very confused Nurse

[husky48]

im a bit confused on the whole HCV dry blood scenarios. the infection control nurse at my old hospital stated that even with eczema (small pin head size scabs from scratching) and possibly touching dry blood i have to go through the occupational testing for HCV/HIV. i know its policy but is it really a plausible risk? ive noticed that on the questions that have been asked on this website most people had replied that the risk is minimal to nonexistent. ive had two incidents with dry blood and with both incidents i didn't know how long the blood had been there, with one of the incidents because it was on a coloured surface i wasn't even sure whether it was blood. is she over reacting, do i really need to go through all that testing?
today i started in a new hospital in emergency. i grabbed the blood pressure cuff off the hook behind the monitor and attached to the patient. later that day i noticed that there was a thin light brownish stain on the hook where the cuff was. i thought it looked like rust and didnt think anything of it as it was a white painted metal hook. later at home i started thinking that it could of been blood smear and then thought about whether i should tell the infection control nurse but i dont know if i even touched it. is it really a risk? had there been any documented case through this way? i know the CDC state that blood is still infectious when dried for 16hours to 4 days but is that more to do with injecting dry blood than touching a surface with cuts that are not bleeding?
sorry i know there is  alot of questions but the old infection control nurse really didnt explain to me and i see so may conflicting arguments. im just really confused

[HectorSF]

Of course you need to follow policy otherwise you are not only potentially infecting yourself but you could be spreading infections to patients. If a patient has serious health issues an infection can be fatal as you know.

Wherever you work you should contact the Infection Control Department are get the facts. The contact number should be posted in treatment rooms. We are not doctors or nurses here and we should not be used as the source of your information for control of hepatitis C infection or any other infection. Speaking as a patient, I don't want someone treating me who does know or follow hospital infection control procedures. An infection from any nurse could likely be fatal to me because I have advanced cirrhosis caused by hep C and end-stage liver cancer.

I understand it can be inconvenient to be tested when there is a low risk of infection, but no one wants a health care worker infecting patients. Hospital-acquired infections are a leading cause of death in this country, with estimates of the death toll nearing 100,000 lives a year—more than that of car crashes, breast cancer, or AIDS.

We see the horror stories every now and then of a health care worker spreading hep C to many unsuspecting patients. It is a tragedy that doesn't need to happen.

The amount of risk for hepatitis C is very low overall with the greatest risk being needle sticks/cut and even with a needle stick/cut from a needle used on a infected hepatitis C patient the risk is in the single digits.

The point is you are a health care worker who is responsible for not spreading infections (and there are dozens of infection other than hep C) that you need to be aware of.
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As you know, except for airborne and droplet infections Standard Precaution is used to control infections.

· Clean hands before & after patient contact, after removing gloves & upon exiting room
· Clean hands after contact with patient environment & equipment
· Clean equipment with disinfectant between patient use
· Use gloves for contact with blood or other body fluids, excretions, secretions
· Anticipate need for protective barriers (gowns, gloves, mask, eye protection)
· Place patient in appropriate room
· Report all blood & body fluid exposures
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The Centers for Medicare and Medicaid Services has published the infection rates on its Hospital Compare website, where the government already publishes data about patient satisfaction and some other types of medical errors in order to help consumers choose quality hospitals.

http://www.medicare.gov/hospitalcompare/?AspxAutoDetectCookieSupport=1

Type in your hospital's name or location.

The type of infection being tracked by CMS is central-line-associated infections, or CLABSIs, among patients in intensive care units. Central lines are catheters inserted deep into the body to deliver medicines and nutrition.

Next year, the government will be publishing the rates of infections patients get during surgery and urinary-tract infections from hospital-inserted catheters.

Hector

[Idyllic]

I think when it comes to "Occupational" exposure in a clinical setting that "occupational"  is the operative word when it comes to exposure. Next, "Definition of Exposure" as outlined in your workplace might have its own meaning. The "reality check" or perspective from the CDC or elsewhere might be inconsistent with the workplace

To be honest this sounds like one instance where I would go by what is considered "risk" and procedure as outlined in the workplace rather than what might be considered plausible elsewhere. Standard universal precautions, sterilized materials and gloves are the name of the game in a clinical setting. . Surely has to be an employee handbook or somewhere on your work place where you can research,  the policies of exposure, ** reporting **  and the steps that follow.

I mostly see stuff about percutaneous exposure to HCV but I suppose eczema might be considered "non-intact skin" which could have initiated the requirement to test.  There are a couple of people who have worked in healthcare and allied health on here who might be able to reconcile why it might be different in the work place.

Here is a random (Google search result) that shows has a few good charts on HIV exposure (or you might want to post on that forum)
http://depts.washington.edu/madclin/providers/guidelines/pep_occ.html

The section (III) on HCV is pretty vague though

__________________________-
HCVAdvocate on Occupational Exposure to HCV
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/occupational%20exposure.pdf
__________________________
Example of Definition of Exposure
DEFINITION OF EXPOSURE
An exposure that may place health care personnel
at risk for hepatitis B, hepatitis C, or
HIV infections is defined as:

• A percutaneous injury, eg, a needle-stick
or cut with a sharp object (or “sharp”) that
may be contaminated with blood or other
body fluid; or

• Contact of a mucous membrane or nonintact
skin with blood, tissue, or other body
fluids that are potentially infectious, eg,
semen, vaginal secretions, and cerebrospinal,
synovial, pleural, peritoneal, pericardial, and
amniotic fluids.4,5 (Feces, nasal secretions,
saliva, sputum, sweat, tears, urine, and vomitus
are not considered to carry hepatitis B,
hepatitis C, or HIV unless they contain visible
blood.)

In the case of human bites, the clinical
evaluation must consider possible exposure of
both the person bitten and the person who
inflicted the bite.
http://www.ccjm.org/content/70/5/457.full.pdf
_________________________
Be sure you are vaccinated for Hepatitis A & B
(Hepatitis B can survive in dry blood for 1 week)

[ceanothus]

I'm not an expert and I hope others will chime in on this, but I do believe that you are being advised to get tested partly as a "CYA" measure. Transmission is blood to blood, not blood to skin. There will always be some incredibly tiny risk of a still-viable viral particle getting into a tiny cut, but really, the odds have to be almost infinitesimal. Studies of hospital cases where someone gets stuck by a needle known to be contaminated with HCV still only show about 5% transmission risk, so it's hard to even think of a number small enough to represent transmission risk of skin contact with dried blood. On the other hand, any time you are worried at all you might as well get tested to gain the peace of mind.