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Workplace exposure and HIV PEP?
Jan 8, 2006

Dear Dr. Frascino,

I am a surgery resident in Philadelphia, Pa, and I have a couple of questions regarding an incidnet that I was involved with recently.

I was teaching some med students how to do a debridement and dressing change on a patient with AIDS, and when I was finished I noticed that my latex glove had a tear and that my left index finger was covered with a sanguinous fluid from the patient. I immediatley rinsed my finger with tap water. I had no obvious percutaneous injury, but a discussion arose as to whether or not the fingernail bed consititutes a mucous membrane and whether or not there are microscopic lacerations around the fingernail? Another discussion arose involving the role of PEP in general and whether or not it was warranted in this case? Also, what is your knowledges as to the risk to surgeons involving glove failures and blood under the fingernail?

Thank you very much, and your website is excellent!

Dr. Shaw

Response from Dr. Frascino

Hello Dr. Shaw,

1. The fingernail bed is not a mucous membrane. I'd suggest you review your old dermatology and anatomy notes from medical school.

2. "Microscopic lacerations" around the fingernail are not considered a risk for HIV transmission, even if they were to exist.

3. PEP is not warranted in the "incidnet" you describe.

4. For a detailed discussion of PEP for occupational exposures, check out the "Updated U.S. Public Health Service Guidelines for Management of Occupational Exposures to HBV, HCV and HIV and Recommendations for Post-Exposure Prophylaxis." It can be downloaded from the CDC website or the MMWR. And please do those medical students a favor by giving them a copy as well.

Stay well.

Dr. Bob



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