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CT tech from the great white north needs your help:)
May 19, 2008

hi dr bob:)

hoping you can help me. i was doing a contrast CT scan on a HIV+, HEPC+ patient yesterday. i hooked up the CT tubing to a port on an already existing line (the port was about 4-6" from the hub). i ran 70ccs of contrast through the line and an additional 10 cc's of saline afterwards. however when i went to disconnect the CT pump line from the port, and reconnect an additional 10cc saline flush to the same port, i got splashed in the eye with either what i presume to be sterile saline or residual IV contrast (since no visible blood was present at or around this port and no backflow of blood cold be seen in the line). i reported the incident to the ER in our hospital and the ER doc didn't think i needed PEP cause the exposure was most likely to a sterile solution and positive pressure had been run through the line prior to my being exposed. my questions are however

A) what if that port was previously used to draw blood from the patient. would the 70cc's of contrast i ran through the line clear out any residual HIV cells from the port?... just concerned that maybe an errant cell of two were sitting in the port and the contrast didn't clear them down the line... i'm being maybe a bit paranoid???

B) do you agree PEP was not warranted in this situation

C) i can't find an exact risk for this scenario... what do you think it is? (source patients line is on a known HIV+ source who is a street person not on HAART with an unknown viral load).

I'd greatly appreciate your expertise in this matter dr bob... i live way way way up north in the Canadian wilderness and experts such as yourself are hard to come by.

will donate.

MAny thanks

Response from Dr. Frascino

Hello Great White North CT Tech,

A. Your concerns about an "errant cell or two sitting in the port" are unwarranted as far as transmission of bloodborne pathogens for this type of occupational exposure. Consequently I'd agree you are ". . . being maybe a bit paranoid."

B. Absolutely. PEP was not warranted.

C. Regarding "exact risk for this situation," the risk for occupational transmission of HIV following a mucous membrane exposure is approximately 0.09% (confidence interval 0.006% to 0.5%). Your specific risk would be even less, as the chances you actually had an exposure are negligible. You can download a copy of the formal guidelines for occupational HIV exposures at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm. For potential occupational exposures not serious enough to warrant a course of PEP, the guidelines suggest HIV-antibody testing at baseline, three and six months.

Thanks for your pledge to donate to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated. In return I'm sending you my good-luck karma. I'm extremely confident you did not contract HIV from the potential exposure you described.

Be well. Stay well.

Dr. Bob



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