Expert: Terry B - 12/9/2007

Question
I am a nurse and a few days ago I was starting an IV on a patient who is not known to be hiv positive.  When I was taking off my gloves I noticed a rip in one of the fingers of the glove. Some blood had gotten on a few of my fingers. I then washed my hands and thought nothing of it. Later I began to worry because 2 days prior I sustained a papercut on one of the fingers. It had not bled since the initial injury, I didn't have a bandaid on because I had forgotten about it. Would this papercut be considered non- intact skin, the definition is vague. I did talk with occupational health who told be it would only be a concern if the cut was fresh and still bleeding. I still can't stop worrying about it. Thank you for your feedback.

Answer
Dear Annie:

Peace.  On review of several factors, your risk seems very low.  I would direct you to the CDC site and statistics on the low rate of infection of health care workers from occupational exposures (including deep needle-stick injuries) to further reduce your fear.
  
The key question is whether this constitutes a significant exposure.  The Centers for Disease Control and Prevention, in 2001 (reference below), stated that this would be considered a significant exposure if " evidence exists of compromised skin integrity (e.g., dermatitis, abrasion, or open wound)." "Occupational health" evidently determined that your healing papercut did not constitute compromised skin integrity.  

A little research on whether your papercut of two days prior would constitute "intact skin" led to an interesting article by researchers at Duke on the physiology of wound healing (http://bte.egr.duke.edu/Cutaneous%20overvew.pdf) but no clear answer that would contradict the occupational health professional.  

As a possible option, you could possibly appeal to the occupational health, risk management, and/or infection control officer at your institution and ask about followup testing of source blood; in some settings, blood drawn from the patient for other purposes can be tested for Hepatitis and HIV in the case of occupational exposures.

Further guidelines are available at the afore-referenced website cited below.

I hope this is of some help.

The best of health to you and yours,

Terry

http://www.cdc.gov/MMWR/preview/MMWRhtml/rr5011a1.htm