lealf-ye

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This happened when I was assisting my doctor for a procedure in his office yesterday. I accidentally touched blood from this patient with my finger without glove. I rinse the blood out right away but did not use any soap to wash until 30 minutes later. I also noticed there was some peeling of my skin on the finger that touched blood without visible open wound. What is my risk of get HIV infection if the patient is HIV positive? I am worried. :oops:
 

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With intact skin, the risk of infection is virtually nil. If that's the case, I wouldn't worry about it.

Of course, the best idea would've been to mention it to your preceptor, who could've examined the "peeling skin" in order to determine if it was intact or not, and if any exposure had occured. This forum is not the place to go for medical advice.
 
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lealf-ye

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KentW said:
With intact skin, the risk of infection is virtually nil. If that's the case, I wouldn't worry about it.
two questions I have:
1) will finger with skin peeling/scaling be considered as intact skin?
2) any reference to data show that the risk is virtually nil?
 
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lealf-ye said:
two questions I have:
1) will finger with skin peeling/scaling be considered as intact skin?
2) any reference to data show that the risk is virtually nil?
3) any evidence the patient actually had HIV?

I would be more worried about hep C and B than HIV. HIV dies as quickly when exposed to air. Hep B (and somewhat C) can live for 10 days in dried blood and becomes infectious again as soon as the dried blood is rehydrated.
 

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lealf-ye said:
two questions I have:
1) will finger with skin peeling/scaling be considered as intact skin?
2) any reference to data show that the risk is virtually nil?
My understanding is that even after a needle stick the chance of contracting HIV is pretty low. I think it is very unlikely that you have anything to worry about. Having said that, keep in mind that the chances of contracting Hep C is much higher when exposed to blood. However, given the fact that you really are not sure if your skin was exposed and the fact that you at least rinsed your hand with water, kind of takes the concern away. Again this is advice from and MS IV so take it with a grain of salt and it is NOT to replace a physicians opinion. However, I've been stuck before and I know it can be very frightening.

I guess the moral of the story is :

1. Always wear gloves
2. If exposed to blood wash hands with water and soap thouroughly
3. Let someone know
4. Welcome to the world of medicine

All the best
 
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lealf-ye

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southerndoc said:
3) any evidence the patient actually had HIV?

I would be more worried about hep C and B than HIV. HIV dies as quickly when exposed to air. Hep B (and somewhat C) can live for 10 days in dried blood and becomes infectious again as soon as the dried blood is rehydrated.
no one can be sure....
 

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lealf-ye said:
This happened when I was assisting my doctor for a procedure in his office yesterday. I accidentally touched blood from this patient with my finger without glove. I rinse the blood out right away but did not use any soap to wash until 30 minutes later. I also noticed there was some peeling of my skin on the finger that touched blood without visible open wound. What is my risk of get HIV infection if the patient is HIV positive? I am worried. :oops:

Your risk is almost zero. Everyone knows that hugging and sharing toilet seats are the best ways to contract HIV.
 

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The last data I saw said that the incidence of seroconversion with HIV after a significant needle stick on and HIV+ source was 0.3%. Anyone with some extra time want to see if there's any newer data out?
 

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To the OP:

I experienced a situation very similar to you. I had blood exposure to intact skin. I too did not know the status of the patient. I did A LOT of reading on this (I read about every single reported case), and here are some of the things I found:

1. The estimated risk following needle sticks is, as someone said, .3%. Nearly all cases of occupational transmission have occurred as a result of needlestick injuries.
2. Mucous membrane exposure carries a risk of about .09% (most cases involved EXTENSIVE exposure, however).
3. There are 2 documented cases of HIV transmission via the skin; however, in all cases the patient had compromised skin integrity (chapped and/or abraded skin). Current guidelines do not recommend PEP for skin exposure.

Another interesting fact that I learned in my studies (unrelated to your question, but interesting nonetheless) is that our surgical masks do not
filter aerosolized viruses. The CDC has stated that there is no risk of contracting HIV from inhalation of infectious aerosols; however, they are relying on epidemiological studies to make this statement. They basically looked at surgeons in areas of high HIV prevalence, and found that none were infected. They concluded then that aerosol transmission is not possible. I personally am skeptical.
 

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Like everyone else is saying, your chance of actually getting HIV from that exposure is very slim. But in the future, if you're ever truely worried about an HIV exposure, I know my school/hospital will give people an HIV test ASAP (and again in 3 months) and will also give you a short course of anti-retrovirals to further reduce your chances of getting HIV. So perhaps they do the same thing at your school?
 

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lealf-ye said:
This happened when I was assisting my doctor for a procedure in his office yesterday. I accidentally touched blood from this patient with my finger without glove. I rinse the blood out right away but did not use any soap to wash until 30 minutes later. I also noticed there was some peeling of my skin on the finger that touched blood without visible open wound. What is my risk of get HIV infection if the patient is HIV positive? I am worried. :oops:

WOW !! At first I thought you were joking... I hope you are not considering applying to medical school... because you have certain issue you need to deal with.
 

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futrdr said:
WOW !! At first I thought you were joking... I hope you are not considering applying to medical school... because you have certain issue you need to deal with.
Everyone's first exposure is pretty freaky. Fortunately (or unfortunately, I don't know) you get used to it over time. If you are a clinical person in health care you will get some exposures over the course of your career. You just have to do everything you can to minimize it.
 

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I had mine a couple of weeks ago as I was suturing a dude with Hep C. Gave myself an idiotic/accidental pin prick and proceeded to get super pissed and worried. I know that the risks of transmission are very low, but it will always be in the back of my mind as I get tested in 6 weeks, 3 mos, and 6 mos. It definitely shakes you up.
 
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lealf-ye

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WOW !! At first I thought you were joking... I hope you are not considering applying to medical school... because you have certain issue you need to deal with.
not sure what you really mean, but it is too late..... as you may notice, this is not premed forum....
 

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lealf-ye said:
not sure what you really mean, but it is too late..... as you may notice, this is not premed forum....
Yes, it was a very ignorant response in my opinion. If you look at one of the cases of skin transmission (not trying to scare you or anything--your risk is extremely, extremely small), it involved a small amount of blood on the hands.

OP, let me tell you now from personal experience that you should get tested. It will ease you mind. I spent an entire year worrying about this before getting tested. It isn't worth it.
 
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lealf-ye

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Reaganite said:
Yes, it was a very ignorant response in my opinion. If you look at one of the cases of skin transmission (not trying to scare you or anything--your risk is extremely, extremely small), it involved a small amount of blood on the hands.

OP, let me tell you now from personal experience that you should get tested. It will ease you mind. I spent an entire year worrying about this before getting tested. It isn't worth it.
Thanks everyone, your responses have been very helpful.

Reaganite, I could not find the cases you mentioned, could you tell me where it is or give me a link?
 

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If you are a medical student, resident, PA, etc:
You should be doing a literature search on this topic, and talking with the ID expert at your hospital - Getting quick advice from us on a forum is not the best way to learn the actual risks, nor a good way to approach the study of medicine. Yes, it is a quick input, easy way; but if I was in your shoes, I would be doing a great deal of reading peer reviewed clinical and research literature.
Maybe you can share or tell us what you find.

Thanks, and like the posts have said, not to worry about this.
lealf-ye said:
This happened when I was assisting my doctor for a procedure in his office yesterday. I accidentally touched blood from this patient with my finger without glove. I rinse the blood out right away but did not use any soap to wash until 30 minutes later. I also noticed there was some peeling of my skin on the finger that touched blood without visible open wound. What is my risk of get HIV infection if the patient is HIV positive? I am worried. :oops:
 

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C'mon guys, give her a break. People that have never been exposed to blood get a little freaky over it. As a paramedic I had quite a few exposures. Initially I would worry about small drops of blood on my skin. Eventually, althgough I tried to avoid it, I would just try not to let it saturate my clothes or let it splash in my eyes. Often, getting blood on me was an unavoidable part of the job. As far as I am aware from previous reading (old literature), there have been 4-5 cases in total that may have come from skin exposures secondary to dermatitis. Your chances are close to nil.

Needlesticks, now they worry me a bit...
 

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If you are a resident or medical student report the incident immediately to your employee/ student health. This way in the remote chance that you later turned up positive for something, you would be covered by the hospitals insurance. If it is not documented and you later develop something, you can not then state that you attribute it to an exposure months earlier.

In the future, I would immediately wash the area with soap and water and then go to the ER. One would want to decide whether they want to take retroviral prophylaxis within one hour from exposure.
 

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So everytime I get a little blood on my finger in the OR I should report it and go to the ER.
No.
GrahamGreene said:
If you are a resident or medical student report the incident immediately to your employee/ student health. This way in the remote chance that you later turned up positive for something, you would be covered by the hospitals insurance. If it is not documented and you later develop something, you can not then state that you attribute it to an exposure months earlier.

In the future, I would immediately wash the area with soap and water and then go to the ER. One would want to decide whether they want to take retroviral prophylaxis within one hour from exposure.
 

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lealf-ye said:
Thanks everyone, your responses have been very helpful.

Reaganite, I could not find the cases you mentioned, could you tell me where it is or give me a link?
I am having a hard time re-finding them myself. I KNOW that they exist. I read them on the CDC web page. Both cases were discussed in detail. I'm kind of busy today, so you might try the CDC page. When I have time, I will look again.
 
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lealf-ye

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I am having a hard time re-finding them myself. I KNOW that they exist. I read them on the CDC web page. Both cases were discussed in detail. I'm kind of busy today, so you might try the CDC page. When I have time, I will look again.
Thanks again, your info is really great. I found 2 cases about skin transmission at home. Are those the ones that you talked about?
 

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lealf-ye said:
Thanks again, your info is really great. I found 2 cases about skin transmission at home. Are those the ones that you talked about?
No, the 2 that I am talking about are occupational transmissions. I believe you are talking about: (1) a mom who applied cream to psoriatic lesions on her son and (2) two women who were sharing a razor. Is that right?

I remember one of the occupational transmission cases: a nurse with chapped skin on her hands and ears who got a small amount of blood on her hands. I can't remember the other case.
 
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lealf-ye

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you are right, that's the ones find. I am still looking....
 

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I don't know how the rules vary on that similar to a needle stick but I would still tell someone. My understanding is HIV doesn't last long in outside the body like Hep C does but playing it safe is the right thing to do.
 

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emtcsmith said:
I don't know how the rules vary on that similar to a needle stick but I would still tell someone. My understanding is HIV doesn't last long in outside the body like Hep C does but playing it safe is the right thing to do.
I think the idea that HIV doesn't last outside the body for too long is a myth. I've seen some studies to suggest that HIV can persist as long as 30 minutes outside the body. Still, the risk of HIV transmission through intact skin, which is the topic of this thread, is extremely low. The fact that the risk of transmission through needlesticks is .3% says something about the difficulty of acquiring the virus.
 

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Are you kidding me? Are you a doctor, med student, or what? If your a either you have a lot to learn.
 

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endodoc said:
Are you kidding me? Are you a doctor, med student, or what? If your a either you have a lot to learn.
If you are talking to me, please educate me. :rolleyes:

An extensive study on the survival of HIV after drying was reported by Resnik and coworkers (Stability and inactivation of HTLV-III/LAV under clinical and laboratory environments. Journal of the American Medical Association 1986;255:1887-91). The purpose of the study was to determine the inactivation rate of HIV under experimental conditions - an objective that required the use of extremely high levels of HIV. The concentrations studied were at least 100,000 times greater than those typically found in the blood of HIV-infected persons. It is not surprising that when such high concentrations of HIV were used, the virus could be detected 1 to 3 days after drying. Upon close examination of these data and from other results that have been obtained by CDC, however, it is clear that drying causes a rapid (within 1 or 2 hours) reduction in virus concentration and renders 90 to 99 percent of the virus inactive.

By the way, generally when you question someone's intelligence, you should probably know how to use "you're" correctly.
 
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