[Question #1376] occuptional exposure

67 months ago
Thank you for this great website .I just found it practical and scientific .

I had an incidence last week at my work .

I'm doctor in ER . I just had an occupational exposure and I need from you kindly make an assessment .
Last week one patient came with facial bone fracture(mandible) . He is in 30 of age , black  , socioeconomic low " ethnicity for epidemiology ".
Patient asked whether he has medical problem , and he just admitted that he was isolated two years back because of TB and now he said he is ok and he used medications ( I don't know if this was the truth and he don't know name of medications) .

After that, I were assistant for my partner working together we try to make bone reduction for his jaw by using wires . The wire were inserted first in the patient mouth and patient was bleeding that time .
Accidently the wire while it was out of the patient mouth pricked my thumb finger  . Immediately ,I removed the gloves and washed my hands with soap .I could not really find blood from my thumb or cut in skin . However , I felt like pricking by the tip of the wire ( I don't know if I can call this  percutaneous injury ) .

As you know TB comes in some cases with HIV ( that what I'm worried From) .
patient referred for other hospital another day .I report the incidence for the infection control and they decided to make my viral screening after 2 weeks( they didn't even tell me if I can use medications or no)

1-Please , I need to listen from your experience and understanding  about occupational exposure and when it comes serious with hiv patient , because I could not find   detailed information about it .
2-assessment of my occupational exposure ?

Edward W. Hook M.D.
67 months ago

Welcome to the Forum.  I will be happy to provide some information.  You do not know that this person had HIV and while there is a statistical association in which persons with TB are somewhat more likely than those without TB to have HIV, most people with TB still do not have HIV.  Further, with regard to the specific event you describe, this was a relatively low risk event for two additional reasons- first there was no visible bleeding after you were pricked with the wire so, although you felt the stick, it apparently did not meaningfully break the skin.  Secondly, the wire was solid, unlike needles which are hollow.  There is much less transfer of blood in your case, on the surface of a solid wire, than there would have been if you had been stuck with a hollow needle which could carry blood inside it.  Putting all of these factors together, this was a low risk event.

Having said all of this, I would add that your infection control persons did not follow the sorts of protocols that we would.  Both you and the patient should have had an HIV test at the time, and there should have been discussion of Post Exposure Prophylaxis while you were waiting for the test result.  Since this was not done, at this time there is little more to do but wait and test in the future as planned.  PEP is most effective when started immediately after an exposure and is not at all effective if not started within three days of the event.   Thus at this point, the thing to do is to not worry too much as this was a low risk event and to test as planned.

I hope this information is helpful.  Ia and when you reply it would be helpful to know what country this occurred in.  The strength of the association of TB with HIV varies from country to country.  EWH

67 months ago
I'm talking from Saudi Arabia .

I really don't know what I should do ?!

Edward W. Hook M.D.
67 months ago
Thank you.  As you know, most people in Saudi Arabia with TB do not HIV.  As I said before, this was a low risk exposure for all of the reason I mentioned above,  hence the best thing to do is not worry as there is little risk to you but to verify this by having the HIV blood test already planned for you.  EWH
67 months ago
Hey again Dr.Edward .I'm very pleased for you sir.

I just tried to investigate about the hospital which patient was isolated there and hospitalized .One of my colleague told me the hospital  mainly works for patient with
respiratory infections including TB or HIV patient who has TB  .

However , honestly I just struggled with  infection control in our hospital because they just use me like " wait and see " . They don't make any practical step
that relied on evidence -based .They don't even assess the risk of my exposure . I feel like I'm a victim who waits his sentence . I doubt they care or they know what they must do !! .

Regardless their carelessness , I need to assess the risk from a practical point view, because " low risk " in the theory I don't know how I negotiate it in the practice  .
If we suppose the patient was HIV + , is this exposure pose  risk to transmit HIV sepcailly the wire gauge is small ,solid and not impenging my blood stream " not seen by naked eye " ?
and wearing surgical gloves + pluse I washed my hands immediately .

About the test

is combo test enough after 28 days in like this exposure  !?


Edward W. Hook M.D.
67 months ago

This will be my final answer to your questions.  From a "practical point" you do not have enough information to appropriately or effectively classify this event as "high risk" and given the time that has passed, you have no choice but to get tested at an appropriate time.  A stick with a "wire gauge is small ,solid and not impenging my blood stream " not seen by naked eye " is effectively no risk.  It is not something that should worry you.  Having said that, I also understand your desire to be sure that you were not infected.  A PCR test performed at any time more than two weeks after you r exposure would have a greater than 95% chance of detecting a recent infection and a 4th generation, combination HIV antigen/antibody test would give you completely definitive results at any time more than 4 weeks after the event you have described. 

I hope this information is helpful to you.  As you know, our site will provide up to three replies to questions.  This is my third reply.  This thread will be closed in a few hours.  Take care.  EWH