[Question #6371] Occupational Risk

16 months ago
I was placing a suture at work after a tooth extraction. The tip of the suture needle which had gone through a patient’s gum pierced through my glove and lightly pricked my finger on the fingerprint side (I barely felt it). I degloved and inspected but couldn’t see anything (I.e. no blood/prick/spot).  I washed under warm soap water. 

I tend to have OCD about these things. I spoke with the patient extensively and the patient denied any infectious diseases and doesn’t take part in questionable behavior. Patient assured me that he was clean and frequently visits his physician. Patients medication list does not include anything for infectious diseases. Should I have gotten PEP? I’m vaccinated against Hep B.
16 months ago
Can you also comment on infection rates for people of unknown status? The 1 in 300 stat is for HIV positive people but I’d like to treat this case as unknown (even though patient considers himself clear of all infection).
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Welcome back to the forum. Sorry to hear of this event.

From your description of the event, with no visible skin injury the chance of HIV transmission -- even if the patient has it, which seems unlikely -- is extremely low, probably zero. Personally, I would not recommend PEP or even testing for HIV. However, policies on this might vary widely. All medical and dental offices are supposed to have infection control policies, or relationships with infection control experts. If the dental clinic or practice has this service, you need to speak with them. You should follow their policies and advice on testing (for both you and the patient) and PEP. I would expect them to recommend no need for either testing or PEP, but I can't guarantee it. In addition, they will want to know the event occurred in order to evaluate whether remedial training or other steps are warranted to prevent a recurrence of such an event in the future, either with you or another provider in your office or clinic.

If you're in the US, there's under 1 chance in a thousand the patient has HIV, especially since s/he denies infection and risk behaviors.

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

HHH, MD
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