[Question #1442] possible occupational exposure

53 months ago

Hello Docs, I am a physician and perform interventional procedures (epidural steroid injections) and have been in practice for 6 years. However, recently I have developed an anxiety/OCD about contracting HIV/Hepatitis while performing my procedures. I had a potential incident in my training years ago where I had the same anxiety/OCD but recovered and now it is back in  full force. Please comment on any risk of HIV/Hepatitis transmission of: 1) touching tip of  used plastic syringe (leur lock) after using on patient but wearing gloves (usually not bloody on the tip of syringe as I inject meds/contrast through syringes and tubing 2) squeezing the extension tubing which is in line with the touhy epidural needle 3) Touching open hub of touhy needle when inside patient wearing gloves. 4) If the tip of luer lock tubing touches my gloved finger after disconnecting from the touhy needle.  Are any of these scenarios concerning for exposure of HIV or hepatitis? Please help. I feel like I may lose my career if I keep having these thoughts. Thank you.

53 months ago
Also, just today while I was manipulating the hub of a spinal needle while it was in the patient, I felt a twinge on my thumb. Immediately, I got nervous. Then after finishing the case put water in the glove and there was no leak from the glove and no broken skin on my thumb. I am even considering testing the patient. I know it cannot be possible to have a needlestick injury when needle is inside patient and I am only manipulating the back part of needle (hub) but cannot shake the possibility of a needle stick potential as I do not want to give any disease to my wife or kids. Please talk me out of this madness. I cannot live like this.
Edward W. Hook M.D.
Edward W. Hook M.D.
53 months ago

Welcome to the Forum.  I will make some comments but it appears to me that you already appreciate just how uncommon health care associated HIV (and hepatitis) is and, for that reason, I would urge you to work through your concerns with a professional counselor. 

Having said that I will make the following observations:

1.  Occupational HIV and hepatitis is extraordinarily rare and occurs almost exclusively following needle stick exposure.

2. Even when exposure to an untreated patient with HIV, current infection rates in persons who do not take prophylaxis are on the order of 10% per exposure.  When you are talking about exposures which occur related to touching infectious materials with a glove hand, infections virtually never occur. 

3.  NONE of the scenarios you describe above are simply not realistic real risks for acquisition of HIV or hepatitis.

Which brings me back to my original point, my advice is to seek professional counseling on this difficult problem.  I hope my perspectives are some small help.  EWH. 

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53 months ago
Thank you for the response Dr. Hook. So, I have a few follow up questions: 1) What do you think caused the twinge in my thumb if I was only manipulating the hub of the needle? I have been very anxious recently worried about contracting HIV/Hepatitis.  2) Should I test the PATIENT for HIV/Hepatitis given the exposures I have described? 3) Should I test myself for HIV/Hepatitis? 4) Would it be obvious if I stuck myself with a quincke  or touhy needle? 5) How do I get over these fears/thoughts?? Please help. thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
53 months ago

Straight to your questions:

1. I cannot explain the twinge in your thumb but I can assure you that this is not a symptoms of any STI of HIV infection acquired recently. 

2.  from what you describe, you have not had a meaningful exposure.  There is no indication for you to test your patients for HIV or hepatitis. 

3.  If you think testing for HIV or hepatitis would relieve your anxiety there is no reason not to test.  A single test should be sufficient however and there is no need for repetitive testing.

4.  Yes, needle sticks are obvious.

5.  Once again, my advice is to seek the advice and counseling of a mental health professional to get by your unwarranted fears.  EWH

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53 months ago

1. My worry was could the hub of the needle cause a needlestick like feeling which caused me to feel sharp twinge on my thumb? Could anxiety have caused this? However I did not see any hole in glove when I put water in it and no skin break or bleeding on my thumb. So, any risk for HIV or hepatitis from this? Have you ever heard of someone contracting HIV/Hepatitis by manipulating needle hub or in the exposures I have described?

2. So, In summary, Are you saying all the exposure I had are ZERO  risk for HIV/Hepatitis transmission?

3. Would you test the patient for HIV/Hepatitis based on the exposures?

4. Would you test yourself given the exposures?

5. 10% infection transmission seems high for HIV if stuck with needle in HIV positive untreated individual without taking PEP per incident. That is scary.  I guess that is just a job hazard I will have to live with.

6. I have begun to talk to a mental health professional per your advice. I decided NOT to test the patient for HIV/Hepatitis so I hope I am not going to get the infections and trust your advice.

Thank you.

Edward W. Hook M.D.
Edward W. Hook M.D.
53 months ago

1.  I have never heard of a needle hub causing a puncture would.  I think you may be over thinking this.  I have never heard of anyone acquiring HIV, hepatitis, or any other infection from handling a needle hub in the way you describe. 

2.  Correct, from what you have told me, I would say that you are at zero risk from the events you describe.

3.  I answered this before- there is no reason to test this patient for hepatitis or HIV.

4.  Also answered this above- I would not test myself under these circumstance, nor do I see any reason for you to test. 

5.  10% is the high end of the range.  Most HIV infected persons are now on therapy and not infections and less than 1/2 of 1% of the population has HIV. 

6.  I agree with your plan.  You may want to print out this exchange and share this with your mental health care provider.

I hope my comments have helped.  As you probably know, Forum Guidelines allow us to provide just three responses per client.  Thus this will be my last reply and the thread will be closed later today.  I wish you the best.  EWH

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