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at risk of contracting HIV?
I work in the ER and recently worked with a patient who is HIV positive. He presented with a hand fracture and a laceration to his pinky finger that he had sustained 6 days earlier. The laceration was sutured and dressed. When he took the dressing off, there was dried blood on it and a small amount of dried blood around the laceration. I cannot recall if I was wearing gloves when handling him. He later washed the affected hand and I applied a splint to his hand-I know I wasn't wearing gloves when I applied the splint. I'm just wondering if there is any possibility of contracting anything from the dried blood I may have come into contact with, and if his washing his wound would have caused him to bleed again. My hands were dry from frquent handwashing but were not actively bleeding. I am 9 months pregnant and am a bit worried. Thank you for taking the time to answer my question.
Thank you for you reassurance and well wishes.
MEDICAL PROFESSIONAL
Probably my comments came across as too critical of your procedures and your understanding of universal precautions. If so, I apologize. Certainly this sort of lapse is understandable; I'm not sure it was really a lapse at all.
In any case, you really should not have any worries over this. Best wishes for a successful delivery and a healthy baby.
In any case, you really should not have any worries over this. Best wishes for a successful delivery and a healthy baby.
thank you. i always wear gloves when coming into contact with bodily fluids, but for some reason i didn't when applying the splint because i didn't think i'd be touching the laceration and it was 6 days old and not actively bleeding. unfortunately, i guess i just wasn't thinking.
MEDICAL PROFESSIONAL
Welcome to the HIV forum.
In addition to my advice below, please discuss this with your supervisor and/or the infection control professional for your institution. In almost all health care settings, there are standard protocols to assess potentially risky body substance exposures and criteria for management often vary from one place to another. And for legal and employee relations reasons, they like to know about all such instances.
My second comment is that it really should not be necessary to remember whether or not you wore gloves when managing a patient if there is any chance of contacting blood or other body secretions, tissues, etc. Undoubtedly your institution's policy, like all others', is that universal body substance precautions are automatic and routine -- i.e. gloving should be automatic if there is chance of contact. If you are not now doing that, please start!
Third comment: The reason body substance precautions should be universal is that usually health care providers simply don't know which of their patients have HIV, hepatitis B, or other blood borne infections. You happen to know that this particular patient had HIV, but the odds are strong that you have had many contacts with persons with HIV or other blood borne infections of which you are unaware.
OK, lecture over. This sounds like a zero risk exposure. Dried blood isn't likely to have any surviving HIV, and even with wet, fresh, HIV infected blood, contact with intact skin is virtually zero risk, even with a little irritation from washing etc. In the entire US, only a couple of health care providers catch HIV on the job each year, and those usually involve overt, deep sharp instrument injuries with obvious blood contamination. You don't need HIV testing on account of this event -- although of course you could always do that if this reassurance doesn't settle your fears and you would sleep better knowing you have had a negative test. If so, follow the advice of your infection control personnel about timing of the test. But you really don't need it except for psychological reassurance.
Bottom line: I see no reason for concern here, but it still would be best to discuss this event with your supervisor or the infection control team. You can expect them to affirm my assessment. Probably they will also give the same good-natured lecture I did about universal precautions.
Best wishes-- HHH, MD
In addition to my advice below, please discuss this with your supervisor and/or the infection control professional for your institution. In almost all health care settings, there are standard protocols to assess potentially risky body substance exposures and criteria for management often vary from one place to another. And for legal and employee relations reasons, they like to know about all such instances.
My second comment is that it really should not be necessary to remember whether or not you wore gloves when managing a patient if there is any chance of contacting blood or other body secretions, tissues, etc. Undoubtedly your institution's policy, like all others', is that universal body substance precautions are automatic and routine -- i.e. gloving should be automatic if there is chance of contact. If you are not now doing that, please start!
Third comment: The reason body substance precautions should be universal is that usually health care providers simply don't know which of their patients have HIV, hepatitis B, or other blood borne infections. You happen to know that this particular patient had HIV, but the odds are strong that you have had many contacts with persons with HIV or other blood borne infections of which you are unaware.
OK, lecture over. This sounds like a zero risk exposure. Dried blood isn't likely to have any surviving HIV, and even with wet, fresh, HIV infected blood, contact with intact skin is virtually zero risk, even with a little irritation from washing etc. In the entire US, only a couple of health care providers catch HIV on the job each year, and those usually involve overt, deep sharp instrument injuries with obvious blood contamination. You don't need HIV testing on account of this event -- although of course you could always do that if this reassurance doesn't settle your fears and you would sleep better knowing you have had a negative test. If so, follow the advice of your infection control personnel about timing of the test. But you really don't need it except for psychological reassurance.
Bottom line: I see no reason for concern here, but it still would be best to discuss this event with your supervisor or the infection control team. You can expect them to affirm my assessment. Probably they will also give the same good-natured lecture I did about universal precautions.
Best wishes-- HHH, MD
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