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Occupational exposure questions
I am a medical resident and I have a couple of questions for you. I know that you specialize in sexual HIV transmission, but maybe you can help ease anxiety concerning HIV. My fears stem from becoming infected either by direct contact with patients-having hangnails and other small open wounds that may place me at risk of becoming infected if I were to touch some blood or other body fluids on patients, or from getting saliva or other body fluids in my eyes,nose and mouth.A couple of times this month alone,I have thought that I may have put myself at risk of getting infected,merely by touching a patient and seeing that i was touching their skin where they were previously poked and there was some dried up blood,or by talking to a patient and feeling some drops of saliva land on my lips or in my mouth during our conversations.I always practice universal precautions,but my fears have become so excessive that I even wear gloves to examine every patient, just in case I were to come in contact with body fluids.I have consulted a psychiatrist to help me confront my fears,I would appreciate the medical perspective on these issues to help make me not feel as if I always have to get tested every few months.I have a few other questions:
After a possible exposure like I just mentioned,when do you think it is appropriate to get tested to definitively say that I have not been infected? Has anybody become infected in this manner?I have read the CDC guidelines extensively and I guess that my fears come from the definition of "non-intact skin".If I have some dry skin with hangnails because I bite my nails,is that a valid portal of entry for infection with HIV/Hep and should I be worried if I touch dried blood or other body fluids unintentionally with my hands?As a medical resident, I do think that I will get over this worry,but I would really appreciate anything you can tell me to help me get over these thoughts and continue to practice good medicine. I really appreciate your help!
After a possible exposure like I just mentioned,when do you think it is appropriate to get tested to definitively say that I have not been infected? Has anybody become infected in this manner?I have read the CDC guidelines extensively and I guess that my fears come from the definition of "non-intact skin".If I have some dry skin with hangnails because I bite my nails,is that a valid portal of entry for infection with HIV/Hep and should I be worried if I touch dried blood or other body fluids unintentionally with my hands?As a medical resident, I do think that I will get over this worry,but I would really appreciate anything you can tell me to help me get over these thoughts and continue to practice good medicine. I really appreciate your help!
MEDICAL PROFESSIONAL
That sort of exposure definintely does not warrant HIV testing on the basis of transmission risk. Whether you need a negative test for reassurance, i.e. for psychological reasons, is up to you.
Thank you for your reply. It is definitely reassuring to hear you say that most serconversions are from needlestick injuries.
Just a quick question...Do you think that the situations that I described merit any HIV testing, and if so, what interval of testing would be appropriate to see that there was no seroconversion. I know that you have answered many questions like this before, but I would be reassured to hear what you have to say about the scenarios I described, and wheher you think that there may be a potential risk, granted that most seroconversions occur with needles. Thanks a lot.
Just a quick question...Do you think that the situations that I described merit any HIV testing, and if so, what interval of testing would be appropriate to see that there was no seroconversion. I know that you have answered many questions like this before, but I would be reassured to hear what you have to say about the scenarios I described, and wheher you think that there may be a potential risk, granted that most seroconversions occur with needles. Thanks a lot.
MEDICAL PROFESSIONAL
To clarify my comment about no unexplained occupational HIV infections, I should have specified "to my knowledge". And of course there are health professionals who acquired HIV through standard behavioral exposures (sex, injection drug use) -- and I suppose it is possible some of those might have had uncertainties about the source of their infections. But the basic take-home message of my reply stands unchanged.
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help. But you have put your finger (with or without a hangnail) on the main problem here, which is your difficulty reconciling your intellectual understanding of the risks with your somewhat irrational fear about it.
Occupational infection with HIV is extremely rare among health professionals. There has never been an unexplained acquisition of HIV by health professionals. If you think about your personal experiences in patient care plus your general knowledge, and knowing that many or most physicians, nurses, etc probably are less careful about these things than you are, you will understand that across the US each year there must be tens of thousands if not hundreds of thousands of "exposures" like you describe, either to people with known HIV infection or patients infected but not tested or diagnosed. And yet no unexplained HIV acquisitions in health workers. The very few cases that occur (under 10 per year, I believe) always follow overt, known exposures like deep/traumatic injuries with HIV contaminated instruments. What does that tell you?
This is not a counseling site and I am not a mental health professional. But I doubt that most people like you "will get over this worry" without professional assistance. I'm glad to hear you are consulting a psychiatrist and suggest you continue to do so.
Best wishes for successful training and a rewarding career. You have no realistic worries that an occupational HIV infection is going to spoil it.
Regards-- HHH, MD
Occupational infection with HIV is extremely rare among health professionals. There has never been an unexplained acquisition of HIV by health professionals. If you think about your personal experiences in patient care plus your general knowledge, and knowing that many or most physicians, nurses, etc probably are less careful about these things than you are, you will understand that across the US each year there must be tens of thousands if not hundreds of thousands of "exposures" like you describe, either to people with known HIV infection or patients infected but not tested or diagnosed. And yet no unexplained HIV acquisitions in health workers. The very few cases that occur (under 10 per year, I believe) always follow overt, known exposures like deep/traumatic injuries with HIV contaminated instruments. What does that tell you?
This is not a counseling site and I am not a mental health professional. But I doubt that most people like you "will get over this worry" without professional assistance. I'm glad to hear you are consulting a psychiatrist and suggest you continue to do so.
Best wishes for successful training and a rewarding career. You have no realistic worries that an occupational HIV infection is going to spoil it.
Regards-- HHH, MD
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