Health care worker risk

[wetferret]

Hi,

First of all, what a fantastic website you guys have built, and what an amazing forum community. Keep it up!

About two weeks ago, I returned from a two week work-cation in Haiti. I'm an EMT, and I was working at a hospital in Port-au-Prince. Obviously, I followed universal precautions when touching patients who had any indication of blood or infectious disease. However, there were two instances that have me a little worried (I'm a good EMT, but I'm even better at worrying).

1) After assisting with placing an IV on a patient (the IV bled quite a bit as we collected a blood sample) who was later diagnosed with gonorrhea, I helped take another patient to X-ray. While sitting outside, I scratched the side of my nose just underneath my eye. I noticed a second later that the tip of my finger had a small bit of dried blood on it, just enough to cover the tip. I don't know why I hadn't changed gloves, but it had been at least 5-10 min since I came into contact with the blood. I immediately tore off my glove, cleaned my hands with hand sanitizer, and used the hand sanitizer to wipe away anything that could've gotten on my face. I've read a little on HIV infection through mucous membranes like that in your eye, but I'm just wondering whether there really is any risk here at all, even if we pretend that I got wet blood on my finger and rubbed the hell out of my eye. But like I said, I'm 99% sure the blood was dry and it was a small amount.

2) Another patient came in will severe skull and facial trauma. He was bleeding pretty severely on the right side of his face. I was holding his neck in place for a while before another EMT took over for me. When I stepped away and removed my gloves, I noticed a significant amount of blood on my left ring finger. I'm a habitual nail-biter, and I had a small cut on that finger next to the cuticle from biting that nail earlier. I went white as a ghost, until another EMT told me that if it was the patient's blood, it would've been on my right hand, and that it was almost certainly my own blood; I just hadn't noticed that I was bleeding a little. While I had my gloves on, I didn't notice a major tear in either of them. But again, please humor me and pretend that I did get enough of the patient's blood to cover half of my finger and it got into the small (obviously superficial) cut. Any risk at all?

I should also mention that I did not know the HIV status of either of the two patients who gave me little scares.

I'm planning on taking an antibody test 10 weeks from now just for complete peace of mind. I just feel that if someone on the forum can tell me that, even in the worst case scenarios that I described, there is no to a very low HIV risk, I can put it out of my mind until I get tested.

Thank you in advance for your help and your patience. I promise I will not bombard you with additional irrational questions ad nauseum.

[jkinatl2]

Even in the worst case scenarios that you described, there is no HIV risk in the events you report.

It does worry me that you seem to have had inadequate training insofar as HIV infection is concerned, along with what appears to be a bit of HIV phobia.

[wetferret]

Thank you for your prompt reply.

The HIV phobia you detected is actually a touch of generalized anxiety. I have it under control enough that it doesn't affect me day-to-day, and I seek professional help when I need it. Thank you for your insight and your concern.

As to the "inadequate training insofar as HIV infection," could you please elaborate?

If you mean my freaking out over the slightest possibility of contracting HIV or other bloodbourne pathogens, then I can assure you I'm not alone. Many health care professionals I've worked with share the same fear. A nurse who was in Haiti with me got a needle stick, and none of us could do enough to assure her that she was most likely fine. I think it's because we all hear the CDC's cover-your-ass risk assessments and follow them blindly. Yes, I agree it's ridiculous.

If you mean that I seem poorly trained in using personal protective equipment, then I wholeheartedly agree that in the scenarios I described I was more careless and less focused than I usually am.

If you mean something else entirely, like you think my education and training in HIV infection specifically is lacking, then I would love to hear any suggestions you might have or resources you can refer to (assuming you have the time and patience). I am always eager to improve my practice and educate my peers.

Thank you again for your reply. Keep up the great work that you're doing!

[Ann]

wet,

You need to keep in mind that universal precautions are designed to protect the patient first and foremost and the health care provider second. I would be appalled if I discovered I'd been taken into an A&E and the EMT had not been changing his or her gloves. Haven't you ever heard of MRSA? Forget hiv. Jeeze. Worry about the pathogens you're more likely to be spreading around yourself.

You haven't had a risk for hiv infection, regardless of what your emotions are telling you.

Ann