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Nursing Student ?? Exposure
Nov 11, 2004

First I must tell you that I think that the work that you do on this forum is wonderful in the education and allaying/dispelling any fears or myths that people have about HIV. Unfortunately we as Americans are not properly educated on these topics. Our government has done a poor job educating us in schools about this subject, particularly in the right wing southern state like I live in. I guess if you give them condoms they'll have sex, right? It's funny how in high school I took an entire year of Geometry, but hardly ever learned about HIV/STDS. I have never since used the Pethagorean Theorem, nor do I care what a hypoteneuse is, but important subjects such as sex education were basically hush-hush and swept under the rug. Sex is too popular and too prevalent to ignore, and ignorance in this case is anything but bliss. I have learned a great deal since I have been coming to this site, and you have been the only one that I feel like has given people straight forward answers without passing judgement.

OK, here goes my question. About 10 weeks ago I was involved in a delivery. When the MD cut the umbilical cord, blood splashed everywhere. It went on nearly everyone in the room, and it went in my face. I was not wearing a mask. I went to Occupational Health to report the incident. When I talked with the blood exposure nurse, she asked me if it went into my mouth. I knew it did not go into my eyes because I wear glasses and had them on. I told her that I did not know if it went into my mouth, but it was definetly around my mouth. If it did go into my mouth, it was a miniscule amount. There were only tiny specks around my mouth. She said that if it went into my mouth I would definetly know it and that it would have to be a substantial amount to even expose me to anything. We checked out the pt's labs and she was negative for all STDS and her HBsAg was negative. She had declined an HIV test. The blood exposure nurse said that in order to test this lady she absolutely had to be sure that I had an exposure because there were a lot of legal implications in asking a person a bunch of personal questions and asking them to consent to an HIV test. She assured me that if she felt that there were any risk she would follow the exposure protocol. I did fill out an incident report, so that is on file. She told me that they have 250 bad exposures a year at this hospital (it's a big teaching facility) and that they've never had anyone get anything and that I didn't need to worry. But somehow I can't help but worry. Do you think she was just brushing me off or does it really sound like a non-exposure to you?

Since this incident I find myself constantly questioning myself after doing something with a patient like looking at my hands to make sure there's no visible blood, etc. I know that there are risks involved in this job, but I really love what I'm doing and I feel that I will be an extremely loving, compassionate, caring, and nonjudgemental nurse who will provide the best care possible to my patients. Is it reasonable/expected for a health care worker to have this anxiety? I know that as I become more seasoned some of this anxiety will decrease.

Ok, so do you think it is reasonable to take a test in two weeks or is one not needed? Does it even sound like an exposure to you? I did take a test at 2 weeks and it was negative. I just wanted to be sure of my status which I was pretty sure of anyway. What do you think? Thanks so much for all that you do. I will be sending a donation, and I will definetly continue to help in the battle against this terrible disease. Oh, what a joyous day it will be when there is a cure!!

Concerned RN 2 B

Response from Dr. Frascino

Hello Concerned RN2B,

Thank you for your kind comments. I couldn't agree more with your assessment of the inadequacies of HIV/AIDS education - and sex education in general! And sex is so much more fun to learn about than algebra or physics! (Most kids are already doing the homework for that subject!)

Regarding your potential occupational exposure, you did the correct thing in reporting it and completing an incident report. Regarding HIV risk, the first thing to realize is that HIV cannot pass through intact skin; however it can be absorbed through mucous membranes, like those in your mouth or the conjunctivae of your eye. You report no blood entered your eye and that a miniscule amount, if any, got into your mouth. Based on this information alone, I, too, would assess your HIV risk as extremely low to nonexistent. I certainly would advise against PEP (post-exposure prophylaxis).

As for HIV testing the source patient, I have never met any resistance by merely explaining the situation to the patient and asking if we could run an HIV test. Knowing there's been an accident (needle stick) or other type of occupational exposure (spurting umbilical cord), patients generally readily consent to testing. So you might revisit that option.

As for your getting periodic HIV tests per the occupation exposure protocols, if the source patient refuses to be tested, that is ultimately up to you and your occupational health team. Your transmission risk is extremely minimal; however, this was a potential occupational exposure. Consequently, testing could be considered, although all things considered, I don't think it's absolutely necessary.

You might also discuss your work-related anxiety stemming from this event with your occupational health department. We all need a healthy respect for the risks involved in our profession, but constant self questioning and anxiety are neither expected nor reasonable. Some counseling may be helpful.

Thank you for your donation and for joining the battle against HIV/AIDS.

Stay well!

Dr. Bob



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