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Scratched by IV drug user

Jul 31, 2010

I am a resident physician and was seeing a patient on the medicine service last night. I was examining him with my gloves on when he reached out and scratched my knuckle on my hand through my glove. There was a small scratch that had a minimal amount of blood on it. I washed my hands with soap/water and alcohol. I ordered a rapid HIV test which was negative. Let us assume the worse and say he did have HIV, should I still be worried? Should I have used chemoprophylaxis? I have read your other posts and am ashamed to ask this since I am a physician, but I would like your expert opinion please. Thank you for being there for all these people who are seeking knowledge just like myself.

Response from Dr. Frascino

Hi Resident Physician,

It's always a bit difficult to evaluate a potential occupational exposure over the Internet, as we don't have the opportunity to get a detailed history, perform a physical examination or have access to medical charts, laboratory tests, etc. As with any potential occupational exposure, you should immediately report the incident so it can be documented, properly evaluated and treated if necessary. All medical training programs have policies and procedures in place to promptly evaluate and, if necessary, treat occupational exposures. Based on the limited information provided I strongly doubt you sustained a significant exposure or that PEP (post-exposure prophylaxis) would be warranted.

Several points would need clarification:

1. You report the patient scratched your knuckle through your glove. Did the latex break or remain intact. If the latex remained intact, obviously there would be no direct exposure.

2. You report ordering a rapid HIV test, which was negative. Was the test performed on you or the source patient? If the patient tested HIV negative, the only possible risk of transmission would be the remote possibility that he was only recently infected and still within his window period.

I would suggest you report the incident to your chief resident and/or the occupational medicine division of your training program, even though the incident is now a day old. If necessary they will arrange for routine HIV testing; however, in all likelihood this will not be necessary.

Good luck.

Dr. Bob

Re: Sorry If I came off rude (4th mail please answer)

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