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Asalam Alekum ...sos Dr.Robert
Jun 28, 2008

Asalam alekum Dr.Bob, I am writing to you from the middle east.It a bit of a rarity here, but yes I am a qualified 'Lady Surgeon', having been alumni of a certain medical school in great britain.I wish to ask you a question please.I was operating upon a patient who presented with a ultra sound diagnosis of severe oligohydramnios, justifying an emergency cesarean section.Now towards the end of the proceudre, I inadvertently pricked my thumb with the suture needle, through the gloves.Now as far as I can remember, there was no visible blood of the patient on the suture needle, and the needle was solid ..not a hollow bore.Sir, we do not have a system of maintaining an occupational exposure record here, and when I enquired with the staff, they were not sure if that patient was tested for HIV antibodies.Since that event transpired, I have been trying to access information from all possible sources...eventually reaching your door step.Please tell me Dear Sir, if post exposure prophylaxis for HIV is warranted in the afore mentioned circumstances.Solid needle prick, slightly more than a superficial prick from a patient of unknown HIV status, the needle not having visible blood ....to summarise.Please do answer Dear Sir...Khuda.

Response from Dr. Frascino

Hello,

The chance of HIV acquisition from the occupational exposure you describe would be significantly decreased by several factors:

1. We do not know the HIV status of the source patient.

2. The needle was a solid suture needle.

3. The needle had to pass through a rubber glove before contacting you.

4. There was no visible blood on the needle.

I do not believe PEP would be warranted. In order to be effective, PEP should be started as soon as possible and no later than 72 hours after a potential exposure. Since you know the source patient, perhaps you could contact her and ask her to have a confidential HIV test. At any rate, the only medical intervention I would suggest for you would be HIV-antibody screening at baseline and at three and six months. You can download a complete copy of the Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Post-Exposure Prophylaxis at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm.

Good luck!

Dr. Bob



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