[Question #8351] Blood contact.

46 months ago

Hello doctors, I’m a nurse and 2 days ago I was withdrawing blood from a 54 years old Kuwait man in Kuwait and he start bleeding massively, I stopped the bleeding but at the end I saw a fair amount of blood directly on my hand and fingers

I got scared and told my supervisor who told me that’s his medical record show no infection at any kind and I don’t have to worry and there is no need to report the incident.

1- I know that’s a blood on intact skin, doesn’t lead to infection it’s need an open wound but if the blood came to the nails can it cause infection?

2- can the blood enter the blood stream through the nails? Like it’s goes inside through it if a fair amount of blood was flowing directly to it?

3- does the cracks around the nail, considered open skin? And it’s risky for infections?

4- how risky I but my self in?

5- it’s been 2 days since, do you recommend prep? The hospital won’t allowed me to according to my supervisor, but I can find a clinic.

6- I’m married, can my partner be safe if we had sex?

7- if a 54 years old man have a clean record, does that’s mean he is safe? And do the hospital test him before surgery in your experience?

8- is there is a record for infection in this manner? Touching blood in the skin?

Thank you so much doctor, and forgive me for all there quastions, I’m confused and scared

H. Hunter Handsfield, MD

46 months ago

Welcome to the forum. Thanks for your confidence in our services. It's always nice to hear from a fellow health professional.

First, can you give more information about your blood exposure? "Bleeding massively" suggests much more than I would expect from drawing blood. Did he have a GI bleed? A bleeding surgical wound? An accident victim with open wounds? Also, were you not wearing gloves? That of course is a universal recommendation and precaution when drawing blood -- and I would think probably routine in Kuwait and/or at your institution.

Second, if the exposure indeed was substantial, i.e. a large amount of blood and you were ungloved, you did the right thing by informing your supervisor. I cannot speak to policies and approaches in Kuwait, but for large blood exposures in most industrialized countries, it would be routine for the patient to be tested for blood borne infections (HIV, hepatitis B and C viruses) to help guide next steps for the exposed health care worker. However, for a relatively minor exposure, your supervisor's advice that nothing more need be done may be valid. Personally, I would not be at all concerned, and would not seek testing of the patient, if my hands (including fingernails) were exposed to a modest amount of blood while obtaining a blood specimen.

Third and perhaps most important, there are no known cases (anywhere in the world, in the 40 years of the worldwide HIV/AIDS epidemic) of a health worker being infected on the job, except by injury with a sharp instrument contaminated with blood. No known cases from simple skin exposure.

To your questions:

1-3) In theory, a cut or wound on the exposed area, e.g. around the fingernails, might increase the risk. But the risk still would be exceedingly low, not something I would worry about -- especially if you did not have an obvious recent wound that you could see (i.e. still bleeding). There is no reason to suspect any risk from exposure of intact fingernails.

4,7) Probably little or no risk, for the reasons discussed above. In general, HIV is uncommon in Islamic countries, but I have no way of judging your patient's risk for this or for HBV or HCV infection. Of course a "clean record" is no guarantee someone has no such infection, especially in societies where risky activities are almost always kept very private. Most patients in most countries are not automatically tested for blood borne infections prior to surgery -- only if they are known or suspected to be at risk.

5) I definitely would not recommend post exposure prophylaxis (PEP) unless there were higher risk than seems likely. But I await your additional information about the level of exposure, and any information you might have about the patient's risk for having a blood borne infection.

6) Here too, I see no reason (yet) to avoid sex with your husband.

8) See above: I know of no of blood exposure to skin that transmitted HIV, HBV or HCV.

I'll be happy to comment further if you can say more about the exposure. But from what I know so far, I very much doubt you are at significant risk. In the meantime, I hope these comments are helpful.

HHH, MD

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46 months ago

I was drawing blood from arterial Line (ABG), it’s was emergency situation so I didn’t wore gloves.

After I withdrawal the blood successfully, the line

drops amount of blood in the floor, some of it came directly to my fingernails while I was trying to close the arterial line, it’s was not large just a little amount.

I have no open cut or bleeding wound at any kind, my skin is very intact.

my concern is the fingernails it’s possible the blood could penetrate from it? Can it’s get to my bloodstream specially if it’s has a normal cracks like most people, does the blood on the skin might cause an infection or so.

The patient is 54 years old, he is having a knee surgery, his record is clean no infection is there but of course it’s not guaranteed.

After 12 hours I will complete 72 hours for this exposure and I really have no idea what to do.

H. Hunter Handsfield, MD

45 months ago

Thanks for the clarifications. I have a better picture now. Certainly this was not a "massive" exposure as you first stated, but a minor exposure. You appear to have an inflated view of the risk of infection from blood exposure. As I said above, there is no increased risk from exposure of the nails in comparison with skin elsewhere. I also said that cracks and minor cuts make no difference, and that no health care provider is known to have been infected when caring for HIV infected patients, except by direct injury with a contaminated sharp instrument, needle, etc. Even that has been very rare, with only a small handful of cases worldwide in the past 40 years.

Therefore, my advice is unchanged, i.e. I would not recommend PEP and would advise you to not worry. From a medical/risk standpoint, you don't even need testing (although I would understand if you choose to be tested in a few weeks, strictly for reassurance). Or you might coordinate with the patient's doctor(s) to ask the patient to be tested for HIV and HCV (and maybe HBV, but no need if you have been vaccinated).

I still don't understand why you weren't gloved for the arterial line puncture. There is no emergency that should interfere with gloving in a hospital setting. But I don't know the details of your situation: maybe gloves are not provided and readily available (?).

I hope these comments are reassuring, as they are meant to be. Perhaps this will turn out to be a valuable learning experience!

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