Concerned About Baby Exposure to HIV in ER

[bxlmom]

Dear Dr. Hook: I'm writing to you as the concerned mom of a 9-month-old. I should mention we currently live in Belgium and the hygiene standards in Western Europe differ from those in the U.S. The other day, we were in the ER because my daughter had a high fever. The nurse told us to take her temperature. She gave us a thermometer wrapped in a plastic sheath and said she would be back. We took the baby's temp rectally as I'd been shown in the hospital right after her birth - no vaseline. The sheath was thick with rough edges - I remember thinking it would probably hurt or scratch the inside of the baby's rectum. The nurse came back, we removed the thermometer, she took off the plastic sheath and placed a new one on it. She then put the thermometer back on the shelf! That's when I noticed a sign that read: "Do not take the thermometer with you or you will be charged for it." I asked the nurse if they disinfected the thermometer between uses and she said: "There's no need. We use a plastic cover."

You see where I'm going with this. We'd been taking my baby's temp 8 times a day for the past 4 days - rectally, no vaseline (I later saw online you're supposed to use vaseline) meaning she probably had some scratching inside. In addition, the plastic hospital sheath was rough. This is a big urban hospital that treats most of the country's HIV+ children. The admitting room in the pediatric ER unit has one thermometer which is not disinfected between patients. What if an HIV+ child was in that room before us? Condoms break. I'm sure thermometer sheaths break too. If there was blood or any body fluid from an HIV+ child on that thermometer and our plastic sheath was also defective, what is the risk my baby got something, considering she probably had some internal scratching? Since a new sheath is put directly on the thermometer right after the old one is removed, would this prevent the virus from dying? Finally, what about other stuff like hepatitis?

[Edward W Hook, MD]

No risk for hepatitis B either, particualrly since your daughter has been vaccinated with the very effective hepatitis B vaccine.  TAke care EWH

[bxlmom]

Sorry, doctor -- one last thing, that's a promise!

I'm no longer worried about HIV (thanks to you), but in my original question, I was also concerned about Hepatitis B -- forgot to mention that again in my last reply :)  (My daughter's had three Hep B shots so far, but there's still one more left at 15 months and another at 5 years.)

Thanks a million... you've really helped me a lot.

[Edward W Hook, MD]

I understood  that the sheath was soft plastic. This does not change my assessment or advice.  Your daughter will be fine and there is no realistic chance that she was infected. There is no need to test your daughter related to the events you describe.  Take care. EWH

[bxlmom]

Thank you, doctor. For lack of space, I couldn't specify that the sheath was not the hard plastic variety I'd always seen in the U.S., but the soft kind you might buy at a pharmacy for home use (only it was a tad bit thicker.)

As a new mom, it's scary taking your child to the ER for the first time, and absolutely terrifying when it's in a foreign country! That said, your reply has been very helpful and has assuaged many of my fears. My daughter is doing much better -- hospital tests showed no serious infection.

After the thermometer thing, I was actually considering asking to have my daughter tested for HIV in a few months' time, but I think I won't do that now. I just want to be sure -- you think it would be OK to skip that test? (I'm not even sure how they test for HIV in babies, but I'm sure it's not comfortable...)

Thanks again for your time and your insight! It's very much appreciated!

[Edward W Hook, MD]

Welcome to the Forum.  I understand your concerns and know just how much we as parents worry about our children's health.  Having said that. i urge you not to worry about the events that you describe.  There are several comments regarding this issue below:

1.  The environment.  It is unlikely that the thermometer used on your child was contaminated, that if it was, that it was contaminated with material from another person with HIV (even though the hospital that you were at takes care of most children with HIV, I am confident that only a relatively small proportion of the children have HIV), or, had it been contaminated that any virus present would have been infectious.

2.  The thermometer sheath. Even here in the US where electronic thermometers are used, the norm is to cover the thermometer with a sheath and to use the same instrument repeatedly, going from patient to patient.  In some areas the sheaths are hard plastic and in others the sheaths are clearer, more flexible sheaths but either way, the norm is to simply cover the thermometer with a protected shear.

3.  Despite repeated taking of the temperature and the rough feeling to the sheet, rectal thermometers are typically not traumatic when placed in the rectum.

4. Finally, were such things to be a hazard for patients like your child, by this time there would be reports in the scientific literature of transmission in this way.  There are none that I am aware of.

Bottom line, I would not worry about your child’s risk for HIV form the way her temperature was taken.  If there was, we would have heard this described and that is not the case.

I hope these comments are helpful to you.  I hope your child's fever has gotten better as well.  EWH