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Needle Stick Injury to Girlfriend
Oct 21, 2002

My girlfriend, a nurse, was giving a subcutaneous injection of heparin into the patients abdomen who is HIV +. On the needles way out, he flinched, and she stuck her finger and it bled a little. However, she did observe that the patient did not bleed as far as she could tell. She quickly cleaned her finger with alcohol and Bentadine (spelling) and sqeezed out any blood from her finger. She started taking Combivir that night, and has a 28 day supply of the drug.

Obviously we are a little nervous. We know how small the odds are, 0.3 I believe, but need some answers and reassurance.

A couple questions:

After how many tests and months is it safe to say that she is -?

Does the fact that the drug was heparin decrease her chances of transmission?

Response from Mr. Kull

Data collected regarding HIV transmission to healthcare workers via accidental needle injuries show that transmission is uncommon through this route. One source estimates a .3% risk of HIV infection after a needlestick exposure to HIV-infected blood. Only 56 confirmed cases of occupational transmission have occurred in the United States as of June 2000. Factors that might increase the risk of transmission are: depth of the puncture, size and type of needle (hollow-bore needles pose a greater risk), where the puncture occurs (vein and artery punctures are greater risk), and the viral load of the host. Punctures that produce spontaneous bleeding might pose a greater risk. A person who is in very early or late-stage of HIV disease is more likely to have a higher viral load, possibly increasing the risk to the person experiencing the needlestick injury.

Studies evaluated by the CDC suggest that a person is greater risk when there is a larger quantity of blood exposure. This is measured by "a) a device visibly contaminated with the patient's blood, b) a procedure that involved a needle being placed directly in a vein or artery, or c) a deep injury."

If possible, post-exposure prophylaxis should not be discontinued until the entire regimen is completed. The CDC recommends a 28 day/4 week treatment with an approved antiretroviral regimen. Treatment should not be stopped based on testing performed during treatment. After treatment is completed, antibody testing should be conducted periodically during the six months following exposure (the CDC suggests, as an example, testing at 6, 12, and 24 weeks following exposure).

See the CDC's publication on Exposure to Blood.

I'm not aware of any evidence that suggests that Heparin would reduce your girlfriend's risk for infection.

RMK



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