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please help a worried resident
May 6, 2009

Dr. Bob,

I want to start off by saying that your advice is so helpful and even though I am a resident and can look up official guidelines and advice, I often refer to this site for any questions I have pertaining to HIV. I have a question for you. I was on call one night, and there was a ptient who had a cardiac arrest. The crash cart was present, and I was acting quickly. As I was approaching the patient, my arm brushed up against the disposed sharps container and I may have felt a prick, although I am unsure if I was pricked by something or if I was scratched superficially by the container as they are quite sharp. I remember looking at my skin right after the incident, and did not notice any blood or wound. The following day, on my arm, I did notice a red papule on my arm- could have been a folliculitis or possibly a needlestick wound? Im unsure. I remember looking down at the box right after the incident and did not see a needle sticking out at that time, but I couldnt help but think that maybe I got pricked by a needle that then fell back in the box. I called occupational health the next day, but the nurse reassured me and said that if there was no initial wound, then there really is very little risk, and in addition, the virusesdont last for long time outside the body. She offered me testing but said it was unnecessary. What do you think about the story? Your opinion is very valuable to me. To be honest, it happened very late at night, and Im unsure if I got pricked but it is a possibility? Do you think I should get tested up to 6 months, and after how much time could I be reassured that I did not get infected by HIV or hepatitis C from this incident

Thanks a million for your help.

Response from Dr. Frascino

Hi,

I would agree with the assessment of the occupational health department: negligible risk. Even though you can always ask me questions, because you are a resident, I urge you to download a copy of the updated guidelines regarding occupational exposures for your own edification. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm )If you remain worried, get HIV tested per the guidelines (baseline, 6 weeks, 12 weeks and 6 months). A single assessment for hepatitis C is all that's required. From the description of the event provided I agree testing is certainly not essential.

Good luck.

Dr. Bob



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