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nurses aid with needlestick injury

Mar 20, 2006

Dear Dr.Frascino

My injury occured on Feb.2 of this year. I work not in a hospital but in a hotel which houses marginalized people most with mental illness and drug addiction. Many of our residents have hiv. And most would prefer to die in their rooms than in hospital. The resident I was caring for was dying of liver cancer and as far as I know did not progress to full blown aids. Patient also had hcv. She has since died. What happened was that I was removing a garbage bag from her room and it lightly tapped my leg, when I opened the bag I saw an uncapped needle, there was a small amt. of blood where it hit my leg. But I did not notice any blood in the barrel of the needle. I paniced and ran to my supervisor, squeezed the area and cleaned it with an alcohol swab. When we went to retrieve the garbage bag another staff member had emptied it down the shute, so we couldn't get a good look at it. But as I said there was no visible blood. Nevertheless because the patient was a known drug user and positive I was put on antiretrovirals (3 of them)within 2 hours and I took them for 28 days. It has been scary for me, because I was diagnosed with ocd many years ago, with ruminations about my health being the worst symptom. In fact many years ago I developed a phobia re: hiv and aids. Since stopping the antiretrovirals I have had a bad cold/flu, and of course I'm thinking of seroconversion, like I knew that I would. Could you please help me to come to terms with this, I really am scared to be tested. All my baseline tests were negative.

Bless you for your patience with all of us,and health to you dear Dr.

Response from Dr. Frascino


It is difficult for me to comment specifically, as I'm not exactly sure what you mean when you write "I was removing a garbage bag from her room and it lightly tapped my leg." Did the uncapped needle actually pierce your skin??? If there was no puncture, you have nothing to worry about. HIV cannot permeate intact skin. At any rate, you did the correct thing by reporting this to your supervisor. The protocol for an occupational exposure (or potential occupational exposure) is to evaluate and document the actual exposure and degree of risk. Testing for HIV and other bloodborne pathogens (hepatitis) is conducted per protocol. PEP is offered if the exposure is deemed significant enough to warrant it. OCD, AIDS phobia or whatever, the only way for you to "come to terms with this" is to follow the protocol and get re-tested. Being scared will not change the results of your tests. If necessary, get counseling or therapy for your psychological problems. From what you've written, your risk of actually acquiring HIV or HCV form this potential exposure is minimal at best. You've also taken a full course of PEP begun within two hours of the incident. You've done everything you can to prevent transmission. Take your follow-up tests as recommended. There really is no other viable or even reasonable option.

Good luck.

Dr. Bob

looking for a second opinion...

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