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Question re: occupational exposure (edematous legs)
Nov 24, 2010

Hi, Dr. Bob! I combed the archives and couldn't find anything that was that similar to my situation so I figured I'd ask again (this is my 3rd try).

I am a nurse case manager and work with alot of individuals with HIV and Hepatitis C. I don't do direct care but I do visit people in their homes and encounter a variety of situations. A few days ago one of my clients (who has HIV and Hepatitis C) asked me to help her pull up her socks. She has congestive heart failure and her legs are very edematous. I bent down to assist her and in the process of helping her with her socks I touched her leg which was wet from clear, leaking edema. After I was done assisting her I immediately washed my hands and used hand sanitizer. I checked my hands and I didn't have any visible open areas or scratches on the part of my hands that touched her legs but I did have two scratches/paper cuts on the side of one of my fingers (although I think I may have gotten one of the scratches after the incident I'm not 100% sure). The client takes anti-retroviral medication and has had HIV for many years. I'm not sure what her viral load is at this point.

I reported the incident to HR and was sent to a health center where they tested me for HIV and Hepatitis C (baseline) and recommended I return in 6 weeks, 3 months and 6 months. They told me that PEP was not warrented as my exposure was low risk (I asked for PEP but was turned down)and that had I not had the scratches they wouldn't have tested me at all. My anxiety has been off the charts and I ended up going to my primary care doctor to get a prescription for anti-anxiety medication (I've had trouble sleeping, concentrating or eating since this whole thing happened)and she told me that I shouldn't be worried and that my concerns were to due to my anxiety disorder. What do you think? Any data re: HIV and Hepatitis C concentrations in serous fluid that's on the body? I wish I would have thought to put on gloves but since it was a non-medical task (and I didn't want to make the client feel uncomfortable) it didn't even cross my mind. I'm kicking myself now.

Thanks in advance for your help! You do good work!

Response from Dr. Frascino

Hi,

I agree with the advice and plan recommended by your occupational health department:

1. Extremely low risk

2. PEP not recommended

3. Routine screening at six weeks, three months and six months

Anti-anxiety drugs can be helpful during the six-month window period. I agree that since your potential HIV risk is so extremely low, your degree of anxiety is not warranted. Counseling (psychotherapy) may help with this problem as well as with any underlying chronic anxiety disorders you may have.

I see no reason to kick yourself! I wouldn't have put on gloves in that situation either, if that makes you feel any better.

Good luck.

Dr. Bob



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