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Possible Transmission to Nurse in Labor and Delivery
Jan 11, 2008

I am a nurse in a labor and delivery unit. I was taking care of an HIV positive patient who refused medication during her pregnancy because she did not believe she had HIV (they are from the Congo). In preparation for the section we were able to get 140mg of AZT in her as a loading dose, and had 70mg/hr of AZT running up until the cord clamping of the baby. Her last known viral load was 4000. Approximately 1hr after the cord clamping, this patient started to hemorrhage slightly. I de-gloved but had not washed and may have still had non-visible microscopic amounts of dried blood, along with possibly amniotic fluid, vernix and maternal urine (I am thinking worst-case scnario here). In this chaos, I managed to have a plastic container shatter in my hand cutting me in 3 places... 2 rather superficial and one a few millimeters deep and 2.5 cm long. When I reported this to our occupational health and safety I was told I likely was not exposed since there was no visible blood on or near the cut areas, and should not be worried. What are your thoughts on this situation?

Response from Dr. Frascino

Hi,

From your description of the events, I would agree with the assessment of the occupational health physician. In situations like this where an exposure is "not likely," certainly PEP is not warranted. HIV testing may or may not be warranted, based on the circumstances and your degree of concern. If you remain worried, request HIV testing now (baseline) and again and three and six months, which is the recommended protocol for occupational exposure.

Good luck.

Dr. Bob



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