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Occupational Exposure
Sep 7, 2011

Hello Dr. Bob,

I was performing a biopsy on a HIV + patient with a half razor blade. I don't know if you are familiar with that tool, but it is a flexible instrument that is held with my thumb and index finger. The top edge(clean end of the blade) cut my thumb during the biopsy. I looked at glove and there was no blood on it, but there was a hole in my glove and laceration to my thumb. There was blood on the patients skin and bottom edge of the razor blade. I quickly finished the biopsy. I put the specimen in the bottle. I think I was in such shock that I had cut myself so don't remember what happened after that. I forgot to check my cut glove to see if the patients blood had touched my broken glove/skin. All I know is when I took my glove off I was bleeding. This patient was on anti-retrovirals(atripla). Said his viral load was undetectable. I started PEP within 4-5 hours as a precaution because I don't want to take any chances. Is my risk of getting HIV high? This has consumed my everyday. I know all I can do it wait to test, but I can't help obsessing about it. Also, I checked my glove in the trash can later and there was blood on the thumb portion of the glove. I don't know if it's mine or his or both. If I cut myself with the clean edge of the blade and then came into surface contact with his blood(not through a direct needle stick) but still through an open wound what are my chances? Probably and impossible question for you to try to answer. But any guidance will help. The information I can't find is...have people come in contact with an hiv + patients blood to their open bleeding wound and not become infected? It seems unlikely. Is the 1/300 chance of a healthcare worker becoming infected a statistic of people who have actually had an HIV + patients blood enter their non-intact skin? Or is that a stat from superficial wounds, intact skin? Thanks for your time and reply.

Response from Dr. Frascino

Hello.

The statistics you found are correct. There is a 1-in-300 chance of contracting HIV following a significant occupational exposure to a patient confirmed to be HIV infected.

Your overall HIV-acquisition risk remains quite low based on the information you provided. I would advise you finish your course of PEP and then follow the post-PEP HIV-testing guidelines which recommend follow-up HIV tests at four-to-six weeks, three months and six months from the date of exposure.

You can read additional information about occupational exposures to HIV and their management in the link below.

Good luck.

Dr. Bob

Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis



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