Sharps exposure with HIV+ patient

[ARV]

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I cut my thumb with a scaler today on a HIV+ pt. His viral load is undetectable and his CD4 count is 1300 and he's had it since 1998, which are good signs, but I've never been more scared in my life. There was visible blood on the scaler, and the cut was a few mm deep. I bled it for a few minutes and then 5 hours later, I took my first post-exposure prophylactic drug cocktail, which consisted of Kaletra and Truvada.

I know the risks of seroconversion are pretty low but I'm still mortified. Anyone else have had an experience like this they could share? What happened and what became of it? 🙁

 

[peg lateral]

I cut my thumb with a scaler today on a HIV+ pt. His viral load is undetectable and his CD4 count is 1300 and he's had it since 1998, which are good signs, but I've never been more scared in my life. There was visible blood on the scaler, and the cut was a few mm deep. I bled it for a few minutes and then 5 hours later, I took my first post-exposure prophylactic drug cocktail, which consisted of Kaletra and Truvada.

I know the risks of seroconversion are pretty low but I'm still mortified. Anyone else have had an experience like this they could share? What happened and what became of it? 🙁

There were two people in my class that in their first week of oral surgery rotation right when we started third year had sharps exposures to Hep C patients, and they did not contract Hep C.

 

[Bereno]

I cut my thumb with a scaler today on a HIV+ pt. His viral load is undetectable and his CD4 count is 1300 and he's had it since 1998, which are good signs, but I've never been more scared in my life. There was visible blood on the scaler, and the cut was a few mm deep. I bled it for a few minutes and then 5 hours later, I took my first post-exposure prophylactic drug cocktail, which consisted of Kaletra and Truvada.

I know the risks of seroconversion are pretty low but I'm still mortified. Anyone else have had an experience like this they could share? What happened and what became of it? 🙁

I do a lot of sterilization work for some oral surgeons, and this kind of thing is always lingering in the back of my head as well... I'm really sorry to hear that you are this this scary situation. To be honest though, I have heard of the docs getting cut before and not contracting like Peg lateral said. However, you still need to take all the necessary precautions! (sounds like you have). Also, I have heard that Kaletra and Truvada have had really good results in lowering the viral load, so you are probably in the clear. Best of luck, I really hope for the best 👍

 

[lemoncurry]

there have been NO reported cases of a dental professional getting HIV from an exposure. The odds of getting HIV from a patient are like 0.02%. I would rather have an exposure from an HIV pt than a HepC pt.

 

[flapaTron]

there have been NO reported cases of a dental professional getting HIV from an exposure. The odds of getting HIV from a patient are like 0.02%. I would rather have an exposure from an HIV pt than a HepC pt.

agreed.

that 0.02% actually sounds very familiar...i feel like we learned that too at my school.

OP what did you do immediately after you were poked? just curious.

 

[ARV]

agreed.

that 0.02% actually sounds very familiar...i feel like we learned that too at my school.

OP what did you do immediately after you were poked? just curious.

The procedure was an Sc/RP. I took off my glove, saw that there was blood, and bled the wound over running water for a few minutes. I looked at the instrument afterwards (it was a 5/6 gracie) and saw that there was trace amounts of blood. I was done with the patient so I dismissed him, and then I kind of walked around for a while in a state of denial before finally going to EHS 😳.

BTW thanks for the responses guys.. they're helping calm my nerves a little 🙂

 

[omaralt]

I cut my thumb with a scaler today on a HIV+ pt. His viral load is undetectable and his CD4 count is 1300 and he's had it since 1998, which are good signs, but I've never been more scared in my life. There was visible blood on the scaler, and the cut was a few mm deep. I bled it for a few minutes and then 5 hours later, I took my first post-exposure prophylactic drug cocktail, which consisted of Kaletra and Truvada.

I know the risks of seroconversion are pretty low but I'm still mortified. Anyone else have had an experience like this they could share? What happened and what became of it? 🙁

wow same exact thing happened to me back in 12/2008. i was doing my D4 competency (SRP) on a HIV+ pt. the issue with me is that they had no idea what his viral load was; so they put me on the same cocktail until his bloodwork came back undetectable. i continued the cocktail for 30 days i believe and then got bloodwork done regularly. did my year f/u about 6 months ago (ya i know i got careless 🙂) and it was all clear. you initially freak out but once you do some research you realize the odds of getting it are almost zero and that it's never happened to a dentist before; so try to relax your gonna be fine. just hope that the side effects of the meds arent too bad 😉

 

[Doc Smile]

The procedure was an Sc/RP. I took off my glove, saw that there was blood, and bled the wound over running water for a few minutes. I looked at the instrument afterwards (it was a 5/6 gracie) and saw that there was trace amounts of blood. I was done with the patient so I dismissed him, and then I kind of walked around for a while in a state of denial before finally going to EHS 😳.

BTW thanks for the responses guys.. they're helping calm my nerves a little 🙂

You dismissed the pt? With a sharps exposure at my school, we are required to bring the patient to the health services and both get boat load of test done. Maybe since he/she was already confirmed HIV+, that isnt needed?

The risk of contraction of HIV dz in a sharps exposure is SUPER low. But now you have taken your first cocktail, the risk will decrease to something like 0.001%.

 

[ARV]

You dismissed the pt? With a sharps exposure at my school, we are required to bring the patient to the health services and both get boat load of test done. Maybe since he/she was already confirmed HIV+, that isnt needed?

The risk of contraction of HIV dz in a sharps exposure is SUPER low. But now you have taken your first cocktail, the risk will decrease to something like 0.001%.

The pt recently had a full blood lab done, so we just used those values. Otherwise, things probably would've been different

 

[comatose]

First, who's decision was it to get PEP? Was it yours or a faculty member? The viral load was undetectable, so I am not really understanding why you are freaking out. Undetectable means noninfectious (for all practical purposes) with regards to HIV. I wouldn't worry about it personally, but do what you have to do to make yourself feel better.

 

[AmpedUp]

doesn't HIV die within seconds when exposed outside of the body?

 

[Mackchops]

First, who's decision was it to get PEP? Was it yours or a faculty member? The viral load was undetectable, so I am not really understanding why you are freaking out. Undetectable means noninfectious (for all practical purposes) with regards to HIV. I wouldn't worry about it personally, but do what you have to do to make yourself feel better.

This. But nicer.

You'll be fine. Sounds like you handled it well and professionally.

A girl in my class got a needle stick on someone without ANY diagnosed communicable disease and freaked out. Threw stuff down and started frantically washing her hands while crying in front of the patient. Needless to say, she ended up being fine but there's something to be said about staying cool during a scary situation. Props.

 

[Doc Smile]

First, who's decision was it to get PEP? Was it yours or a faculty member? The viral load was undetectable, so I am not really understanding why you are freaking out. Undetectable means noninfectious (for all practical purposes) with regards to HIV. I wouldn't worry about it personally, but do what you have to do to make yourself feel better.

Here is IU's post-exposure plan if you are interested. HIV is discussed on page 21 of the document.

http://www.ehs.indiana.edu/em/IU Bloodborne Pathogen Exposure Control Plan.pdf

EDIT: Appendix C (pg 47 ish) is more specific regarding procedures.

"
IF THE SOURCE PATIENT HAS AIDS OR OTHER EVIDENCE OF HIV INFECTION,
DECLINES TESTING, OR HAS A POSITIVE TEST, THE EMPLOYEE SHOULD BE
EVALUATED CLINICALLY AND SEROLOGICALLY FOR EVIDENCE OF HIV
INFECTION AS SOON AS POSSIBLE AFTER THE EXPOSURE, AND, IF
SERONEGATIVE, RETESTED AFTER 6 WEEKS AND ON A PERIODIC BASIS
THEREAFTER (e.g. 3, 6, AND 12 MONTHS) FOLLOWING EXPOSURE, TO DETERMINE
IF TRANSMISSION HAS OCCURED.

The employee will be informed of prophylactic AZT therapy as a treatment option. If the
employee desires AZT, this will be administered in consultation with the I.U. Health Center.
During this follow-up period, especially the first 6-12 weeks, when most infected persons are
expected to seroconvert, exposed employees should receive counseling about the risk for
infection and to help them follow U.S. Public Health Service (PHS) recommendations for
preventing transmission of HIV. If the source patient is seronegative and has no other evidence
of HIV infection, no further follow-up of the employee is necessary. If the source patient cannot
be identified, decisions regarding appropriate follow-up should be individualized based on the
type of exposure and the likelihood that the patient was infected.

 

[ChubbyBaby]

First, who's decision was it to get PEP? Was it yours or a faculty member? The viral load was undetectable, so I am not really understanding why you are freaking out. Undetectable means noninfectious (for all practical purposes) with regards to HIV. I wouldn't worry about it personally, but do what you have to do to make yourself feel better.

agreed. if it's undetectable it's essentially like they don't have HIV. relax.

and I agree with other posters that HEP C exposure would be muchworse.

 

[tinman831]

agreed. if it's undetectable it's essentially like they don't have HIV. relax.

Uh no.

 

[tinman831]

This. But nicer.

You'll be fine. Sounds like you handled it well and professionally.

A girl in my class got a needle stick on someone without ANY diagnosed communicable disease and freaked out. Threw stuff down and started frantically washing her hands while crying in front of the patient. Needless to say, she ended up being fine but there's something to be said about staying cool during a scary situation. Props.

The patient hasn't been diagnosed with any disease, but that doesn't mean he hasn't picked anything up since his last checkup ages ago. Always get tested after exposure. Small price to pay to reduce the chances of a serious debilitating disease.

 

[DrJeff]

I've personally had 2 sharps incidents with known HIV patients in my career, both during my residency. One in 1998 where I turned quickly while getting up and stuck myself with a flame shaped finishing bur that I left in the high speed POINTING AT ME after just having finished up some subgingival margin contouring after doing class V's on #'s 18 and 19 (learned my lesson about either removing the bur from the handpiece or turning it away from me BEFORE I get out of my chair)

The second one was in 1999. I was digging out the distal root of #30 with an east/west elevator, and slipped and punctured the glove and the skin of my left index finger 😱 In both cases I went to the clinic at the hospital where my residency was after having followed all the protocol's for post exposure. I decided NOT to take the cocktail for the bur event and did take the cocktail for the elevator event. In both cases I was told that the risk of conversion was something like 0.02%. In both cases I thougt something like: 0.02% is a pretty small risk, but there's still a risk and when you're in that position, there inevitably WILL be a bit of anxiety. In the subsequent years, I've always tested negative for HIV and Hep, but I do ask that they run those test whenever I have any routine bloodwork drawn.

The bottomline is that even as carefull as one is, at some point you'll likely get a little complacent and the reality is that you will stick yourself with some sharp. As has been mentioned already, the real disease to worry about with respect to conversion is Hep C. And even that has a low risk. But low and 0 aren't the same thing!

 

[ChubbyBaby]

Uh no.

For the person exposed.

 

[tinman831]

For the person exposed.

yes. hahaha 😳

 

[ARV]

So you guys are saying since his viral load is undetectable the risks are much lower?

Apparently, the source patient has had an undetectable load for more than 10 years, and his CD4 count has never dropped under ~900... good news I guess.

The first 2 days on the meds were horrific.. the fatigue and diarrhea 😳 But I think I'm getting accustomed to them thank goodness.

 

[ChubbyBaby]

So you guys are saying since his viral load is undetectable the risks are much lower?

Apparently, the source patient has had an undetectable load for more than 10 years, and his CD4 count has never dropped under ~900... good news I guess.

The first 2 days on the meds were horrific.. the fatigue and diarrhea 😳 But I think I'm getting accustomed to them thank goodness.

if the viral load is undetectable then there are very few virus units to infect you. Your risk is proportional to the number of viral units you're exposed to. You'll be fine.

 

[puncho]

My sister cut herself with a scalpel while helping with a patient with HIV and Hep C. She didn't contract either, thank goodness. Hope that helps put your mind at ease, but still go through all the necessary precautions.

 

[trust068]

dont worry, i am sure you will be fine.
I had similar experience, I stab in my finger while I was talking to my classmate and performing SRP (dumb i know). I look at my finger, no bleeding. I was not sure if i had exposure, school activated the protocol and send me to ER anyway. I declined treatments. because the hiv patient looks fine and the viral load was not bad (i forgot what was the exact number, it was about 2 years ago). I figure the chance of getting infect HIV is only 3% anyway, way lower than hep C. Other HIV clinic doc told me that he stab his hand few times during surgeries for past 20 years and never had a problem.

 

[hoylematt]

This reminds me of the episode of House, where Dr. Cameron got blood sprayed on her by an HIV+ hipster. The actor that played Data in star trek: the next generation was the one who administered her antiviral drugs and counseling.

If if makes you feel any better, she didn't contract HIV.

In all seriousness though...I hope everything works out for you.

 

[Insipidipisin]

This reminds me of the episode of House, where Dr. Cameron got blood sprayed on her by an HIV+ hipster. The actor that played Data in star trek: the next generation was the one who administered her antiviral drugs and counseling.

If if makes you feel any better, she didn't contract HIV.

In all seriousness though...I hope everything works out for you.

Incidentally, that reminds me of the movie "Outbreak".

In all seriousness, though, I think you'll be fine.