Risk of HIV transmissin

[bshattuc]

While assisting with a fine needle aspiration on an HIV positive patient, I was to expell some blood from a 23 gauge needle into a test tube of culture media (BHI BROTH).  The specimen clotted and depressing the plunger caused the needle to shoot off into the test tube and I felt a rush of air came back at my face with a harsh gurgling sound.  I didn't feel any droplets and wasn't initially worried but now, about 15 hours later, I am unable to sleep.  Please help.

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

Great news.

Be well.

~•~ 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.

[bshattuc]

My DNA PCR was negative and I am feeling much better.  I am awaiting the traditional follow-up testing at 6, 12, and 24 weeks.  Hopefully, all will be well.  Thank you so much for the follow up!

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

Any updates? How are you feeling?

~•~ 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.

[bshattuc]

Dr. Parks,

They recommended a DNA PCR and my symptoms are decreasing...less nausea and occasional diarrhea.  Now I am afraid of the false positive rate vs actual seroconversion.  This has not been a fun experience even though I usually love my job.  I am waiting until Friday for the results.

bshattuc

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

How did your appointment with Occ Health go? Do you continue to have the symptoms that you describe above?

~•~ 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.

[bshattuc]

Thank you Dr. Parks,

I took your advice, reported the incident to Occupational health and was advised to have follow up testing with six, twelve, and twenty four week ELIZAs.  I was not offered PEP due to the low risk of exposure I described.  It is now 18 days after the event and I am having gastroenteritis symptoms: nausea and diarrhea without fever, lymphadenopathy, rash, or headache.  I am starting to worry that this is acute retroviral syndrome and the timeline fits.  I am awaiting Monday morning to consult with Occupational Health but am freaking out a bit right now.  Any insight or advice as to what to do next?  I am not scheduled for a test for approximately 4 weeks.

bshattuc

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

Hello,

It is very difficult to quantify your risk based on the events that you describe--yet, your risk is low but not zero.

I recommend that you discuss the event with your Occupational/Employee Health department regarding whether this should be classified as an exposure or not.

~•~ 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.

[bshattuc]

Thank you for the answer.  I appreciate your assitance.  I hope I can provide enough detail to better clarify for you.  

No, I was not wearing eye protection since I was not performing the procedure, only assisting with specimen collection.  I was wearing gloves and an apron.  

The patient has a known viral titer of 15000copies/ml and there was blood in the syringe and needle hub.  I believe the blood within the needle itself clotted so the when I depressed the plunger on the syringe to place it the culture broth, it caused the needle to come off of the syringe (it was not a luer lock device).  The free air in the syringe caused either an aerosol or droplets of a mixture of the culture broth and the blood from the lymph node aspiration back out of the test tube.  

My face was approximately 15 cm from the top of the test tube.  I felt a rush of air on my face and saw a fine spray on my gloved hands holding the test tube and depressing the syringe.  I did not see or feel a spray of liquid on my face or eyes.

At the time I did not think much of the issue given that I did not perceive liquid on anything other than my gloved hands.  I woke up later that night, however, terrified that I may not have percieved a fine droplet spray, especially given that I did feel air turbulence on my face.  

Given that less than a cc of fresh lymph node aspirate and blood would have been in approximately 5 cc of BHI liquid media, what are my chances of a fine droplet or aerosol in my eye transmitting HIV? Also, given that I did not perceive a droplet or splash to the eye, should I report this as an exposure?



Thank you!

Worried path tech.

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

Hi,

A question for you: Were you wearing eye protection?

Here are the usual statistics that are used to describe risk when people have had an exposure to blood or bodily fluids when the source patient is HIV positive.

Risk of seroconversion to HIV+ after exposure to blood or bodily fluids from a HIV+ source patient: 0.03%

With mucous membrane exposures (for example to the eyes), the risk may be even less.

Other factors that are important: the amount of blood or bodily fluid that is transferred from the source patient to the exposured person; the viral load of the source patient; the nature of the exposure (needlestick, laceration, mucous membrane, etc).

What specific questions do you have?

~•~ 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.