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Nervous medical student with a few questions!!!
Apr 23, 2009

Hi Dr. Bob,

Just want to start off by saying that you are the best doctor around, and your forum is amazing and such a help to so many people!!! I am a medical student, and I have some questions regarding HIV. I find that since I have started my clinical rotations, I have had some fears about contracting blood borne infections. There have been several occasions where I thought that I may have contracted infections, and I contacted occupational health and they reassured me for these times. I would really appreciate your opinion on a few of my situations, and either you could tell me that I have OCD and my fears are unwarranted or that they are rational and I'm not crazy. I do try to practice universal precautions when I can, but of course I am human and mistakes have been made in the past. I love medicine, and although I do have some fears, I plan on continuing in medicine.

What is your opinion on this situation: I got some blood on my hands from a patient's leg wound in the ER. I would have worn gloves before examining this patient, but I did not see that his leg was bleeding before I exained him. I had some hangnails and dry skin on my fingers, but no big cuts on my hands. I'm unsure if the blood made contact with my hangnails or dry skin, but it very well could have. Occupational health reassured me and did not feel like testing was beneficial, but I'm nervous about this scenario because I did get some blood on my "non-intact skin". The patient's HIV status is unknown and I do not remember this patient as it happened 1 month ago. What is your opinion on this scenario and do you think I need testing out to the 6 month mark for this scenario?

Another "possible exposure" happened when I was talking to a patient and I thought that maybe some of his saliva had sprayed and landed in my mouth while we were talking. I know that saliva is not contagious in terms of HIV, but he had a bleeding cancer in his mouth and thus there may have been an exposure. do you think that this could have been an exposure or is this an irrational worry. I just felt while we were talking that he may have sprayed me with his saliva and it landed in my mouth as I felt some wet drops in my mouth. Do I need testing for this scenario and to what extent?

I also wanted to ask you one more thing. When somebody has a potential exposure and the source patient is tested and is negative, are any further tests necessary on the person who may have had the potential exposure?? I ask because I what happens if the source patient is in the window period (but not having any symptoms. Is this reason enough to continue testing the exposed person up to 3 or 6 months as per the guidelines, or does a negative test in the source patient make it sufficient enough to stop all further testing and conclude that there was no significant exposure.

Dr. Bob, thank you so much for your responses and help. I fully trust what you have to say and would really really appreciate a personal response from you since I know that I can trust your expertise. I have heard a lot of different opinions on this matter. I will donate this week to your foundation as you ae such an inspiration!!!

Nervous Medical student

Response from Dr. Frascino

Hi Nervous Medical Student,

Thanks for your kind comments.

Situation one: I would agree with the occupational health assessment. If you are worried, you can follow the protocol for occupational-exposure testing (immediate, three months, six months). Certainly PEP was not warranted.

Situation two: No risk. Testing not warranted but always available if you need it for psychological peace of mind. (The result would unquestionably be negative.)

If the source patient of an occupational exposure tests negative, this is certainly very reassuring. It is true he or she could still be in his or her window period; although the chance of this actually being the case is remote at best. The health care worker can continue to get tested per protocol, but his chance of acquiring HIV would be exceedingly low.

Finally, since this seems to be a recurrent issue for you, I'd suggest you download a copy of the update guidelines for evaluating occupational exposures and when to use PEP (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm). You should find this document enlightening and reassuring.

Good luck.

Dr. Bob



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