Nervous Nurse

Question

Hi,

I was placing a IV in a HIV patient who had pneumonia possible TB ect, (which makes me think he was progressing to AIDS) I was wearing gloves during the procedure then took them off to finish tapping the site. Thats when I noticed I had a small amount of blood on my finger, I went directly to the sink and wash my hands. Then I applied alcohol. Let my tell you about my finger. Twenty hours prior to this I had cut my fingernails too short and made a small 1/2 in long cut that bleed for only a few seconds then stopped and never bleed again. The cut which wasn't in the nail bed was more like a paper cut never scabbed over and was basically gone in 3 days. I don't think the blood was on this site anymore than a couple of mins. My question is since it was almost 24 hours since my cut would there be enough of a protective layer to prevent the virus from getting in along with the length of time on the site and the small amount of blood. I'm also worried about the pts. probable high viral count low cd4 count. It has been a week and I am obsessing over this can't sleep. I have scratchy throat and my nose is running. I also developed one mouth ulcer (which i rarely do). I know these symptoms could be related to allergies that time of the year and stress with the mouth ulcer. I am aware of the statistics that 1 in 1000 will test positive. Considering what I have told you what do you think my odds are. I know I should have told someone and pob. started meds. I completely panicked. Now its a week to late. I will test in 6 weeks and 3 months and 6 months. In the mean time I'll try to stop crying myself to sleep.

Thanks for your time!

Answer

Hello Nervous Nurse,

All occupational exposures, even potential ones, should be reported and documented. Chances are that in your case doing so would have saved you a considerable amount of anxiety. From the limited information you have provided, it would be my opinion that your potential exposure was negligible and certainly would not warrant PEP (post-exposure prophylaxis). If your small cut was already in the healing process, HIV testing may not have even been recommended. (An evaluation by a competent specialist at the time of the incident would have made this judgment call.) So what should you do now?

  1. I would still report the incident. Your hospital or medical facility should have a protocol for evaluation and management that includes follow-up testing, if warranted.

  2. Stop crying and get a good night's rest. Your chances of acquiring HIV from such a minimal potential exposure are nearly nonexistent.

  3. Review the policies and procedures for occupational exposures to HIV, hepatitis B and hepatitis C. Share these guidelines with your fellow nurses and staff. Hopefully doing so will help others avoid the unnecessary anxiety you experienced this past week.

I'll send my best good-luck karma that your follow-up HIV test is negative.

Good luck.

Dr. Bob