Med Student, hiv/hep risk?

[ledzepp880]

I am a medical student, working in a city hospital, had something happen today which I would like to know if I am at risk for after much debate.A few friends and I were practicing exam techniques on each other (specifically neuro exams).Someone had a reflex hammer (essentially same model as seen here – not sure if you’re familiar w/model/type, here it is though (below) has a brush/stainless steel “blunted pin” to test touch/sensation.The problem I have is one of the students used the small “pin” shaped tool which comes in the reflex hammer when trying to test sensation on hand/foot.Now the “pin” comes w/the reflex hammer (as you can see), is NOT a hollow IV needle but a short, semi-rounded-tip, stainless steel rod.The “point” at the end/entire device (which screws into the hammer) is very similar to the piece you attach to the end of a bicycle pump to pump up a basketball (definitely not as sharp as a needle tip, but maybe a little more “pointy” than a pen, NOT hollow at all/solid steel).Now as we were examaining each other, my friend realized/informed me that he had examined a patient earlier who was hiv/hep positive and did not clean it off with any alcohol/wipes (just screwed it back into hammer).I checked for any cuts, washed, did not find any.We began to debate as to whether or not I was at any real risk.No visible blood on “pin”, no visible cut on me, but he was “sliding” the hammer-pin along my skin to elicit neurological signs.Do I need to consider a) PEP b) hiv/hep testing?I have a fiancé (both have no risk factors c) isn’t the purpose of this pointed tool in the reflex hammer to ensure no skin trauma/blood transfer (as in using syringe),therefore would be fine/nothing to worry about, d)forget about it or get pep/tested?If you could give me an accurate read, been really nervous ever since.

[Edward W Hook, MD]

I agree with your plan.  No need for a "special" screening related to this exposure.  EWH

[ledzepp880]

Thanks a lot doctor, have been tested routinely for hiv/bloodborne pathogens as routine, health-screenings (completely agree with your statement on everyone getting tested - its VERY inportant. I meant more as a "baseline" for this event-on (but as you pointed out, no need for PEP/discontinued contact so I will just resume w/my usual hiv/bloodborne screenings/percautions and follow my routine care/sscreenings and not do extra testing for this event).

Thanks a lot for your time, help and experience. It really helps to have someone w/your experience and credentials ease some of the anxiety I was getting over what transpired. All the best.

[Edward W Hook, MD]

I see no need for PEP realted to what you have told me.

No need to abstain from contact with your significant other.  On the other hand, for everyone, it is good to have a baseline HIV test.  EWH

[ledzepp880]

Thanks so much for your response...so am I correct in assuming that I should not pursure/push for any PEP, and should I also be getting baseline/ongoing testing and discontinue any sexual contact with my fiance, or is that overkill, not really enough of a risk to warrant any of the above?

Thanks again for all of your time and quick response.

[Edward W Hook, MD]

The risk from this exposure is low and perhaps non-existent.  For you to have gotten either HIV or hepatitis C from this exposure, your friend would have needed to break the skin of the infected patient he examined, had the virus (either one) survive on the surface of the needle and then be introduced through your skin. This is just not a likely scenario.  As you point out the pin was not hollow pointed and therefore unlikely to transfer any blood. further, I presume your friend is not so heavy handed as to have broken both the patient's and your skin.  I would not worry,.

FYI, from a pathophysiological perspective the hepatitis C is far more infectious than HIV as well.  There are numerous reports in which persons exposed to dually infected patients acquire hepatitis but not HIV.  The hepatitis virus is thought to be far more infectious than HIV.  Further, as you may know, there is no recommended preventative therapy for hepatitis C exposure at this time.

At the same time, the scenario you describe is exactly the reason why for your neuro exams you should use a fresh pin for each patient.  My neurologist colleagues buy safety pins 100 at a time.

I hope this is helpful. I would not worry if I were you but I would buy your friend a different reflex hammer.  EWH