[Question #4428] Was this an exposure? Should I be worried?

29 months ago

Hello expert,

I work in health care. A few days ago I had direct patient care with an HIV/AIDS patient.  I placed a pulse oximeter on the patient’s finger. After taking off the pulse oximeter probe, with my gloves still on, I attempted to pull the pulse oximeter apart so that I could clean it really well.  In doing this, I pulled the pulse oximeter with too much force and it snapped.  The spring wire that controls the opening/closing of the pulse oximeter busted and popped out.  It snapped quickly, poking into my gloved palm hand. It did not get stuck in my hand.  It was just a quick snap that poked me causing a very small/superficial cut in my palm.  I did not appear to bleed. It did not really hurt.  I washed my hands and then looked at the pulse oximeter.  Inside the pulse oximeter there was some flakey skin left behind from the patient’s finger, but no visible blood.  The patient’s hands did not have any fresh blood on them, but they were very dry/scaley with some visible scabs/dry blood.  Before taking off my gloves I did not see any noticeable blood or fluid.  The patient’s finger could not have touched the spring mechanism that poked me as this was hidden on the side of the pulse oximeter prior to me accidentally breaking it and causing it to snap.  The “cut” left behind on my palm was definitely more superficial as it did not bleed and it did not burn when applying an alcohol pad afterward.  In addition, being someone who is VERY cautious, I did not feel as though my skin was not intact afterward. I did not feel need for bandage. I used proper hand hygiene the rest of the shift and used gloves.  I did not report this incident as I did not think this was a true exposure.  However, after a few days I am getting worried. There was no obvious blood/fluid exchange. The spring that poked me was about the same diameter or smaller than a thin paper clip. Is this considered at all an exposure to HIV? Should I be worried at all? I can provide more details if needed. I am feeling very anxious. Thank you!!!

29 months ago
I just wanted to add that when the spring released and poked me it did tear my glove. Not sure if this will make a difference in your response. Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
 Welcome to our firm and thanks for your question. I agree with your assessment that the scratch you sustained when the oximeter broke did not represent a risk for acquisition of HIV. I say this based on several points. 

1.   You indicate that the spring did not fully pierce your skin or draw blood. When needlestick injuries and transmit HIV they typically break the skin introducing infected material deep into tissue. 
2.   You also indicate that the oximeter and attached spring we're not contaminated with blood. The fact that there may have been dried skin flakes present does not represent a risk for HIV in the same way that shaking hands with an HIV infected person is not a risk. 
3.   In addition the spring which scratch tube was solid. When HIV is transmitted through needlesticks part of the mechanism of transmission relates to the fact that needles are hollow and can carry blood in the hollow portion of the needle to transfer infection. This was not the case in your exposure. 
4.  Finally,  you do not indicate whether you were patient was on effective anti-HIV therapy or not. If youR patient was on effective therapy and their circulating HIV was suppressed they would not be infectious. This statement is the  basis for  and ongoing campaign referred to as "U=U" in which the letters U mean undetectable and uninfectious. This campaign is based on a number of high-quality scientific studies which have shown that persons with affective HIV therapy and undetectable HIV virus in their blood are not infectious to others.   Plus, if your paycheck was on affective therapy even if blood was present it may not have been infectious. 

 I hope that this assessment is helpful to you.   EWH
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29 months ago
Doctor Hook, 
Thank you for your response. First, I can give you more information in regards to the patient. The patient when arrived a month earlier had a cD4 under 100 and a viral load of around 20,000. Since being very sick in the hosptial the patient has been on a consistent hart regimen.  I checked to see the repeat labs from two weeks prior to this incident happening and it  showed the patients cD4 climbed to 160 ish and the viral load a little over 100. (Regardless of these numbers the patient is still very very sick). I think the rational part of me should not be too worried about this, but there is a large amount of angst and concern that exists. The point of the spring that poked me, as far as I am aware, did not have any contact with the patients finger. However, it did tear away the slightest bit of skin when it pierced through my glove. Had this been a non hiv patient I would not be worried.  I think about the what if scenarios and that’s what scares me. So I guess what I want to ask is are there any “what if” scenarios regarding this situation or am I just getting in my own head? Regardless of viral load,or anything else, was this a NON exposure? Can I stop worrying? Thank you Doctor. 
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
I understand your concerns.  Exposures of this sort, quite naturally, cause us to reflect on "what if" scenarios which are natural and hard to overcome.  The additional information you provide, particularly his good response to anti-HIV therapy gives me further comfort that this was a no risk event.  Having said that. The question is what to do about it.  If you are unable to quell your concerns, the one additional thing to do, in an abundance of caution, would be to export the event to your institution's employee health specialists.  I suspect they would evaluate your situation in Much history the same way I have but that would give you another source of information.  

My assessment of this as a no risk event is unchanged.  EWH
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29 months ago
Hello again Dr. Hook, and thank you for your advice and kind words.  Like a lot of people on this forum it seems I am having a difficult time shaking the fear of this situation.  Of course, hearing you say "no risk" makes me feel good and reassures me.  I too realize that the incident should not result in transmission of HIV based off the things we both agreed on.  Mainly, that there was not a transfer of blood/bodily fluids into my skin from the pulse oximter wire/spring.  Yet, here I am still feeling scared of the "what if" scenario.  Due to my intense fear of this incident, and inability to accept the overwhelming liklihood that I am fine, do you think I should get an HIV RNA test at around 11-14 days? I've heard that these tests can sometimes result in a slight bit more of false positives, but I hear they are also pretty conclusive if negative?  STDcheck.com states Our "FDA-approved HIV RNA Early Detection test has a sensitivity rate of 100% and a specificity of 99.83%. "     What are your thoughts.  I don't know if my worried mind will allow me to accept the "no risk" of the incident and not sure if I will be able to wait an agonizing 3 more weeks for a 4 week 4th gen.  Thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
I'm glad my comments have been helpful and understand your lingering concerns.  A negative RNA PCR test at around 14 days will be conclusive, with a negative result proving that you did not acquire HIV from the vents we have discussed.  The chance of a falsely positive result is small, less than1 in 1000.   The tests are a bit expensive as well.  If you choose to test (a personal decision) I urge you to do your best to commit to the idea that when the test is negative, you will accept it and move forward without continuing concern.

As I suspect you know, our Forum guidelines allow up to three responses to questions from each client.  As this is my 3rd response, this thread will be closed in a few hours.  Take care and please do your best not to worry.  EWH
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