positivity). The patient's sex partner was seronegative for both viruses, and the patient denied having had another sex partner during the previous 6 months. He had never received blood transfusions and had never been an injection drug user. However, he disclosed that, 3 weeks before the onset of his illness, he had punched a man in the teeth while making an arrest. Although he had noticed 2 wounds on his hand, which was covered with blood, he did not wash his hand immediately after the incident. Within a few days after the arrest, he developed lymphangitis that required antibiotic treatment.

The man who received the punch (patient B) was known to be infected with HIV-1, human T lymphotropic virus type 1 (HTLV-1), HBV, and HCV, but patient B declined all treatment. Six months after the incident, patient B's CD4+ lymphocyte count was 552 × 109 cells/L, his plasma level of HIV-1 RNA was 52,900 copies/mL, and his plasma level of HCV RNA (Amplicor HCV Monitor; Roche Diagnostics, Branchburg, NJ) was 132,052 copies/mL.

The strains of HIV and HCV that infected the 2 patients were compared. Viruses were isolated from the plasma of patient A at 4 months after the incident and from patient B at 6 months after the incident. Both HCV strains were determined to be genotype 2a. Nucleotide sequencing of the amplification product of the V3 region of HIV and the NS5b region of HCV revealed, respectively, 98.7% and 100% identity for the strains infecting the 2 patients. Fifteen months after the fight, the serological results of HTLV-1 testing were still negative.

Simultaneous transmission of either HIV and HCV or HIV and HBV from a single source has been previously described [2, 3]; however, to our knowledge, this is the first proven case of HIV-HCV coinfection that occurred as the result of a blow with the fist. Although HIV is probably infrequently transmitted via this route, this case raises the question of whether prophylaxis should be used after potential exposure to HIV during a bloody fight with an HIV-infected (or possibly HIV-infected) individual, as is recommended after other types of potential exposure to HIV, especially among individuals with frequent occupational exposure to HIV (e.g., police and fire department employees, etc.) [4]. Similarly, the risk of transmission of HCV infection during violent incidents should be taken into account.

References
1. Ippolito G, Puro V, Heptonstall J, Jagger J, De Carli G, Petrosillo N. Occupational human immunodeficiency virus infection in health care workers: worldwide cases through September 1997. Clin Infect Dis 1999; 28:36583. First citation in article | PubMed
2. Ridson R, Gallagher K, Ciesielski C, et al. Simultaneous transmission of human immunodeficiency virus and hepatitis C virus from a needle-stick injury. N Engl J Med 1997; 336:91922. First citation in article | PubMed
3. Brambilla A, Pristera R, Salvatori F, Poli G, Vicensi E. Transmission of HIV-1 and HCV by head-butting. Lancet 1997; 350:1370. First citation in article | PubMed
4. Lurie P, Miller S, Hecht F, Chesney M, Lo B. Postexposure prophylaxis after nonoccupational HIV exposure. JAMA 1998; 280:176973. First citation in article | PubMed
 
leviathan said:
What's in your crash bag? If it is what I think it is, we call 'em "jump kits" up here in Canuckada.
It's as Basic as can be, pun intended. Mostly gloves and gauze. Some SAM splinting stuff. An airway or two, some wound cleaning fluid, I think some roll gauze, and honestly the most versatile and helpful thing is the cling wrap from the grocery store. That stuff can be strapping, it can be packing, and heck no it's not sterile, but what is, on the roadside?

The Dixie EMS one sounds way cooler, honestly.
 
Febrifuge said:
It's as Basic as can be, pun intended. Mostly gloves and gauze. Some SAM splinting stuff. An airway or two, some wound cleaning fluid, I think some roll gauze, and honestly the most versatile and helpful thing is the cling wrap from the grocery store. That stuff can be strapping, it can be packing, and heck no it's not sterile, but what is, on the roadside?

The Dixie EMS one sounds way cooler, honestly.
Ohhh, ok. I've got the same kit myself. I thought you were referring to a kit with O2 tank, BVM ambu-bag, suction, airways, trauma pads, trauma shears, penlight, stethoscope + BP cuff, glucose, etc. etc. and then the rest of the basic first-aid stuff (bandaids, sterile gauze, etc.)
 
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