Expert: Terry B - 3/11/2008

Question
QUESTION: Hi,
My question is: I am a nurse who was recently caring for a patient(that was later diagnosed with aids), two weeks ago-prob. is I can't really remember everything that took place now-but..I started and iv on her after 3 attempts, I finally got one...after you start an iv-a little bit of blood flows from the catheter, now I am always on the cautious side, as believe I was this time as well, however, I always remove one "finger" of the glove to "feel" the vein before I poke it, now I am really worried because of her diagnosis and the fact that I have been having "cuts" on my hands from the winter(I don't remember if they were on that finger or not, or if I covered them up with an occlusive dressing?) I do not remember getting blood on me but I am driving myself crazy--any suggestions or ideas?  Should I get a test?

ANSWER: Dear Trish:

Peace, and thanks for your service to others in such a great profession.  If I understand correctly, your question is whether a possible exposure on your finger to the blood of the patient (known to be HIV infected) places you at significant risk?  What I can gather is that you have some cracking of skin due to dryness and knowing the HIV status of this patient has increased your concern.

First, HIV transmission in occupational settings among health care workers is very rare and usually associated with hollow bore needle-stick injuries.  See www.cdc.gov for more detailed statistics.  Be aware that there are many patients whom you have treated who may have been HIV-positive and not have known their status.

Second, skin integrity is on a continuum; if you were not actively bleeding, infected, or draining from wounds brought in contact with the possible blood, there seems no clear portal of entry for the virus - your risk is minimal.  There seems no mucous membrane exposure.

Third, because I need to address this, the use of universal/standard precautions need become a "habit" - you are not the only health professional who uses barrier protection unevenly, and doing so with a patient known to be HIV infected and not with others leads to increased risk of accidental exposure (as well as apparent discrimination) - because you are less practiced and less familiar with procedures.  While your risk in this situation is doubtful, developing new skills that protect you and your patients through use of gloves and appropriate barrier protection will help you and others.

In conclusion, your risk, as described, seems no greater than having fluids splashed on your skin - the amount seems very small, the duration of the exposure and area exposed tiny, the integrity of the skin probably sufficient to prevent access to your bloodstream.  If you had filed an incident report at the time - reporting the possible exposure - you would have availed yourself of an immediate examination of your hands, testing, and perhaps post-exposure prophylaxis.  What seems more likely is that occupational health would have looked at your suspected exposure and deemed it not significant enough to require these interventions.

I hope this is helpful to you - I don't see significant risk in what you describe, but antibody testing in a month should confirm this if you wish to pursue it for peace of mind.

Best to you and yours,

Terry

---------- FOLLOW-UP ----------

QUESTION: Thank you Terry-I really appreciate your opinion..I do this practice on everyone I start iv's on--and yes I have realized now that I need to stop...all of my-co-workers make fun of me because of how extra-careful I am and how much I worry  :-)

I think I will go ahead with the testing in a month to make sure.
Thanks again,

Trish

Answer
Dear Trish:

Thanks for your note, and please continue appropriate touching where no infectious fluids are present.  I have heard horror stories of patients whose HIV status was known who were greeted by professionals gowned and gloved for the simplest of procedures.  The connection between healing and touch is so important, I would hope you don't distance yourself from patients - known to be infected or not - by being overly cautious.  Barrier protection isn't necessary in every situation - and inappropriate for non-invasive procedures.

Again, thank YOU for your service.

Terry