Hep C

[rubiecita]

I was accidentally stuck with a lancet coming from a patient with hep c, I was still wearing myglobed, but it seems like it pinched me superficially. I didn't bleed and I washed the area inmediately after with soap and water. I can't determine whether or not the skin broke or not. What is the likeness that I would get the virus? I am very worried.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Hello,

The risk of acquiring Hepatitis C after a needlestick is 1.8% but in your case the risk is likely much less because the lancet did not penetrate the skin (by your history). However, just because the site "didn't bleed" does not necessarily mean that the lancet did not penetrate the skin.

Unlike hepatitis B virus, hepatitis C is not efficiently transmitted from a needlestick. The average rate of seroconversion (changing from hepatitis C antibody negative to hepatitis C antibody positive) after an occupational exposure to HCV positive blood is about 1.8%, but has ranged as high as 7-10% in some studies. This risk is highest with hollow-bore needles.

The risk of transmission usually depends on the following:
1. Viral load of the source patient
2. Amount of blood exposure that occurs; for example, how much blood was on the lancet prior to your sharps injury?
3. Type of exposure (hollow bore needle, lancet puncture, laceration, etc.)

Did the lancet penetrate your glove? (I am assuming the answer is "yes")
Do you know the patient's HIV status?
Were you seen and evaluated by your employee or occupational health department?

Please respond with additional questions.

~•~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[rubiecita]

Thank you!!!

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Hello again,

The follow-up plan for checking for Hep C antibodies is as you describe above: day of potential exposure (baseline test), 6 weeks, 3 months, 6 months, and 12 months.

Again, your risk for seroconversion is very low.

I recommend that you discuss your plans to have children with your primary care provider--the most conservative approach would be to use a barrier protection (condom) during intercourse for the first 3-6 months after a possible exposure to Hepatitis C.

However, as you see below the U.S. Public Health Service recommends the following guidelines for management of HCV exposures:

   1. Baseline testing for anti-HCV and ALT activity (liver ezyme activity)
   2. Follow-up testing at 4-6 months for anti-HCV and ALT activity or HCV RNA at 4-6 weeks
   3. Exposed individuals should not donate blood, plasma, organs, tissue, or semen
   4. Exposed person does not need to modify sexual practices or refrain from pregnancy or discontinue breast feeding
   5. When HCV infection is confirmed early, the person should be referred for medical management to a specialist in this area
   6. IG and anti-viral agents are not recommended

CDC Hepatitis C Facts:
1. HCV is not spread by sneezing, hugging, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact.
2. Persons should not be excluded from work, school, play, child-care or other settings on the basis of their HCV infection status.

I assume that you are immunized (and protected against Hepatitis B). Have you received at least 3 doses of the Hepatitis B vaccination? Have you had a test done to ensure that you have antibodies to Hepatitis B (this is called a "Hep B titer")?

I must stress to you that your risk is very low but not zero.

~•~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[rubiecita]

There was very little blood in the lancet, it penetrated my globe, but I felt it poked me but didn't really go in. I checked the site I couldn't really find any rupture of the skin. Pt. is HIV negative. I'm just very concerned that I could have gotten infected. they told me I should check myself in 6 weeks, 3 months, 6 months and then a year. I'm just extremely scared about this situation. I want to have kids and if I catch such sickness I think it is going to keep me from getting what I want in life, I wouldn't want to put my husband throught that much trouble, since it is a very serious thing.