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A Gynec's query
Oct 9, 2007

Dear Sir, I have been going through the archives quite regularly, especially queries pertaining to occupational related risks.I am a Gynecologist, and I carry out surgical procedures almost on daily basis in a private hospital.Now, as most surgeons would agree, superficial suture needle pricks are almost an everyday occurrence while operating. Here in our Private Hospital, as well as in most other hospitals, it is mandatory for every patient or pregnant women, to be subjected to ELISA Test For HIV 1&2, pre-operative.Patients are then taken up for proposed procedures after confirming their NEGATIVE status for HIV1&2. I took the test myself about 2 months ago, preoperative , for an Appendectomy surgery.The test came back Negative. MY query to you Dr.Bob- The superficial pricks that are inflicted when using suture needles, through the Gloves, without visible puncture wounds on our hands, from HIV Negative patients are almost inevitable.There are moments of extreme anxiety sometimes when they do happen, I must confess. The aforesaid 'pricks', are they extremely risky as far as occupational transmission of HIV are concerned? There's a chart in our Operation Theatre which says, superficial pricks from HIV Negative sources-NO P.E.P.required, Deep pricks from HIV Negative sources- No PEP required.Kindly inform me of the risks involved with these inevitable pricks.Awaiting your expert opinion Dear Sir, which I sure hope would help me be far more calm and relaxed.......

Response from Dr. Frascino

Hi,

I'm disappointed that you still would have concerns after not only completing a medical degree, but also an OB/Gyn residency. Obviously our HIV/AIDS training remains suboptimal, even at the post-doctoral educational level!

I'm curious why you would even ask if "superficial pricks from suture needles, through gloves, without visible wounds, from HIV-negative patients are extremely risky as far as occupational transmission of HIV is concerned"!?!?! Are you wondering about the chances of an HIV-negative patient possibly being in her window period and therefore testing HIV negative, even though she is HIV infected? Are you questioning the accuracy of your occupational exposure guidelines, which clearly state "superficial pricks from HIV negative sources no PEP required"??? What I can tell you is that I wholeheartedly agree with the posted guidelines regarding PEP.

My advice is that you download and review the readily available information and published guidelines from the CDC (Centers for Disease Control) addressing occupational exposures (Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HVI and Recommendations for Post-Exposure Prophylaxis, http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm.)

If you have additional questions after reviewing this information, don't hesitate to write back. Your fears are unwarranted based not only on the science, but also on the epidemiology of HIV transmission in an occupational setting.

Dr. Bob



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