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Author Topic: low risk needlestick in high risk setting?  (Read 1595 times)

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Offline toothfairy

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low risk needlestick in high risk setting?
« on: December 09, 2006, 11:59:15 AM »
Hey forum.  Thanks for being here.
I'm a dental student and I experience a stick yesterday. It was from a dental explorer which is, essentially, a non-hollow needle.  I wasn't concerned about HIV at first, but I reported the occurrence and went to the health center with Hep C in mind.  However, once there, they only talked with  me about HIV.  They offered me the PEP, although the nurse practitioner I spoke with said she would not recommend it.  I turned them down, and they told me that I had about 48 hours to change my mind.  Now that I've slept on it I'm wondering if it wouldn't hurt to try the PEP just in case. 

Here's the details:
The explorer that I poked myself with was not even used yesterday.  However, since I did have it out and exposed, I included it in the sterilization process a the end of the appointment.  That process is as follows:
1.  Rinse or scrub off any bits of tissue or gross amounts of blood with water.
2.  Immerse all instruments in an ultrasonic cleaning unit (filled with cleaning solution) for 2-3 minutes. (I do not know if the solution has any antibiotic properties, or if it just knocks debris of the instruments.)
3.  Dry all instruments under a hand dryer (the type you see in public bathrooms).
4.  Seal all instruments in sterilization bags.
5.  Send all sterilization bags to the school's autoclave for sterilization.

In my case, I did not have any tissue or blood, so I skipped the first step and went straight to #2.  This would have been the source of infection, since all the patients who are seen at the school (a VERY large clinic) have their contaminated instruments pass through the ultrasonic.  They were in there or 2 minutes.  I then removed them and dried them under the hand dryer for 2 cycles. I then sealed them in the bags (which are paper on one side and thin plastic on the other).  As I was dending them to the autoclave, the tip of the explorer poked through the bag, through my latex glove, and into my thumb.  I removed my glove and looked at my thumb.  I could not see any mark, so I squeezed my thumb to se if I could express any blood.  Doing so, I did express one small drop of blood which I wiped away.  I was unable to express any more.  I washed my hands and went to report the stick.

Now, my understanding of the HIV virus is that it is very fragile, and really not very infectious.  In other words, that for infection to occur it would require at least a visible amount of an infected fluid, with a high viral load, injected deep, for there to even be a slight chance of infection.   

As I see my case, while there could possibly be just about any virus swimming around in the ultrasonic cleaning solution, HIV would be so dilute, that it already would not be a real threat.  Then I dried my instruments.  Would the drying have killed any virus that may have been present?  Finally, even if live virus had survived and was on the tip of my explorer, there was not enough to be visible, and it was such a Small puncture, that I wouldn't really be at risk, right?

From this reasoning, I turned down the PEP, but the fact that they offered it to me,(even if they didn't recommend it) and gave me 48 hours to reconsider makes me wonder if they're just covering their butts or if it wouldn't really hurt to take it just to be safe.

It's now about 15 hours after the fact and I'm having a little bit of trouble getting it out of my head.  I think about my wife and children and wonder if I should just take the meds, feel rotten from them for a month, and be done.  Any thoughts?


Thanks!

Offline Ann

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Re: low risk needlestick in high risk setting?
« Reply #1 on: December 09, 2006, 01:19:03 PM »
tooth,

You do not need PEP. You don't even need testing. For a start, the instrument hadn't even been used on a patient since the last time it was sterilized. Then you stuck yourself with it after it had been in an ultrasonic. There is no way there would be anything on that instrument you need to worry about.

You do not need to worry in this instance.

Ann
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Offline toothfairy

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Re: low risk needlestick in high risk setting?
« Reply #2 on: December 09, 2006, 06:27:32 PM »
Thanks for the quick response.  After all, this is a time sensitive matter. 

So, you agree that there's no way my explorer could have picked up enough of the virus in the ultrasonic to be infective with a small puncture?

Sorry to beat a dead horse, but being a scientist, I like redundancy and multiple sources.  Thanks for your time!

Online Andy Velez

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Re: low risk needlestick in high risk setting?
« Reply #3 on: December 09, 2006, 07:09:45 PM »
OK. Here's some redundancy. As Ann has told you, there's no cause for PEP, testing nor for further concern about HIV in this situation.

Your concern and caution are certainly understandable, but really and truly, you weren't at risk. Take a breath, let it go and get on with your life.

Cheers, 
Andy Velez

Offline toothfairy

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  • Posts: 4
Re: low risk needlestick in high risk setting?
« Reply #4 on: December 09, 2006, 07:21:46 PM »
Thanks Andy, Thanks Ann, thanks to all other users and moderators.  I'm moving on. 

Cheers!

Online Andy Velez

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Re: low risk needlestick in high risk setting?
« Reply #5 on: December 10, 2006, 11:47:57 AM »
You're welcome. And glad to know that you're moving on. Life at its best is way too short to be spent on worrying unnecessarily as you have been.

Cheers,
Andy Velez

 


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