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Author Topic: Occupational Eye Splash  (Read 8268 times)

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Offline mdstudent

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  • Posts: 4
Occupational Eye Splash
« on: January 10, 2007, 05:57:14 PM »
Hi All,
Thank you for the valuable service you provide to thousands of concerned individuals.  I'm having some trouble w/ the posting of this message, so if it's posted twice, I apologize.  Since I (may) have already posted a detailed explanation of my situation and questions (that window is currently locked, doesn't seem to be proceeding and won't let me /copy the text), I'll try to make this one more lean and to the point.

I'm a medical student, and was given the opportunity to do my first lumbar puncture last week.  The resident didn't think there was any concern for splashing, and I stupidly proceeded w/o eye protection.  As I was injecting lidocaine, I was pushing the plunger against resistance while withdrawing the needle, and ended up getting a small amount of fluid splashed on my face as the needle exited the skin.  I do not know how much of the fluid was ricochet from the skin surface, and how much had actually entered the patient's body, but must assume it was a mixture of both.  I do not recall seeing gross blood in the fluid, but have to assume there was at least a microscopic amount.  I did not feel a direct hit to my eye, but did feel it hit my brow b/w my eyes and my forehead.  I wiped my face off and requested goggles before proceeding.  A couple minutes later my eye began to burn and I mentioned it to my resident.  I am not sure whether it burned because of lidocaine or irritation from wiping my face ( i can reproduce the burning by rubbing my eyes now ), but can't afford to assume the latter.  We finished the procedure and called the infectious disease attending on call.  He advised me that this would be a very low risk exposure, since it was a very small volume of fluid, which was most likely composed of lidocaine>interstitial fluid>>blood.  He told me to wash my eyes out, and call employee health, but said PEP is probably not needed, except for peace of mind.  In fact, he suggested the risk from this particular case would probably be less than that if he had spit in my eye, which is not considered infectious.  After speaking w/ employee health, we decided to begin extended PEP because: a) the patient tested HIV+, b) he had AIDS defining illnesses suggesting high viral load, c) the contact duration was extended since I did not rinse my eyes for at least 40ish minutes, and d) I have OCD and know I will be freaking out about this, especially if I don't do everything I can to prevent infection.
After 4 days on extended PEP, I was miserable and switched to basic PEP because I felt that was adequate.  The only concern I have about that is the end-stage of the patient's disease, and the increased duration of contact I allowed. 

I consider myself relatively educated about HIV and its transmission, but statistics have a way of losing their meaning when I try to apply them to myself.  I know that the "average" predicted risk of a mucous membrane splash is 0.09%, however, I haven't been able to find any numbers to describe the increased risk of high viral load and longer duration.. Does it increase it to 0.1%, 0.5%, 1%?  If I were advising a patient about this, I would tell them their odds are extremely low of being infected, and that the use of PEP in this case should only be considered if they feel they can't live with even that small risk.  When thinking about it regarding myself, however, I keep becoming convinced that I'm going to be that 1 in 3,000th person.

I guess my question is this: What kind of real-life-not-statistics-on-a-page risk am I facing here?  Am I going overboard by taking PEP, or do I genuinely need to live in fear that this is going to happen to me?  Also, lidocaine is in an acidic solution (hense the burning), how well does HIV survive in an acidic environment? 

Any input from the experts would be much appreciated
Thank you,
-m

Offline RapidRod

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  • Posts: 15,288
Re: Occupational Eye Splash
« Reply #1 on: January 10, 2007, 06:31:41 PM »
If you would have received lidocaine spray in your eye, it would have stung bad, then your eye would have been numb. I believe the offer of PEP has to been given with an occupational exposure, and it's up to the worker to accept it or decline the medication. I don't see a risk at all.

Offline mdstudent

  • Member
  • Posts: 4
Re: Occupational Eye Splash
« Reply #2 on: January 10, 2007, 06:42:18 PM »
I do hope you're right.  The thought had occured to me to squirt some lidocaine in there to see how bad it burned.. but I'm not quite that stupid.. Thanks for the reply.

Does anybody know what a "large volume" splash means?  Is it 2-3 drops of pure blood splashing in there, or more like holding the eye against a pulsating flow straight from the artery?

Offline Andy Velez

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  • Member
  • Posts: 24,693
Re: Occupational Eye Splash
« Reply #3 on: January 10, 2007, 07:06:38 PM »
MD, I agree with Rod about the risk having been more theoretical than actual in this incident.

Taking into consideration your self-described OCD, doing PEP might not be such a bad idea. Whatever the side effects. it will reduce still further any remote chance of transmission in this case.

Even if you hadn't done PEP I would expect you to test negative when you get around to doing that, which as you may already know should be done at 13 weeks after the completion of PEP.

Cheers,
Andy Velez

Offline mdstudent

  • Member
  • Posts: 4
Re: Occupational Eye Splash
« Reply #4 on: January 10, 2007, 07:22:20 PM »
Thank you for your responses, both of you.  I apologize for posting yet another theoretical-what-if-I'm-the-unlucky-one thread, but it helps to get an objective opinion. 

Also, sorry if I stepped on anybody's toes by posting regarding skin vs. membrane in a nearby thread.

Thanks again,
-m

Offline Andy Velez

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  • Member
  • Posts: 24,693
Re: Occupational Eye Splash
« Reply #5 on: January 11, 2007, 09:09:37 AM »
You're welcome. I'm glad you found the exchanges to be helpful.
Andy Velez

 


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