Dear Dr. Bob, Thank you for validating my reasoning and answering my question about the nonexistent risk regarding vomit that I wrote you about yesterday. I think what started as a reasonable caution and concern has run amuck and has had detrimental effects on my mental health and general well-being. I actually have my first counseling session this weekend, which was scheduled even before this incident, to help me deal with my anxiety and OCD tendencies. Thank you again for your response. I wish you the best! -Nursing student

Hi Nursing Student,

You're welcome. I'm delighted to hear you are addressing your problem appropriately. Good luck with your counseling and future career!

Be well.

Dr. Bob

Possible vomit in eye Nov 4, 2009

Dear Dr. Bob,

I am a nursing student. I have developed an intense fear of both contracting and trasmitting bloodborne pathogens. I have read your archives and current posts extensively, and so I do feel my knowledge has increased considerably. Since I know many of my fears are irrational or focusing on the most nonexistent odds, I have been focusing on not playing into these fears and not allowing myself to freak out about things that are not a risk.

Today I was caring for a pediatric pt w/ H1N1 on contact and droplet isolation. He threw up into an emesis basin, and I took it into the bathroom, rinsed it, and dried it out.

When I was leaving the room and was removing the mask, gown, and gloves I had on, I reached up to remove the mask, and the tip of my finger touched the bottom lid of my eye. Now, of course, I was plagued with an internal struggle between freaking out about this or realizing that 1. wouldn't I have known if there were even visible fluid on my finger?, 2. HIV is not transmitted through vomit, and 3. even if it were, it would have been at least a few minutes between him throwing up and me *possibly* touching my eye or bottom eyelid.

I read your archives again as soon as I returned home and that confirmed that HIV is not transmitted in vomitus - a risk only exists if there is visible blood present. Looking back, I'm relatively certain I removed my gloves before removing my mask, which would make it a nonexistent risk.

I am really trying to have a reasonable perspective on this since I know I have developed a phobia -- was I right in recognizing this as not a possibility for exposure? I know you always say we should report possibly occupational exposures, but I feel that every time I fear about something, I'd be going weekly if not more, and I know that is most likely irrational.

Please help me.

-Recovering-Phobic Nursing Student

Response from Dr. Frascino

Hello Recovering-Phobic Nursing Student,

Your reasoning and assumptions are correct. Your HIV-acquisition risk is nonexistent.

Having "an intense fear of contracting and transmitting blood-borne pathogens" is going to be an ongoing challenge for you should you continue in your present career path. You really have two options:

1. Choose another career.

2. Get counseling (psychotherapy) to help you confront and conquer your totally unwarranted and completely irrational HIV fears.

Good luck!

Dr. Bob