[Question #7145] HIV risk of cannulation

8 months ago
Hello, please help me answer this..

I had a Gastrointestinal Endoscopy yesterday, everything seems okay until I noticed a nurse used THE SAME SYRINGE on me and another patient! I did not know what exact the solution in the syringe because I am not in the medical field, but I think it was saline to flush the cannula. As I was laying next to the other patient, I did know that he (a nurse) used a half of a syringe on the other patient, and then the rest on me. I did not have a chance to ask him because anaesthetic kicked in. So the question is, is that normal to share like that or the nurse did violate the medical safety policy? And in worst scenario, if he did it wrong, is it dangerous in term of HIV infection? I am still in 72 hrs period, should I talk to consultant for early PEP?

Thanks you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
8 months ago
Welcome to the forum. Thanks for your confidence in our services.

Just to be clear, we are experts in HIV prevention, but not in infection control and prevention measures in regard to medical procedures. That said, I really don't think you should be at all worried about this. First, there has never been a known transmission of HIV to a patient from a medical procedure (except for a dentist who apparently injected his own blood into several of his patients 30 years ago). Second, I'm somewhat skeptical that this really happened: how do you know that the ssaline syringe has been used on another patient? If that happened, I see no potential risk:  it sounds like the syringe or its contents did not contact the other patient or his/her blood or body fluids, any more than it contacted your own blood or fluids.

I'm not certain whether this procedure is normal. As just noted, I can imagine it being done and that it likely would be safe.. However, I suspect it is against policy in most health care settings. This is something you could ask the doctor or the institution where the procedure was done. If it's a large institution, probably they have an infection control specialist or team; you could ask to speak with that person.

I see no need for HIV testing in this situation, and certainly not for PEP. If there truly were believed to be some risk, the approach would be to test the other person for HIV and other blood borne infections before making any decision about your risks. But I can assure you that if you were a family member of mine, or if I were in the same situation, I would just let it pass.

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

HHH, MD
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8 months ago
Dr. Handsfield,

Thanks for your response. I have some more details and I hope that it will help bring you the whole view of my experience:

The hospital in which I got the GE is operated by a medical university and it is rated as a trustworthy place for doing such procedures, that's why I chose it to do mine. But its famous also causes overloading because too many people come to seek for services, and dozens of cases are being done here everyday. To handle the large number of patients, they do multiple cases at the same time, at the same room. I  was laying next to other patients, that's why I could observe how the procedure is ran on the others and I am sure that the nurse was sharing the saline syringe among us. The cannula has an injection port, from which saline was pushed into my body.

The hosital has been running for over 10 years and I think they should know what they are doing. Anyways, I still do not believe that sharing used syringes on multiple patients should be allowed in any health care settings. Then I started searching for some sources on Internet and I found that reusing flushing syringe is an unsafe practice. Even there were some cases of disease infection caused by this such as Hep. C. Do you think HIV is an another story since Hep. C is far more infectious than HIV? Will HIV become inactive once it contacts with drug/saline solution?

And lastly, I am likely to get tested to ease my mind. The earliest rapid test available here is 4th gen Alere HIV combo Ag/Ab from Abbott. The manufacturer claims it can give conclusion result after 14 days post exposure. Do you think it is enough for my reassuring purpose?

Thank you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
8 months ago
Thanks for the increased details and clarifications. However, as I said, I'm not sufficiently expert in these procedures to know whether it meets standard criteria and procedures for infection prevention. It certainly is possible that you are right about this procedure not being standard or acceptable, but I just don't know. I am unaware of the reports of HCV transmission that you report -- it surprises me, unless there was more to those situations. From your description, I don't see much opportunity for any blood exchange at all and I continue to see no need for testing for HIV or any other blood borne infection.

The AgAb tests are nearly conclusive at 4 weeks, and 100% by 6 weeks. 14 days is definitely too soon -- maximum ~80% senstive at that time, regardless of the manufactuer's claim.

Sorry I can't be as helpful as you hoped. But I think you understand the forum is oriented to sexual transmission, and to traditional risks for HIV such as shared drug injection equipment. Thanks for your understanding.
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8 months ago
I really appreciate your help. I will let it out of my mind for now and do a test at 6 weeks. Thanks again!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
8 months ago
I asked Dr. Hook to take a look at this thread. He also is unaware of HIV or other blood borne viral infections on account of such procedures, but he further comments "I do know however that use of a single syringe to perform flushes on multiple patients is not recommended." That said, it could still be within a particular institution's infection control guidelines. Anyway, I think it would be reasonable for you to ask if you wish. An institution like you describe undoubtedly has an infection control team, sometimes headed by an infectious diseases physician, but often a nurse. It would not be unreasonable for you to identify and contact that person to ask their policies. You could start by calling the switchboard or paging operator and ask to speak with whoever is on call for infection control. Or maybe call the endoscopy suite first; if this in fact is against policy, they might appreciate not being blindsided by a cold call from infection control! (They are human, after all....)

That completes the two follow-up exchanges normally included with each question. However, you have piqued my interest:  I'll leave this open up to a week, in case you follow through and wish to report what you learn. In the meantime, I hope the discussion has been somewhat helpful.
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8 months ago
Dr. Handsfield,

Thank you for extending the topic! As you suggested, I have contacted the hospital's hotline and addressed my concerns, they told me they will forward my questions to related faculty or staff. The day after, I received a call from the manager of anesthesia department, he appreciated my comments and also help me to clarify it. He told me that the syringes which I thought was being reused were actually anesthetics (milky colored)-- and the reason that may caused me thinking of reusing syringes is that technicians used to store anesthetics syringes in their pockets. After they use it for each patient, they leave it on the tray (maybe I missed this part) and move on to another person with a new syringe. Anyways, he also admitted that storing syringes in pocket is not a proper practice since it may causes difficulties in tracking drugs hence mistakenly reuse them or use them for wrong person. The correct way is to put the syringe on the trolley, bring it to the patient, use it and put it back on the tray. This is in fact should necessarily be applied to the department as the number of patients receiving procedure at the same time is high. He also told me that he will make appropriate corrections to avoid unfortunate consequences in the future. To make sure to clear out all of my concerns, he also checked the CCTV and confirmed that there was no reusing syringe in the time frame that my GE was being done.

I hope that I could help you understand my situation and also my country's medical system.

Best regards.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
8 months ago
Thanks very much for the follow-up. I'm glad on three levels:  that your fear of potential HIV risk has been resolved; that you helped the endoscopy suite (and apparently the Dept of Anesthesiology) improve their procedures; and, reading between the lines, that apparently the professionals involved appreciated your input. Good show all around!

That concludes this thread. Thanks again for raising these interesting issues. Take care and stay safe!
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