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Exposure through a cut?
Hi Doctor,
During an internship in an obstetric facility, I was attending to a patient of unknown HIV and HCV status and I received two or three droplets of blood mixed with amniotic fluid on the intact skin of my wrist. I know that contact with intact skin does not constitute a risk, but I'm afraid about possible contact with a paper cut acquired earlier during the day about 1 or 2 mm deep and 5 mm long on the back of one of my finger while I was washing my hands afterwards. I washed my hands about 2 minutes after receiving the blood on my wrist and I think the blood had started to dry but I'm not sure. I then used ordinary soap and water to first wash my wrist but then I think I used the same foamy water to wash the rest of my hands instead of rinsing it off completely before putting it in contact with my fingers where the cut was. I'd like to know if the contact between the cut and the mixture of blood and foamy water is considered a risk.
I'm worried because this happened a few weeks ago and I didn't take PEP because I realised the possible contact too late afterwards. Also, I can't assess the risk of infection for the patient (drug user? sex worker?). All I know is that she seemed to be in a stable relationship for the last few months, but she had had three voluntary abortions in the past after contact with one or more different sexual partner(s) (not the same partner as the one she currently has).
I know the risk must be very small, but I'd like to know if you consider this an exposure and if I should get tested (at 6 weeks, 3 months and 6 months post exposure according to the guidelines I think?). I already didn't take any chance for contact with my sexual partner and we practice safe sex.
Thank you for your answer
During an internship in an obstetric facility, I was attending to a patient of unknown HIV and HCV status and I received two or three droplets of blood mixed with amniotic fluid on the intact skin of my wrist. I know that contact with intact skin does not constitute a risk, but I'm afraid about possible contact with a paper cut acquired earlier during the day about 1 or 2 mm deep and 5 mm long on the back of one of my finger while I was washing my hands afterwards. I washed my hands about 2 minutes after receiving the blood on my wrist and I think the blood had started to dry but I'm not sure. I then used ordinary soap and water to first wash my wrist but then I think I used the same foamy water to wash the rest of my hands instead of rinsing it off completely before putting it in contact with my fingers where the cut was. I'd like to know if the contact between the cut and the mixture of blood and foamy water is considered a risk.
I'm worried because this happened a few weeks ago and I didn't take PEP because I realised the possible contact too late afterwards. Also, I can't assess the risk of infection for the patient (drug user? sex worker?). All I know is that she seemed to be in a stable relationship for the last few months, but she had had three voluntary abortions in the past after contact with one or more different sexual partner(s) (not the same partner as the one she currently has).
I know the risk must be very small, but I'd like to know if you consider this an exposure and if I should get tested (at 6 weeks, 3 months and 6 months post exposure according to the guidelines I think?). I already didn't take any chance for contact with my sexual partner and we practice safe sex.
Thank you for your answer
MEDICAL PROFESSIONAL
"Broken skin" is one of those HIV risk factors that is often stated for theoretical reasons, but there are very few case reports of such transmission actually occurring. Fibrin and other barriers develop quickly, even in recent wounds, and for the most part HIV transmission though the skin appears to require direct injury with contaminated instruments -- and occurs rarely through contact of blood with healing cuts, eczema, other skin rashes, etc.
Even in very low concentrations, soap instantaneously kills HIV and other viruses. A few seconds probably indeed is sufficient.
I'll be happy to comment one more time if and when you return to report the outcome of your discussion of this event with the infection control personnel and/or another consultant, such as a local ID specialist. Until then, I won't have any additional comments or advice.
Even in very low concentrations, soap instantaneously kills HIV and other viruses. A few seconds probably indeed is sufficient.
I'll be happy to comment one more time if and when you return to report the outcome of your discussion of this event with the infection control personnel and/or another consultant, such as a local ID specialist. Until then, I won't have any additional comments or advice.
Thank you for your prompt answer and your advices.
I must admit I'm a bit curious about what is considered broken skin though, since I've read on uptodate it is associated with a 0,09% risk when in contact with a splash of blood. Does the wound need to be still actively bleeding, or do the edges of the cut need to be very widely apart? And am I right to assume from your previous answer that a cut where the edges are almost completely approximated (but still can be seen) but that burns when you use alcool soap is not broken skin (as in my case of papercut)?
Also, I've read one of your posts where you say that soap kills the virus. Are just a few seconds of direct contact with soap during regular handwashing sufficient (like the time used when rubbing directly the area where the blood is) ?
Thank you again.
I must admit I'm a bit curious about what is considered broken skin though, since I've read on uptodate it is associated with a 0,09% risk when in contact with a splash of blood. Does the wound need to be still actively bleeding, or do the edges of the cut need to be very widely apart? And am I right to assume from your previous answer that a cut where the edges are almost completely approximated (but still can be seen) but that burns when you use alcool soap is not broken skin (as in my case of papercut)?
Also, I've read one of your posts where you say that soap kills the virus. Are just a few seconds of direct contact with soap during regular handwashing sufficient (like the time used when rubbing directly the area where the blood is) ?
Thank you again.
MEDICAL PROFESSIONAL
Welcome to the forum.
Getting HIV infected blood (or HCV or HBV infected blood) on intact skin carries zero risk for transmission, regardless of a recent paper cut. You really shouldn't be at all worred about this event. (Most likely the main response of the infection control team will also be that there was no risk.) I see no need for testing, and if I were in your situation, I would continue unprotected sex wtih my wife with no worries.
Even if there had been a serious exposure -- like a sharp instrument injury contaminated with the patient's blood -- it sounds like the patient is at low risk for HIV, and I would not have recommended PEP. However, the patient could be tested for HIV, HCV, and HBV. You should discuss this aspect with the institution's infection control personnel. They are in a position to contact the patient and ask that s/he be tested, should you wish it and if they agree it is warranted.
Unless the infection control team recomments otherwise, I see no need for testing, and if I were in your situation, I would continue unprotected sex wtih my wife with no worries.
I hope this helps. Best wishes--- HHH, MD
Getting HIV infected blood (or HCV or HBV infected blood) on intact skin carries zero risk for transmission, regardless of a recent paper cut. You really shouldn't be at all worred about this event. (Most likely the main response of the infection control team will also be that there was no risk.) I see no need for testing, and if I were in your situation, I would continue unprotected sex wtih my wife with no worries.
Even if there had been a serious exposure -- like a sharp instrument injury contaminated with the patient's blood -- it sounds like the patient is at low risk for HIV, and I would not have recommended PEP. However, the patient could be tested for HIV, HCV, and HBV. You should discuss this aspect with the institution's infection control personnel. They are in a position to contact the patient and ask that s/he be tested, should you wish it and if they agree it is warranted.
Unless the infection control team recomments otherwise, I see no need for testing, and if I were in your situation, I would continue unprotected sex wtih my wife with no worries.
I hope this helps. Best wishes--- HHH, MD
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