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Intraocular scissors prick-it is hard to be o doc
Sep 22, 2004

Dear Dr.Bob

It is hard to be a dotor this days. You try to do your best in he helping people and you get the human fullfilment when you suceed. But also in the package come the things that are making our job very hard:the pressure of the society that we must not make a mistake,constant lack of free time due to the enormous time we spent in continuous education,risk for your own health (who would better kno this than you) etc.

I am an eye fellow and was assiting a vitrectomy ( intraocular procedure).When attempting to grasp an intraocular scissors I sustained a small prick to my little finger. I inspected the latex glove but found no visible hole, nor I felt any pain. Latter after the op was done, I filled the glove with water and thar was a small leak. Also I notices a little scrath on my corresponding little finger(redish).

I checked with the CDC and they say the overall risk for percoutaneous exposure is 0.3% but can vary.

Please say, please: would this fit into that cotegory of "normal risk " or increased risk ( where the percantage would be higher ).

I assume it wouldn't count as an increased risk ( like hollow bore nidle stuck), but when one is in fear all rational thinking is gone.

The patient was 68, and of no increased risk (can't do the test on him).

Much thanks to you and I wish you a lots of health and love.

Marco

Response from Dr. Frascino

Hi Marco,

I'll make just a couple of general points before specifically addressing your problem. First, all occupational exposures should be reported to your occupational health division and be well documented. Protocols and procedures for proper evaluation and management of occupational exposures to blood-borne pathogens (not only HIV) are, or at least should be, in place in all hospitals, medical centers, clinics, and health centers. Second, I've found that when patients are informed there was an incident during a procedure, they are generally very willing to consent to HIV and hepatitis screening. Third, if an occupational exposure is felt to be significant, PEP (post-exposure prophylaxis) should be started as quickly as possible and definitely within the first 72 hours.

Turning now to your specific situation, from what you told me, your risk would be extremely minimal low-risk patient, minimal puncture, solid needle, etc. Also, as you know, intraocular procedures do not expose the surgeon to copious amounts of blood or other infectious fluids. Therefore, I would certainly advise against PEP, but I would still document the incident and follow the evaluation protocol.

Hang in there Marco, practicing medicine is a privilege afforded to very few of us. You'll find things get a bit easier as time goes on and as you become surer of yourself.

Stay well!

Dr. Bob



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