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worried well...not again
Jun 20, 2008

I'm sorry to do this as I have read other repeaters and thought, man they need to relax. So here I am posting again. I think I should give much more detail as you stated that my post had limited info.

I was doing a finger prick on a patient with no gloves ( in a rush....dumb) his blood dropped onto my thumb and went under my nail. He has no known HIV, and doesnt appear to have high risk behavior for contracting it. Since I don't KNOW his status, if he did have HIV can I contract it in this way? I had no obvious cuts on my hands, but it did get under my thumb nail. What are the risks associated with fingernails, or cuticles if there is no obvious injury?

It has been a lesson learned on getting in a hurry, I just am not sure what to do about my family. Should I be afraid of having sex with husband until the 12 weeks test? Should I even get a test?

My employer feels it is not nessecary to test me or the patient because of the way it happened, yet I worry daily

Response from Dr. Frascino

Hello,

Even with the additional information, my assessment and advice remain unchanged. If you had had a formal incident report filed and evaluation by occupational medicine (or whoever does the occupational exposure evaluations), all your questions would be answered by now. I cannot fully evaluate you over the Internet (unable to examine you, etc.). What I can tell you is that if your skin was intact, the HIV risk is nonexistent.

If you are worried, and clearly you are, use condoms with your husband until you get your definitive HIV test results back. From what you've told me so far, the only reason to test would be to put your residual (and unwarranted) worries permanently to rest.

Good luck.

Dr. Bob

blood under fingernail Jun 16, 2008

I know you get swamped with many questions but I couldnt find another like mine which is why I am asking again:

As a nurse I had a patients blood drop onto my thumb and go under my thumbnail ( I am mad at myself for being in a hurry and not using gloves)I washed my hands and reviewed the patient's chart to find no documented HIV or any other infectious diseases. His social behavior was not essentially high risk ( married, not a drug user, no trasnfusions). So although I do not KNOW his HIV status it appears that he may be ok. IF not, what is the likelyhood that I would contract HIV in the manner I described? I had no visible cuts, although my skin gets kind of dry on the ends of my fingers, but not to the point of bleeding at all. My supervisor feels I need to get a baseline test and then go from there. Is this just precautionary or is there a real risk that I should be concerned about?

Response from Dr. Frascino

Hi,

All potential occupational exposures should be reported to occupational health and an incident report should be filed. Your risk would then be documented and you would be given advice about testing or PEP (post-exposure prophylaxis) if needed. All healthcare facilities have policies and procedures in place for workers potentially exposed to blood-borne pathogens (hepatitis, HIV, etc.). Your supervisor shouldn't be advising you about the need for testing, but rather instructing you to follow the established guidelines for a potential occupational exposure. That said, from the limited amount of information given in your post, I would not anticipate that you had a significant exposure. You can read more about occupational exposures in the archives.

Good luck.

Dr. Bob



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