Medical professional exposed

[jfem4]

I'm  42 yo healthy, female, NP who had an HIV positive pt in for her annual PAP/ complaints of vaginal itching/? yeast. Took a sample of her vaginal secretions and placed it on a lab slide to check for yeast. WHile putting it down, it broke in 2-3 pieces.My gloved hand was holding it. About 10 minutes later, I noticed on my left hand what appears to be a paper cut looking cut. It feels like one, on the side of my hand. ( this was the hand that was not touching the slide, but did not have a glove on it)
I can't recall if I got this before or after the incident, or was it from a piece of the slide that broke off.?
I don't remember feeling it pierce, or anything like that.
ANyway, it did not bleed,( even when pressed and squeezed)  it looks like a very small paper cut, less than 1 inch long. It's not red, and I guess only hurts from the tons of alchohol and washing that I did when I noticed it!
I showed it to the HIV MD at work and he didn't think it was anything to worry about.
He offered me the medications, because as he put it " i have to, but I wouldn't if I were you"...
He is her primary care doctor and he says that she is well maintained.'
Her latest blood levels were:  **CD 4 helper 564    % CD 4 pos. Lymph.
HIV-1 RNA by PCR  less than 48 copies/ml, HIV-1 RNA not detected**

Any thoughts?

[nursegirl6572]

HUH?

Are you saying b/c he is her employer...that would affect how he, as a PHYSICIAN would react?


NOOO way...if anything...he would prolly be OVERLY conservative in that case.

[Wear/a/Jimmy]

I agree also that if there had been any risk...the doc would have reacted totally differently.

If the doctor is her employer, I doubt that would be the case.

[nursegirl6572]

Lizzie is right.

I agree also that if there had been any risk...the doc would have reacted totally differently.

You will be okay.

[LIZZIE LOU]

:)

[jfem4]

Thank you..

You are 100% correct ...that fact that she has HIV is fueling my anxiety...and the more I hear from all of you supportive people, the better I feel.

Being informed is the best way to decrease anxiety...

I looked at the cut this morning, and it still looks like a paper cut...it's  a little red, most likely from all the achohol that I washed it with ...but still it never bled etc...

Anyway, thank you again...

I am feeling better....

[LIZZIE LOU]

"About 10 minutes later, I noticed on my left hand what appears to be a paper cut looking cut. It feels like one, on the side of my hand. ( this was the hand that was not touching the slide, but did not have a glove on it) "

i know the fact that she is hiv + is fueling your anxiety...but you truly were not at risk from this incident.  there are many things in your favor...you stated that it was a papercut that was not bleeding even when squeezed...you did not touch the slide with that hand, and the fact that hiv becomes inactive when taken outside its host and is exposed to air.

if there was the slightest chance that this was a risk to you...i'm sure the MD would have taken the necessary action required.

[Teak]

You said you might have got a cut that did not bleed. That does not constitute a risk.

[jfem4]

I thought that having a cut and not knowing if it were caused by a slide that had  known HIV positive vaginal fluid would consitute a risk...low, but still a risk??? Do you agree??

Again, I'm just trying to quickly assess my risk/exposure level to make a decision, in about 12 hours, if I want to take PEP.

I can't tell you how much I appreciate your thoughts on this.
This is obviulosy all very new and very scary to me.

Thanks again for your time adn thoughts.
JM

[Teak]

You didn't have a risk and PEP is unwarranted.

[jfem4]

thank you for your comments...I think I have worked myself in to a tizzy over this, although I am trying to stay calm...

It's so scary!!!

They did not do a baseline test...the MD really must not have thought it was a bad enough risk. He basically didn't do anything. Just asked me if I wanted to take PEP, and when I asked what he would do he said he wouldn't worry.

I'm starting to think I maybe should take the meds? What do you think??
Her viral load was done in June, is that still ok???

Sorry about the freaking, but now that I have had time to absorb this, I'm starting to worry????

Any thoughts???

[nursegirl6572]

I agree with teak....if anything..the risk would be so small, it wouldn't even be measurable.  I would certainly think it would take a MUCH more significant break in the skin to place you at risk.

I can certainly understand your worry...but honestly...if it were me....I wouldn't opt for PEP...I really think that the risks outweight the benefits.  However, that said...it is still your decision....and would understand if you opted to take the PEP.

I had a large bore needle injury YEARS ago (before PEP)...and while my risk still remained low (person was not confirmed to be HIV+...later tested NEG..but was HEP +...bought me some wonderful gammaglobulin!!!)...I cannot honestly say what I would have chosen had the PEP option been available.

Sounds VERY reassuring....especially the fact that you are not even positive that there was any contact of her fluids with the tiny cut...and the fact that the cut was not bleeding indicates it is probably just a very small layer of the epidermis that was compromised..you know as well as I what a great barrier the skin is.  Also..think of what a tiny tiny sample you would have put on that slide.  We're not talking cups of fluid.  ALL of those things are good things, IMO.

Any which way....I feel for your situation....it sounds like you are getting excellent guidance from the physician at the workplace.

Best of luck to you...let us know what you decided ok?  Did they do a baseline antibody test on you?  I know that is usually standard protocol in most places.

Hang in there!!!

[Teak]

NO RISK.