Expert: Terry B - 7/20/2007

Question
I am an RN in a busy ER.  I had a patient who was a known drug abuser.  I pulled off a bandage that caused blood splatter.  After I took off my gloves I noticed blood on my hands.  I had two small scratches on my hand but not where the blood was.  I washed my hands and went back to work.  After a few minutes and other patient care I noticed that blood had splattered on the earpieces of the stethoscope that was around my neck.   It was a small droplett of blood...I had it in my ears!  I wiped off the blood with a towel as it was still wet, then a EVAC came in and I went back to patient care using the stethoscope...now 2 days later I am scared...I was so busy that I didn't think about it.  I am 4 months pregnant and am really scared.  Am I at risk?  Is the ears a good trasmitter?  Should I be scared?  I am hoping to feel better.  Thank you.

Answer
Dear Kay:

Peace.  Your chances of HIV being transmitted through your ears or described skin exposure seems small, based on my broader understanding of factors in transmission (no 'ear-specific' data).  You should not be scared, but I would encourage you to pursue testing for complete peace of mind.

Here is a course of action I would recommend based on my previous work in an academic medical center.   

1) File an incident report as soon as possible.  Your exposure to blood - apparently through no fault of your own - is an infection control issue.  This triggers some action both to benefit you and hopefully improve procedures in the future.

2) Seek testing of your own blood for HIV and Hepatitis.  This means testing for p-24 antigens, qualitative PCR, or whatever the state of the art might be at your health center.  There are tests that can detect presence of HIV prior to antibody production.  One problem with these tests is that some have a 10% rate of false positives, which may increase your anxiety, and some tests will be reactive because of your pregnancy.  Make sure everyone concerned reads the directions and disclaimers carefully.  While some of these tests are expensive, they should be covered as this is a work-related exposure.

3) An option that may be presented to you is Post-Exposure Prophylaxis (PEP)- taking antiretroviral medications as quickly as possible after an exposure.  You may want to decline this 48 hours since your exposure because of potential risk to your pregnancy; my own thought based on what you have shared is that the risk to your pregnancy is far greater at this point than possible benefits of PEP.  Simply, your risk seems so low and time passed since the incident don't seem to make PEP a good choice.  My non-medical informed opinion.

4) In some cases, and in some States, the identified potential source of your exposure can be encouraged to be tested for HIV.  In Wisconsin, at least, if the person refuses to be tested, blood drawn for another purpose (e.g., CBC drawn at time of treatment) can be tested without the source patient's consent.  Remember that even if the source patient is positive, your described exposure is low risk and does not, by any means, mean you are infected.  What this does mean is that if the source patient is not infected, you could not possibly have been infected from that exposure.

I do not wish to increase your anxiety, and as stated, I believe the risk of transmission in this case is very small.  Even health care workers exposed to large amounts of blood by people who are known to be infected with HIV rarely contract HIV themselves - in the course of the epidemic in the US over the last 20 years the number is quite low.

Long answer to a simple question and I want you to take proper steps for yourself and your colleagues.

Sincerely,

Terry