healthcare worker

[healthcareworker1]

Hi, this is an awkward question but i still have to ask. Last night while working on a hiv patient is had a possible/potential exposure. I was wearing gloves but what happened is that i  was  disconnecting iv tubing from the pts primary site and was going to transfer it to his other iv site. well, the IV tubing had blood in it and as i was connecting it so the second site, i missed and scratched my finger with the bloody tubing. i was wearing a glove but there was a tear in the glove and there is a visible scratch on my finger. my question is that with the bloody tubing (bloody part scratching my finger) and the scratch on the finger that burned when alcohol is applied, what is the chances of getting hiv from this exposure. i know is .3% with needle stick. is it the same chance. pls help me with this.

I also wanted to thank both of you doctors for your time you take in answering everyones questions. You are a live saver to all who ask you questions.

[H. Hunter Handsfield, M.D.]

Whew!  I'm glad this forum isn't your only effort for professional advice.  It would have been good to know that before I responded.

The doctor who advised you probably knows just as much about the risks as I do.  Since s/he has advised that the risk is low, that also is my view.  As I said above, the statistical figure you quote sounds about right.  I can't stand on 0.3% as an exact figure, but if anything I suspect your risk is lower than that.

If moist blood or body fluids are present, HIV undoubtedly survives just fine in plastic tubing.

Please continue to follow-up with the doctor who has advised you about PEP about testing intervals etc.  Whatever s/he advises is what you should do.

[healthcareworker1]

Unfortunately we dont know the pts viral load because he is a psych pts and we were unable to stick him due to his extreme violent nature, it takes around 10 health care professionals to bring him down. He was released from prison a few weeks ago and started on a drug binge (IV drug use). He is not on any medication for hiv. I forgot to mention that i did report it and PEP was discussed but after at length discussion both the dr and i agreed that i should not take it. the cut was extremely superficial. with that information do you beleive there is something to worry about. basically the plastic missed the adaptor port and tore through my glove. also can hiv survive in plastic iv tubing.

[H. Hunter Handsfield, M.D.]

Welcome to the forum. But we do not provide the service you really need.  Please immediately contact your supervisor and/or the infection control professional and describe the situation.  Depending on your institutional policies, you probably qualify for postexposure prophylaxis (PEP) with antiretroviral (ARV) therapy.  The figure you quote for HIV transmission risk sounds about right, and given the superficial nature of the exposure, your risk is very low.  But it isn't zero, and a PEP decision may depend on information you don't provide, like the HIV-infected patient's viral load and whether or not s/he is on ARV therapy.  After direct evaluation and explanation of the pros and cons of PEP, you and the responsible health care provider (probably an infectious diseases specialist) might decide not to pursue PEP.  But the decision must not be made by a distant online advisor like me.

Don't panic.  I truly believe the risk is miniscule.  But the situation still requires immediately professional assessment, because PEP is most effective the quicker it is given and must be started within 72 hours.  You should have reported the incident last night, within minutes of the event.  Do not delay any longer.  Get on the phone right now; I don't care that it's Sunday night.

Please report back after the formal assessment has been done and a PEP decision has been made.  Until then, don't waste any more time and energy on this or any other online forum or website.

Regards--  HHH, MD