Expert: Terry B - 11/9/2007

Question
QUESTION: I was cut by a dirty dental hyg. scaler, last week.  It had no visible blood on it.  However it had been soaking in a "bath" of water and an enzyme tablet. The water had been there for days. This bath also soaked instruments from 2 days before in which an AIDS patients instruments were.  My question is, am I at risk from this "bath" even if the instruments had soaked 48 hours prior?  And there was no visible blood and they were not the AIDS patients instruments?  I've heard that my chances are extremely low...but I'm still very worried.  I am 18 wks pregnant and the stress is really effecting me.  Please help.  Thank you.  K.

ANSWER: Dear Kat:

Peace and congratulations on your pregnancy.  You have enough stress without worrying about the scaler.

Briefly, I don't have any idea what the enzyme tablet might have been, so I will ignore it in my analysis.  I could probably assume it is a disinfectant - further eliminating your risk.

If a blood cell with intact virus were present at some point, that cell would be likely to bloat and fall apart if free-floating in a water solution for this length of time; a dental scaler would not retain sufficient blood in fluid form to pose an HIV transmission risk after this much time in water, and the probabilty of such a cell being present on the scaler at the exact time and site of your injury seems non-existant.  In summary, no HIV risk at all.  

I hope this puts your mind at ease.

Sincerely,

Terry

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

QUESTION: Thank you.  Thank you.  I'm a mess over this.  I took the baseline test at the hospital and they say I have to go back and retest in 6 weeks.  I know I should and will....do you think I could do it in 4?  The waiting is driving me mad.  K.

ANSWER: Dear Kat:

Again, peace.  Based on what we have discussed and what I know about hospitals and procedures, I will share my advice:

1) You COULD probably ask for other tests (PCR, p24 antigen, BDNA) if available, which would give you faster results but are expensive and not as reliable.  In example, some testing has high rate of false positives - meaning they are very good at finding the virus if it is present but sometimes (10% for some tests) indicate positive when the virus ISN'T present - and that would worry you more.  Given that we are more than 72 hours past your exposure, it wouldn't really make that much difference in terms of what to do.  I don't know who would bear the cost of these often expensive tests.

2) If the 'enzyme tablet' in the water was a disinfectant, and even if not, I do not see you as being at real risk for HIV infection (as expressed earlier) and think you are overly worried about possibility of HIV from this situation.

3) Based on your continued anxiety about this, testing at four weeks would probably leave you with persisting concerns until the six week test anyway; it would be better to follow the hospital procedures.

I don't know if this is what you wanted to hear, but it is the best recommendation I can provide.  I would strongly suggest talking with a counselor about your anxiety and see what might help; the worry is good neither for you nor the baby.  

Sometimes when faced by fearful situations, I imagine the worst thing that could happen and try to be prepared in dealing with same.  Risking even a look at a 'worst case' scenario (which I again think is improbable), if you were infected, knowing that and getting treatment would reduce your  risk of passing the virus to your child to less than 1%, and treatment for HIV disease today has rendered it a chronic and manageable disease for many.

Really trying to offer anything that might be helpful to you, hope you find something that will work.  You can handle this.

Sincerely,

Terry

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

QUESTION: I apologize for beating a dead horse.....but, your responses are really helping.  Based on my info you think I'm at no risk at all?....but I should still take the re test?  And one thing, the instrument that cut me soaked in that liquid for a very short amount of time.  Also, the enzyme tablet has an extremely low level disinfectant, which I  think had lost its effectiveness b/c it had been sitting too long.  I do apologize for your time and my obsessiveness.  Thank you and peace to you.  K.

Answer
Dear Kat:

Peace and thank you for your goodness.  In attempt to be as helpful as possible, I realize that I am addressing several issues simultaneously:

1) Probability - the overwhelming probability is that you were not exposed to HIV, and even if you were, your chances of being infected are remote.
2) Possibility - even the most improbable things sometimes, though very rarely, happen.  In the course of recording HIV exposures in health care settings (20+ years of data) there are only a handful that became infections.  See http://www.cdc.gov/hiv/resources/qa/qa28.htm for a summary and link to more data.
3) Procedure - for your protection not just from HIV but against any difficulties that might arise from your employer, there is value in following established procedure and policy.

Summary - based on my experience and research, your becoming infected with HIV from this exposure would be extremely unlikely.  Because there is no such thing as absolute certainty, and because there are options and procedures in place, I recommend that you err on the side of caution and follow through with established policies and procedures in your workplace.  I recommend also that you talk with someone face to face - this is really a bit of an awkward way to communicate about something so sensitive.

Does that help clarify?  Again, best to you and thanks for your questions and patience.

Terry