Expert: Terry B - 4/20/2008

Question
Hi, I'm currently employed as a dental assistant and I work with all kinds of patients. Last week, I have assisted a doctor with fillings for an HIV positive patient. So, the problem is during the clean up, one certain instrument called "fast speed" was needed to be cleaned a certain way, instead of dipping in an empower solution. The steps in cleaning it were to spray a solution in one of the two small tubes in the end of the instrument and placed it on a machine for thorough cleaning. At that time, there was no plastic to cover up the head of the instrument, so it was left exposed with the polishing stone. As I stuck in the instrument to the machine, it whirled fast and I believe I got some water mist in my left eye. My concern is, will I acquire aids easily that way since I heard it can be passed through bodily fluid and I'm not sure, eye fluid is one. I then, did not rinse my eye afterward because I had my contact lens on. So, i'm beating myself up over this and I'm going to get tested next week for it. I need your expertise to analyze this scenario. Thanks in advance for your help.

Jane

Answer
Dear Jane:

Peace.  Thanks for your question and happy to help.

First, some clarification about body fluids.  The bodily fluids that transmit HIV from an infected person to another include blood, semen, vaginal secretions, and in some cases breast milk.  The contact of these fluids with skin or mucous membranes (eye) which allow varying degrees of contact with your bloodstream is how infection occurs.  Tears from an infected person do not contain sufficient HIV to be infectious.

Secondly, treating patients (and instruments) differently for people whose HIV status we know puts everyone at risk.  The procedures - known as Universal or Standard precautions - which should be in place are meant to protect you from not only HIV but other infections more easily transmitted.  Briefly (it's an important point), people develop habits for handling patients/instruments/waste which are along a continuum of "risky" - if you have a way of doing something, and you change that to respond to an identified risk (e.g., known HIV positive person) your chances of having an accident are greater.

Third, and what you've been waiting for me to get around to, I suspect, is analyzing your risk.   I don't know the fluid which came in contact with the instrument - let's assume blood - nor the amount of virus in the fluid (if the person was known HIV and receiving treatment, the amount of virus may have been very, very low).  The instrument may or may not have had intact blood/virus on it, but the amount would have been miniscule.  This would still provide significant risk if this were a direct exposure to your bloodstream, a sore, an infection; but a misted spray that might have gotten in your eye seems an additionally low risk.  

You can read through this forum for more detailed factors for analyzing risk, and I recommend you go to www.cdc.gov for statistics and other information on HIV transmission in health care workers.  In the course of the epidemic, there have been very few transmissions from patient to worker, most in cases of more dangerous exposures.

Lastly, make sure you let the counselor at your testing center know this is a very recent exposure.  The tests available with such a recent exposure may not be definitive for this incident.  Standard antibody tests for HIV are rarely accurate within six weeks, and antigen testing can produce up to 10% false positive results.  Go to www.thebody.com or www.avert.org for more on testing.

I hope this helped.  I know it is scary, as I’ve “been there” with a needlestick.

Terry