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Exposure to Blood on Paper Towels
Aug 9, 2011

RESUBMITTED BECAUSE NO CONFIRMING EMAIL RECEIVED.

Hello Doctor Frascino,

First and foremost I wanted to say that I really admire your work on this forum and your life generally. You are truly an inspiration. I have read through the forums and think that you have answered portions of this question already but I would appreciate a response based on my specific circumstances:

I am a 36 year old male. Back on Wednesday, July 28 I conducted a Blood Typing Lab in my undergraduate microbiology class. I was approximately 45 minutes late that day due to a phone conference. Upon arrival [since I had already missed the professors mini-lecture about the lab], I worked through blood typing lab as I understood it from the lab book and the white board instructions. When I initially set up my paper towels on my desk I noticed some liquid on its surface. [I was later able to confirm by speaking to my fellow students over the course of the next few days that some classmates had set up their paper towels, doused them in Sani-Sol, then removed them to re-setup at their own desk.] This made me a little hesitant so I placed my paper towels on top of the spilled liquid then douse the paper towels further in Sani-Sol. [I am not a trained medical worker, and based on what I have since read this was improper procedure.] I subsequently performed the lab which involved pricking my index finger on my left hand to obtain blood drops which were placed onto a glass slide. We then added various antigens in order to determine if agglutination occurred]. Upon completion of the blood typing experiment I used my right hand to pick up the wet paper towels on which I had performed my experiment.

I walked over to put the paper towels in the garbage can adjacent to my desk. Someone was already there so I waited my turn. As I was dropping the paper towels into the garbage, a different student, stepped over and dropped her wet [used] paper towels which landed directly on top of my left hand before falling into the garbage. I was immediately concerned and stepped over to the sink and washed my hands in soap and water for 2-3 minutes. Afterwards I made a sarcastic comment to her about her being so clumsy and she apologized and said: "[d]on't worry, I promise that I don't have anything." After washing my hand I did not observe any cuts nor abrasions. Six days later I noticed redness on my left hand [3 mm by 2mm square] in the area where contact was made with the wet towels, as well as two (2) red bumps on the top of my left hand. [I think that the redness was new as I dont recall it previously.]

I spoke with the Professor later that day following lecture and he explained that I had nothing to worry about. Unfortunately for myself, I think that I may be predisposed to being a little anxious and I have been unable to let go of the experience. I have a wife and infant child and am concerned about exposing them to an infectious disease that I may have acquired. I have spent a little too much time as of late on the internet researching infectious diseases such as HIV and Hepatitis C. Fortunately I have already been vaccinated for Hepatitis A and Hepatitis B. My most recent HIV test was a rapid antibody test on 7/11/2011 which was Negative. [This was prior to the date of exposure].

I have spoken with my primary care physician [7 days after the exposure], and she explained that based on what I had told her that I had a low risk of exposure. When I asked her she did not recommend PEP.

I would appreciate hearing from you as to whether I should report this to my university Health Department as an Exposure? My stress would be greatly alleviated if I knew the source student's HIV status. I am debating asking someone for her phone number and calling her directly.

Since the date of exposure I immediately suffered from a strong cold, sore throat, cough [although generally accompanied by some nasal drip], a two bump rash on my left hand [which my primary care physician said was not indicative of early symptoms of HIV], mild fatigue, and lingering headaches. All of these symptoms may simply be stress and anxiety related, but I feel as though I am spending my time waiting for something to happen.

I realize that there is a fine line between being cautious and being paranoid. I hope that you see this email as an effort to seek your counsel regarding an unfamiliar circumstance.

1. Is my exposure defined as non-intact skin exposed to blood?; 2. Is my risk therefore less than 0.09%; 3. IS RNA PCR testing an option? [I am at day 12 post-exposure]; 4. Should I contact the other student and ask them about their HIV status?; 5. Why isnt PEP offered to everyone regardless of type of exposure? It seems to me that if I was willing and able to pay for it, that I should have had that option;

Thanks,

Your friend in San Francisco, Me.

Response from Dr. Frascino

Hello, Friend in San Francisco.

1. Your potential exposure is so minimal that it does not constitute an HIV-acquisition risk.

2. Yep.

3. Not warranted.

4. Not necessary.

5. PEP consists of potent antiretroviral medications that can have significant side effects or toxicities. When prescribing PEP the physician must weigh the potential benefits against the potential risks. Being "willing to take it" and being able to "pay for it" are not the only (or even the most important) issues when considering a course of PEP. I agree PEP was not warranted and should not have been offered.

Relax Max! All is well, including you!

Dr. Bob



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