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RE Medical Student, you are the only one who cared
Feb 1, 2004

Hi, Dr. BOB, I hope this message finds you well and happy.

Three months ago I sent you a post which you replied (thank you so much), it was about getting blood all over my hands while I was cannulating a patient.

I took your advice and spoke to the occupational health people, but they said it was a low risk exposure therefore they are not going to follow it up, also they said they are not going to test the patient HIV status because it will be unethical.

I just feel that everything was based on assumption, that they assumed the patient did not have HIV and my hands with some hangnails on it was not a significant route for transmission.

They made me feel that they really didn't care.... thanks God you replied otherwise I would have been so lost and helpless

Anyway, I went to the GUM clinic and have myself tested for HIV and HepC at 11.5 weeks and it came back negative, feel really good for a few days until someone told me I have to test again at 6 months that the 3 months test was not conclusive. (apperently there are some studies suggests that occupational exposure is different to sexual transmission, that people who had occupational exposure takes longer to seroconvert)

I just want to forget about it and get on with my studies, what is your advice? Believe my 3 months test that I am negative? or test again at 6 months.

Your little med student form the UK

Response from Dr. Frascino

Hi Little Medical Student,

I'm quite surprised by the response you received from the occupational health folks. I'd suggest going to the head of your training program (make sure it's an M.D.) and advise him/her about what has transpired. Demand that an incident report be filed and tell them you are not satisfied with the advice you received form the occupational health folks, because it is not consistent with published guidelines for the type of occupational exposure that occurred. You can refer them to the CDC updated Public Health Service Guidelines for Management of Occupational Exposures. (MMWR June 29, 2001/50 (RRII); 1-42. I'm quite sure guidelines in the U.K. are very similar.

It is not "unethical" to contact the source patient and advise them of the incident. Most patients are very willing to be tested in this situation. It seems to me the only thing "unethical" here has been your treatment by the occupational health department.

Your 11.5-week test results are very encouraging, and you are indeed most likely not HIV-infected. The guidelines here in the U.S. do call for testing at six months for "significant exposures". Without a much more detailed history, I cannot advise you on how significant your exposure was. An HIV specialist (and presumably the occupational health folks) should be able to more accurately assess that risk.

An exposure that might place you at risk is defined as a percutaneous injury (needlestick or cut with a sharp object) or contact of mucous membranes or non-intact skin (skin that is chapped, abraded, or afflicted with dermatitis, etc.) with blood, tissue, or other body fluids that are potentially infectious. Screening should include not only HIV, but also hepatitis B and C.

Medical student, you are most likely fine, but I am disappointed in the evaluation you've had so far by your training program. Speak to the director. Ask for a copy of the occupational exposure guidelines, and don't be shy about demanding the appropriate evaluation, if warranted.

Good luck with your studies. Perhaps someday you'll consider a career in immunology and/or HIV medicine?

Dr. Bob



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