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med student - possible occupational exposure
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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med student - possible occupational exposure

I am a med student, and I was suturing up a guy's arm laceration in the ER yesterday. I wasn't wearing eye protection and I thought I felt a speck or tiny droplet of blood go into my eye. At the time, I wrote it off because it didn't seem like an obvious blood exposure. I'm not even 100 percent sure anything actually went into my eye. But now I'm wondering I should take any action.

1) Is any sort of action warranted? Should I report this to my hospital? Should I get tested for HIV, Hep C, or anything else?

2) Is there any risk of HIV, Hep C or any other bloodborn pathogen from this incident?

3) From a risk standpoint, if I don't wear glasses, is it worth it to use eye protection even when doing minor procedures such as suturing a wound in a conscious patient, aspirating somebody's joint, etc.?

4) For future reference, what would the threshold be for a reportable bodily fluid occupational exposure to mucous membrane? .

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Welcome to the forum.

It is OK to ask these questions here, but it must not be the only advice you receive.  The hospital (or whatever agency runs the Emergency Department) should also be informed.  Even if no action is necessary, they want to know about any and all such events, to provide advice to you, to consider whether revised procedures are necessary for other providers, and to monitor the frequency of body substance exposures.  If their advice differs from mine, it is theirs you should follow.

You don't say anything about the patient you were caring for.  Is there any particular reason to believe s/he was at high risk for HIV or other blood-borne infections?  To the specific questions:

1,2) This most likely was a zero-risk event, especially since it seems that blood or other secretions didn't enter your eye.  But as already implied, this could depend in part on the patient.  Probably no testing or prevention steps are needed, but as noted above, you do indeed need to inform the hospital and then follow the advice of the infection control team.

3) Eye protection definitely is recommended when performing any medical procedures that may result in splash, spray, or other contact with body substances.  Check with your ED and/or infection control specialists about specific recommendations in your institution.

4) There is no single answer to this question.  It depends on the amount/size of the exposure, what is (or isn't) known about the patient's risk or known infections with HIV or other blood-borne infections.  Every case of potential exposure needs to be individually assessed.

I would be interested to hear the outcome after you have obtained professional advice.  But in the meantime, you should not be seriously worried.  I believe that in the entire US, in most recent years there have been no recorded nosocomial HIV transmission events.  Most such transmissions involve deep wounds with obviously blood-contaminated instruments, e.g. a scalpel slash or deep penetration of an overtly bloody large-bore needle.

Regards--  HHH, MD


Hi Dr. Handsfield,

Thank you for your input. I did take your suggestion of getting another professional's advice, but I cheated a little. I spoke to an ER physician as "curb-side consult" as opposed to reporting to the hospital, and he thought that I didn't have exposure. He thought that the fact that I didn't have irritation or lacrimation of the eye means I probably didn't actually have blood getting in the eye. He felt there was no need to report anything.

The patient was a young college guy. To my knowledge he doesn't shoot drugs or have high risk sex, though I don't know for certain.

What are your thoughts on the ER doc's assessment?

The chance a patient like you describe had HIV is very low.  The ER doc's judgment sounds reasonable, but I still suggest you go through official channels.  By not doing so, you may be denying yourself genuine expertise, which the ER doc may or may not have -- and which a distant forum like this does not provide.
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H. Hunter Handsfield, M.D.Blank
University of Washington
Seattle, WA
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