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rn exposure
15 days ago i was working at a surgical center when i was starting an iv on a male pt. During iv placement, i struggled to get the iv and pulled off a finger of the glove to help feel for vein as he was a hard stick. After placement i noticed blood on my exposed finger. I washed my hand and did not think much of it and even had a co worker examine my finger for any laceration as the day before i nicked my finger with razor. Small cut no bleeding from site. She said she did not see any noticable abrasions. I did not think too much about it but the patient did express somewhat of a risky lifestyle while under anesthesia during the procedure. Now, 12 days later i have diarrhea, muscle aches, loss of appetite, and pain in my groin no noticable or palpable swelling of lymph nodes. Is this all coincidental? What constitues a nonintact skin exposure? would you consider this intact skin from my discription? How at risk am i from this exposure? I am a bit ocd and very concerned as i try to rationalize this but keep turning to hiv. Please help with advice on risk and explaination of nonintact vs intact akin exposure. Thank you!!
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
All occupational HIV transmissions in health workers have involved overt, unmistakeable injury with a visibly contaminated instrument -- usually a deep stick with a large-bore hollow needle, scalpel slash in surgery, etc. There is nothing in your description that suggests a high risk exposure. And of course the large majority of people with "somewhat of a risky lifestyle" in fact do not have HIV. Further, if I understand correctly, your hands were protected with gloves; and even if a 24 hr wound were exposed, there would be little risk of infection. Exposure of healing wounds appears to carry no material risk of HIV.
In addition, your symptoms are not typical for a new HIV infection. The classic acute HIV symptoms are fever, sore throat, and body-wide skin rash, none of which you mention. Diarrhea and loss of appetite are very nonspecific -- i.e. not particularly associated with HIV.
So from a purely risk assessment standpoint, you shouldn't be worried and do not need testing, and you can safely continue unprotected sex with regular partner(s). Of course you can always seek testing in a few weeks if you need you need the additional reassurance of a negative test result. If I were in your situation, I wouldn't feel any need.
Best wishes-- HHH, MD
All occupational HIV transmissions in health workers have involved overt, unmistakeable injury with a visibly contaminated instrument -- usually a deep stick with a large-bore hollow needle, scalpel slash in surgery, etc. There is nothing in your description that suggests a high risk exposure. And of course the large majority of people with "somewhat of a risky lifestyle" in fact do not have HIV. Further, if I understand correctly, your hands were protected with gloves; and even if a 24 hr wound were exposed, there would be little risk of infection. Exposure of healing wounds appears to carry no material risk of HIV.
In addition, your symptoms are not typical for a new HIV infection. The classic acute HIV symptoms are fever, sore throat, and body-wide skin rash, none of which you mention. Diarrhea and loss of appetite are very nonspecific -- i.e. not particularly associated with HIV.
So from a purely risk assessment standpoint, you shouldn't be worried and do not need testing, and you can safely continue unprotected sex with regular partner(s). Of course you can always seek testing in a few weeks if you need you need the additional reassurance of a negative test result. If I were in your situation, I wouldn't feel any need.
Best wishes-- HHH, MD
MEDICAL PROFESSIONAL
A night sweat, with no other symtoms, is never caused by HIV.
That will definitley end this thread. You cannot expect to return for reassruance about every additional thought that comes to mind.
That will definitley end this thread. You cannot expect to return for reassruance about every additional thought that comes to mind.
Dr. HHH,
I have researched all of the posts regarding cutaneous exposure risk and re-read your explaination to my questions 100 times to calm my nerves. I was ok until last night when I had a night sweat and woke up with a painful slightly enlarged lymph node in my left axilla, with redness in my armpit. Am I correct to assume this would not change your risk assessment with my skin exposure to blood during the IV stick (no puncture wound) just coincidental?
Lastly, are lymph nodes in ARS typically painful or painless? No fever, no sore throat just redness and painful node in armpit at this time oh and some obvious anxiety.
Thank you so much and I will end this thread after or if you respond.
Respectfully,
Sothpaw
I have researched all of the posts regarding cutaneous exposure risk and re-read your explaination to my questions 100 times to calm my nerves. I was ok until last night when I had a night sweat and woke up with a painful slightly enlarged lymph node in my left axilla, with redness in my armpit. Am I correct to assume this would not change your risk assessment with my skin exposure to blood during the IV stick (no puncture wound) just coincidental?
Lastly, are lymph nodes in ARS typically painful or painless? No fever, no sore throat just redness and painful node in armpit at this time oh and some obvious anxiety.
Thank you so much and I will end this thread after or if you respond.
Respectfully,
Sothpaw
Thank you for that explaination. I appreciate your attention to this question. I was actaully moonlighting and am an army nurse (two deployments to iraq) and cant reallt go back to occupational health at this facility I fully am aware of my foolishness and need to reaccess my approach to all clientel while working. But i will find comfort in your response.
God bless you for your time and patience with this scared community in this forum
God bless you for your time and patience with this scared community in this forum
MEDICAL PROFESSIONAL
The official advice that "non-intact" skin exposure risks HIV is based mostly on caution, not documented risk. The term typically is meant for inflammatory conditions of the skin -- eczema, psoriasis, etc. However, I am not aware that any HIV infections have actually been documented from exposure of such lesions. Many years ago, I think there may have been a report of a health worker who had eczema of the hands, somehow got HIV infected blood under the glove but it wasn't known for a couple hours of surgery, and became infected. But of course that was known-infected blood with prolonged exposure under occlusion -- probably not applicable to an event like yours.
Really, I don't think you need to be at all worried. But if you want still further reassurance, I would advise you speak with the infection control people at hospital. If they believe there was any potential risk at all, they might arrange for testing of the patient; if negative it would resolve the issue entirely.
Really, I don't think you need to be at all worried. But if you want still further reassurance, I would advise you speak with the infection control people at hospital. If they believe there was any potential risk at all, they might arrange for testing of the patient; if negative it would resolve the issue entirely.
Doc Handsfield. THANKS! I understand your view on "at risk" activity. Just guess i was more inquizative about what is a intact vs a nonintact skin exposure? I appreciate your time and attention to this matter Sir. Respectfully sothpaw
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