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csf exposure (CSF EXPOSURE, occupational exposure to cerebral spinal fluid)
Oct 16, 2009

while helping an intern during an LP on an HIV+ pt, csf leaked onto my scrubs. i didnt think much of it at first, but remembered that I had a scab about the size of a nickel on my shin where the csf leaked. does this pose a risk? what if i touched my scrubs and then touched my eye a few hours later?

Dr. Just trying to help people

Response from Dr. Frascino

Hello,

Your HIV-acquisition risk is negligible to nonexistent. As with all occupational exposures (or potential occupational exposures), the incident should be reported, documented and evaluated by your occupational health division (including an HIV knowledgeable physician). Policies and procedures are in place at all medical facilities to evaluate and manage occupational exposures to bloodborne diseases.

I'll repost below some information from the archives dealing with cerebral spinal fluid (CSF) exposure.

Good luck.

Dr. Bob

CSF exposure, PEP not recommended by HIV docs Sep 25, 2009 Bob, I am a medical resident. I was preforming a lumbar puncture and some of the CSF leaked onto my wrist. I estimate the amount was less that 1cc. within 2 minutes I had washed with soap and water and shortly there after, used abrasive viracidal wipes and alcohol based gel.

30 minutes later I noticed a 2 mm linear abrasion on my wrist in the area of the exposure. I am not sure if this was old or was secondary to my cleaning the area.

I reported the incident to employee health and provided the above details. They spoke with one of the HIV docs at the hospital and the doc indicated that they did not feel like PEP was necessary.

I have since come home, gotten online and read that PEP is indicated in instances of cutaneous exposure in the setting of an HIV splash exposure to open skin. Now I'm worried. The pts CD4 is 390. The viral load was not yet available nor were the results of the LP.

Any Recommendations?

Response from Dr. Frascino

Hi,

You reported the incident. Hopefully it was documented (should have been). I would agree PEP would most likely not be recommended (although if I were the consulting HIV specialist, I would have wanted to examine your abrasion). At this point, the only thing to do is get HIV screened (HIV-antibody test) at the three- and six-month marks per the occupational guidelines. You can download a copy of these guidelines at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm.

Good luck.

Dr. Bob

Resident with exposure to CSF May 2, 2003 Hi Bob

I was running some CSF from a gal I had just done an LP on to a lab(her CD 4 count was 10) and I don't know why or how but one of the four tubes leaked the fluid onto my hand( I wasn't wearing gloves,the tubes were double bagged)I washed my hands within minutes and decided then that the exposure was low risk and decided not to report the incident ,cos it was too fricking busy ,I also had a cut that seemed to be healing.

The CSF had zero white cells no red cells(if that tells you anything),I tested negative three months out to what has been totally nerve racking ,my ID attending thinks I'll be fine,but I am racked with irrational fears,that I am loathe to submit to my attending,and heres where I turn to you,have you seen cases with exposures similar to mine and what is the risk vis a vis needlesticks??

Thanks a lot ,god bless.

Response from Dr. Frascino

Hello,

I remember those busy internship, residency, and fellowship days and nights very well. First off, occupational exposures to blood and/or other body fluids that might contain hepatitis B, hepatitis C, or HIV should be reported. The CDC has published guidelines for evaluating risk and offering post-exposure prophylaxis when warranted. These were most recently updated in June 2001 and can be found in the MMWR (June 29, 2001/50 (RR11); 1-42. Having said that, it appears that your exposure was HIV-positive CSF leaking on to intact skin (assuming the cut was indeed healing). This would carry an extremely small risk for possible HIV transmission. Your 3-month negative test confirms your negative status. I agree with your attending physician. Have I seen cases with exposures similar to yours? Yes, many cases of similar exposure to blood, CSF, and other fluids, and none of them ever resulted in HIV seroconversion. The risk with needle sticks is approximately 1 in 300, and depends on a variety of factors hollow bore, deep puncture, viral load, etc. These statistics do not apply to your case. Take a couple of big breaths and relax! OK, feel better? Good. Now get back to work! Stay well.

Dr. Bob

Paranoid Resident, I know this is crazy Apr 21, 2009 What if someone came into my call room when I was not in there and put infected CSF in my contact lens case that had contacts in them. And then a couple of days later, I put the contacts in my eyes. Could I get infected this way? Has anyone ever gotten HIV from sabotage?

Crazy Resident

Response from Dr. Frascino

Hello Crazy Resident,

You're worried someone would sneak into your on-call room and put HIV-infected CSF into your contact lens case and then you might contract HIV by putting your contacts in several days later????? Oh my . . . . Just how much paranoid powder are you putting in your protein shakes every day??? Dude, you signed your post "crazy resident" and I agree you are totally wacked. If this is a real fear and not some transient paranoid delusion induced by sleep deprivation from being on call, I suggest you consider getting some counseling. These types of irrational fears often get worse without intervention and can seriously impact your future career. Crazy resident is bad enough, but crazy doctor is even worse!

Dr. Bob



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