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30 gauge needle poke through glove - patient is HIV+
It's one of those things in life you don't ever think will happen to you. I am a dentist with a few years of experience, comfortable at my job and focused at it. 3 days ago, as I was giving my second infiltration of local anesthetic on an HIV + patient to extract all 4 of his wisdom teeth, my patient had moved his head and I had subcutaneously injured myself causing perforation to the glove (and liquid seeping in it which at the time thought was blood but turns out was local anesthetic). I calmly interrupted the procedure, removed the gloves, noticed one drop of blood on the top of my left index finger, squeezed it out and washed my finger with soap and water for a whole 3 minutes until my finger turned almost blue. I then looked at the clock (9am) and knew I had a few hours to get myself to the ER.
I placed a bandage, put my gloves on again and proceeded to extract the patient's all 4 wisdom teeth and treated a little emergency right after him. Prior to my HIV + patient leaving, I had shared (confidentially) what had happened and asked him if like based on his medical chart, he was adherent to his tri-therapy and asked him what his viral load was. He had no idea what it was but said he felt great, shared his physician's contact and gave me verbal consent to contact him.
By the time I got to the ER, have them do my blood baseline test and took the pills that were given to me at the time (Kaletra and Truvada) it was noon. Needless to say not even an hour later (and back at work) I felt nausea, had gastrointestinal symptoms and had a metallic taste in my mouth with even loss of appetite by that same night.
2 days following my work related incident, I consulted with an infectious disease specialist who was comforting in statistics. He was so confident I would be off the hook that he dropped my prescription down to just Truvada once a day (which I don't know if I am relieved as it is obviously less efficient than taken together with Kaletra) and that the undesirable effects were much less pronounced. So I discontinued Kaletra after 2 days and a half of hell and am now only on Truvada. The specialist in question had many reasons as to why he has treated me this way. Here they are:
1) 30 gauge used (ridiculously small tip) and was wearing gloves
2) I had placed in a new anesthetic carpule right prior to my incident and always by nature push the anesthetic to the floor prior to inserting the needle in the mouth which pushed away any blood to the floor (from inside the needle at least)
3) there was no visible blood onto the tip of the needle
4) my perforation site on the skin was not even visible after 1 hour
5) the HIV + patient's physician shared with me that the patient's viral load was undetectable and was last tested in Aug 2012
6) unrelated (the patient was tested for Hep C last month and was - )
7) probably is just an assumption as to how safe the patient is but the patient is in a married relationship
8) I followed protocol of rinsing with soap and water for 3 minutes
Now the physician told me that without those factors listed above and without any medication, that I had a 0.3% chance of contracting the disease but thanks to those, I have far less of a risk to acquire sero conversion and that in his 30 years + practice he had never met anyone in my case who has.
My 2 questions would be:
1) do you agree ? (it is quite obvious this incident has me going insane especially because of it being out of my control)
2) protocol says to wait a whole 6 months prior to having unprotected sex but my husband and I had started trying to conceive a few weeks ago (thank goodness I wasn't found pregnant 3 days ago because of all the meds that were administered to me) and my husband (who also happens to be a physician) is convinced it is so highly unlikely if not impossible that I had contracted anything based on what happened that he wants us to try again once the 28 days therapy is over. Added to his arguments is the fact he knows so many MDs to which this and even much worse has happened who are in the clear.
To be quite honest, I really do wish to try conceiving after my first 6 week test, assuming it is clear (I am so anxious when the thought of me not beating the odds runs through my mind) since 97% of the people who are found cleared after 6 weeks do not develop anything and since my injury is so mild I should definitely be beating the odds...right? Am I being irresponsible considering everything I have mentioned? Thanks!
Hechel
I placed a bandage, put my gloves on again and proceeded to extract the patient's all 4 wisdom teeth and treated a little emergency right after him. Prior to my HIV + patient leaving, I had shared (confidentially) what had happened and asked him if like based on his medical chart, he was adherent to his tri-therapy and asked him what his viral load was. He had no idea what it was but said he felt great, shared his physician's contact and gave me verbal consent to contact him.
By the time I got to the ER, have them do my blood baseline test and took the pills that were given to me at the time (Kaletra and Truvada) it was noon. Needless to say not even an hour later (and back at work) I felt nausea, had gastrointestinal symptoms and had a metallic taste in my mouth with even loss of appetite by that same night.
2 days following my work related incident, I consulted with an infectious disease specialist who was comforting in statistics. He was so confident I would be off the hook that he dropped my prescription down to just Truvada once a day (which I don't know if I am relieved as it is obviously less efficient than taken together with Kaletra) and that the undesirable effects were much less pronounced. So I discontinued Kaletra after 2 days and a half of hell and am now only on Truvada. The specialist in question had many reasons as to why he has treated me this way. Here they are:
1) 30 gauge used (ridiculously small tip) and was wearing gloves
2) I had placed in a new anesthetic carpule right prior to my incident and always by nature push the anesthetic to the floor prior to inserting the needle in the mouth which pushed away any blood to the floor (from inside the needle at least)
3) there was no visible blood onto the tip of the needle
4) my perforation site on the skin was not even visible after 1 hour
5) the HIV + patient's physician shared with me that the patient's viral load was undetectable and was last tested in Aug 2012
6) unrelated (the patient was tested for Hep C last month and was - )
7) probably is just an assumption as to how safe the patient is but the patient is in a married relationship
8) I followed protocol of rinsing with soap and water for 3 minutes
Now the physician told me that without those factors listed above and without any medication, that I had a 0.3% chance of contracting the disease but thanks to those, I have far less of a risk to acquire sero conversion and that in his 30 years + practice he had never met anyone in my case who has.
My 2 questions would be:
1) do you agree ? (it is quite obvious this incident has me going insane especially because of it being out of my control)
2) protocol says to wait a whole 6 months prior to having unprotected sex but my husband and I had started trying to conceive a few weeks ago (thank goodness I wasn't found pregnant 3 days ago because of all the meds that were administered to me) and my husband (who also happens to be a physician) is convinced it is so highly unlikely if not impossible that I had contracted anything based on what happened that he wants us to try again once the 28 days therapy is over. Added to his arguments is the fact he knows so many MDs to which this and even much worse has happened who are in the clear.
To be quite honest, I really do wish to try conceiving after my first 6 week test, assuming it is clear (I am so anxious when the thought of me not beating the odds runs through my mind) since 97% of the people who are found cleared after 6 weeks do not develop anything and since my injury is so mild I should definitely be beating the odds...right? Am I being irresponsible considering everything I have mentioned? Thanks!
Hechel
I never had a doubt, but it's nice to read the update. Congrats on your pregnancy!
Thanks for taking the time to come back and post your results, and glad to hear you're negative (as expected).
Best wishes with your pregnancy!
Best wishes with your pregnancy!
Little update! I didn't beat the odds, the odds were always on my side :D I'm HIV - and am now 8 weeks pregnant. Thanks for the comforting words!
Hechel
Hechel
Thanks you two. It has and it continues to be a tough road for me and I am not even past my first week of exposure. I hope I will remain sane for the sake of my physiological health too. I will keep you posted.
You really have nothing to worry about. With a 30 guage needle, there wouldn't be a significant enough of an entry point, to allow for enough blood to get into the opening in the skin to cause a risk. Splinters would cause a bigger break in the skin.
You followed proper protocol. Of course, anytime there is an exposure with a known + patient, there is room for worry, that's understandable.
However, physiologically, it would basically be impossible for you to get infected under these circumstances...largely due to the extremely small guage needle you were working with. Add on the measures you took, including nPEP...it's just not going to happen.
A test at 3 months after your last dose of nPEP will be conclusive, however, many post exposure protocols dictate 6 months for testing, that's pretty much standard. You will have to follow the protocol, but your 3 month test will be as good as gold. Your negative at that point will be cause for a sign of relief!
Am I being irresponsible considering everything I have mentioned? Thanks!
Actually, not at all...you are using reason and factual knowledge to ascertain that you will be just fine. You've got a very good sense of how HIV is transmitted, and you recognize that your chances of becoming infected are slim to none. Boy, how I wish others who come to this forum could do the same! :0)
Good luck, be sure to update us!
You followed proper protocol. Of course, anytime there is an exposure with a known + patient, there is room for worry, that's understandable.
However, physiologically, it would basically be impossible for you to get infected under these circumstances...largely due to the extremely small guage needle you were working with. Add on the measures you took, including nPEP...it's just not going to happen.
A test at 3 months after your last dose of nPEP will be conclusive, however, many post exposure protocols dictate 6 months for testing, that's pretty much standard. You will have to follow the protocol, but your 3 month test will be as good as gold. Your negative at that point will be cause for a sign of relief!
Am I being irresponsible considering everything I have mentioned? Thanks!
Actually, not at all...you are using reason and factual knowledge to ascertain that you will be just fine. You've got a very good sense of how HIV is transmitted, and you recognize that your chances of becoming infected are slim to none. Boy, how I wish others who come to this forum could do the same! :0)
Good luck, be sure to update us!
You did all the right things and you were given PEP which is 86% effective in preventing HIV transmission,3 months after your last dose of PEP is enough--6 months is old and not required.
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