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instrument stick with HIV+ patient

I had a patient earlier this week for her 6 month RC and she is HIV+. During scaling, I somehow managed to slip. The instrument cut my glove and I ended up with a very small nick in the back of my left hand (which I didn’t see until much later). I got up, removed my gloves and went into the sterilization room to wash my hands. I washed and waited to see if I was bleeding at all. There was no blood so I continued treating my patient.

The next day, my office said that I should go to my regular doctor to get blood drawn as a precaution. I made an appointment for the following day (48 hours after seeing the patient). When I went to my regular doctor’s office, she called the hospital to see what she should do. They said that I should come directly to the hospital.

I went to the hospital and had blood drawn. Everything came back negative of course. Then they said that I have to do 4 weeks of med prophy as a preventative measure. They started me on Combivir and Kaletra.

Has this ever happened to anyone else? The hospital wanted me to give up all the patient data, but I honestly can’t see her going in and waiting as long as I did in the ER just to give some blood to see what her viral load is. The meds are not agreeing with me very well, and I am not thrilled at the prospect of taking them for 4 weeks.

My dentist and I had a long talk yesterday and we agreed that I should take them as prescribed (I have an appt on Monday with my regular doctor to discuss what we are going to do). Honestly, I didn’t even see the nick when it happened, so I thought I was overreacting to my glove being cut. I didn’t see the tiny cut in my hand until the next day. My dentist said that there’s no issues with me double gloving in the future (I live/practice in Europe and apparently it’s common to double glove with these pts), and he even said that I have the option to refuse care in the future (which I definitely will not do – this is a mistake I made).

So has anybody been through this med prophy treatment? I’m nauseated constantly but hoping it will get better as time goes on. Thanks for any response.



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3 Answers

HIV can take 4-6 months to show positive in blood work. This is why OSHA has standards on testing protocol. After an injury, you should wash the area (which you did) and go to the emergency room within 2 hours after filling out the necessary OSHA paperwork. It must be logged! They will need to test you at intervals of 1, 3, and 6 months after the injury happened. This should all be covered under workers’ comp. These protocols should be clearly listed in a conspicuous area (like the sterile room) so you know exactly what to do if this happens. Don’t leave it to chance, even if the risk is small. I had a needle stick once and went through all of this and had great relief when it was all said and done. The protocols are in place for a reason and if followed, you should be covered.

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Thank you so much for your answer! I agree that Hep would be a more likely problem. In fact, that was the first thing my regular doctor asked – if she was positive for Hep.

My regular doctor prescribed the meds for 4 weeks and something to help with the nausea. I forgot to ask how often I need to go to be tested, but that’s something I can talk to her about after the holidays.

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The link is a starting place for you to research.
I’ve never had this happen with a known diseased patient. We treat everyone as if they have every disease imaginable so double gloving isn’t going to help you. You are more likely going to hurt yourself due to the extra thickness of the gloves that you are not use to wearing. I don’t think you should be worried to ask the patient to go have her viral load tested. She was upfront about her infectious disease and she will understand your concern. Be honest and open about what happened while treating her and she most likely will be happy to be tested.
Correct me if I am wrong……..we are more likely to contract Hep B with a puncture of needle or instrument than with an HIV infected stick. This past summer one of our assistants stuck herself with needle and she was tested and the pt agreed to be tested for HIV, Hep B and C etc…..the pt was negative and now the assistant does not need continued testing at 3 and 6 months or whatever the prescribed testing regimes were. Hope this helps.

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