Phlebotomy accident: Panicking
Jun 22, 2005
I have been HIV infected for 5 years. Earlier this week, I was made to be a guinea pig for a classmate to practice phlebotomy on. When I tried to refuse, the teacher didn't let me and made a crack about it just being a tiny needle.
The girl practicing on me did a very stupid thing and tried to recap the needle and ended up sticking herself. Needless to say I hyperventilated and had to disclose my status. She took PEP for 3 days before stopping because of the side effects. I couldn't live with myself if I infected anyone. My questions are the following:
1. What are the chances of a shallow needlestick transmitting HIV?
2. Did those 3 days of PEP that she took provide any protection at all?
Response from Dr. Frascino
One of the most common mishaps resulting in needlestick injuries is "recapping" of syringes and needles. Never recap a used syringe or needle is also one of the first lessons those learning phlebotomy should be taught as part of "universal precautions" to prevent occupational exposure to bloodborne diseases. That said, mistakes, of course, still happen. The risk for HIV transmission following an occupational needlestick exposure from an individual known to be HIV positive is estimated to be .3%. The overall risk would be expected to decrease if:
1. The source patient's HIV viral load was undetectable.
2. The needlestick was shallow.
3. The needle was solid rather than hollow bore.
When an occupational exposure occurs, the patient should be evaluated as quickly as possible by an HIV specialist or HIV-knowledgeable physician to determine if PEP is warranted, and if so, which antivirals should be prescribed.
Regarding your specific situation, the young phlebotomist-in-training should be evaluated by an HIV specialist. Her HIV risk would be assessed and she would get baseline HIV screening. If PEP were deemed advisable, the choice of medications would depend on what medications you have taken previously, your current medications and any known resistance to specific HIV medications.
Would three days of PEP provide any protection? No one knows. The recommended duration for PEP is 28 days.
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