[Question #1909] potential risk in clinical setting

45 months ago
Hello doctor, Your previous advice to me was wonderful. In combination with my psychologist, your assurance that environmental needle sticks are not a need for concern or testing has contributed to a 90% reduction in my checking behavior. I can't thank you enough for this.Also as part of my treatment, I was encouraged to finally have an HIV test completed. I completed this HIV test today. However, I was nervous going into my local allina clinic because the last question I asked you was about public settings and you pointed out that clinics are a higher risk area. I have two concerns: After taking my weight, I dropped one of my credit cards on the ground. I picked it up. It was next to what appeared to be a paper towel. My anxiety kicked in and I worried what if I was poked by a needle when picking up my card. Although this would be a clinical setting, would you still agree that any needle stick wouldn't be cause for concern? Obviously I did not see a needle or feel any sort of deep wound. Worst case scenario, even if I was poked I assume it would still be a 1 in 300 chance for contraction of HIV IF the needle was contaminated with HIV?Second, after getting my blood drawn, the lab technician asked me to hold a bandage over the needle entry point in my arm. I did. I later noticed I had some kind of discoloration on my fingers -- the fingers that I used to hold the bandage. If this discoloration was blood, I assume this would still be no risk (via whatever was on my fingers potentially getting into the wound? I'm also looking for general advice (like the general advice you gave me about public settings that was so helpful) about going to clinics in the future. Can I assume that any sort of risky needle stick in a clinic setting is very unlikely (e.g., when I pick something up off the ground) or otherwise move about a clinic and not something I should concern myself with?Thanks so much for all your help and expertise.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome back to the forum. I happened to be logged in when it arrived; most users should not expect nearly real-time replies!

I read your recent discussion with Dr. Hook. I'll start with a general observation that probably you already know: With OCD and/or GAD, factual information about low chance of a bad outcome (whether it's HIV, other health problems, or accidents) doesn't usually settle things. Factual information about risk can be helpful, but the underlying mental health issue usually fosters additional "yes but", "what if", or "could I be the exception" concerns. I would put these questions in that category, wouldn't you? Of course I will answer these questions. But in the interest of both your sanity and forum priorities, let's make this your last new question until and unless there is an entirely new issue, definite high risk exposure, etc.

Nobody in the world has been known to catch HIV from having blood drawn. Perhaps a few exceptions occurred 30+ years ago, when some medical facilities in developing countries still re-used injection or blood drawing needles without proper sterilization. However, for sure it has never occurred in the US. Also, you have to agree it's a bit irrational to suspect you could have been pricked by a used needle, which happened to be contaminated with HIV infected blood, without even knowing about the injury. And even your "worst case scenario" is absolutely zero risk for HIV. No chance, no way. For sure you should never hesitate to go to any clinic, whether or not they specialize in HIV testing, in the future.

I hope these comments are helpful. Let me know if anything isn't clear.

Best regards--  HHH, MD

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45 months ago
Dr. Hhh,

Thanks so much for your prompt reply!  As you may have noticed from my previous thread, I'm seeing a mental health professional and already noticing significant improvement. My going to the clinic was part of my behavior plan (testing) but given dr. Hooks comments I was nervous.

Thanks for your answer. I wanted to be clear about your answer to my second question about the discoloration on my figers -- fingers in used to hold the bandage down after blood draw. E.g. if the discoloration on my fingers were blood contaminated with hiv, still no risk via my fingers getting any blood into the wound created by the blood draw.

Thanks again for all your help. And I understood your comments about ocd and can recognize them in myself. I just wanted to let you know that grappling with uncertainty is part of my mental health treatment and dr. Hooks previous advice on potential needle pokes in the environment has made a huge difference in my life (with very very few what if questions popping up). I don't want you to think your expert opinion will fall upon deaf ears.
45 months ago
Hi Dr. HHH,

I was hoping that when you wrote no no questions you meant no new question thread and that you'd still be willing to answer the follow up question I wrote yesterday. I asked:

I wanted to be clear about your answer to my second question about the discoloration on my fingers -- fingers I used to hold the bandage down after blood draw. Am I right that even if the discoloration on my fingers were blood contaminated with hiv, I still would be at no risk via my fingers getting  blood into the wound created by the blood draw.

From what I understand, the reasons for this are that my exposure to blood in this way would be 1. too indirect 2. the blood would have been exposed to air and temperatures 3. even a hole from a blood draw would be very small and not a place for HIV to realistically enter and 4.  even if there was a risk it would be far less than the 1 in 300 for a needle stick.

Thanks so much, I very much appreciate it. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Sorry I neglected the comment about colored fingers. I cannot imagine it was blood. But if it was, still no risk. Blood or other infected body fluids on skin are zero risk for HIV transmission. That's why hand-genital contact, for example, is risk free.---
45 months ago
Thanks Dr. HHH -- and your comment includes blood on skin even with the potential of getting into the wound caused by my blood draw?

I know this is my last follow up. Thanks so much for your expertise and time.
45 months ago
What I meant was, your "no risk" assessment takes into account the potential for blood on my fingers (if it was blood) getting into the wound caused by my blood draw (when I held the bandage over my wound the nurse asked me to hold).

Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
You're really over thinking this. Keep working with your counselor!

The only wounds ever known to result in HIV acquistion were those made in the presence of HIV infected blood, e.g. scalpel wound by a surgeon operating on an HIV infected patients. While in theory existing wounds might be a source of infection if exposed, as far as we know, such cases have not been reported. Most likely blood clotting and other components of would healing form an effective barrier from HIV susceptible cells and tissues. So if there is risk, it is trivally low and should be ignored.

That's going to complete this thread, which will have to be your last on the forum on this or similar topics. Here is our standard notice along these lines:

Please note that the forum does not permit repeated questions on the same topic or exposure, especially when the questions are obviously driven by anxiety or when there is apparently difficulty in believing or accepting advice already given. This will have to be your last one; future questions on this topic or about this exposure will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce the temptation to keep paying for questions with obvious answers; because experience shows that continued answers tend to prolong users’ anxieties, when professional counseling often would be a better approach; and because repeat or anxiety driven questions have little educational value for other users, one of the forum’s main purposes. Thank you for your understanding.    
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