[Question #8567] HIV risk in hospital setting

42 months ago

Dear Doctors Handsfield & Hook,

Thank you for the service you provide. I will seek counseling for my contamination fears. I understand they are a stress response for me and have no desire to be burdened by them (or burden you with them!) Your compassionate and science-based answers have been helpful to me in the past, and I hope that I can apply your responses here to any future concern that might come up for me.

I work in a hospital and was helping a coworker drain IV bags and tubing that were recently disconnected from a patient. My coworker was moving quickly with the tubing and handled it in a way that caused fluid from the tubing to splash my face. I am not sure that the IV fluid got in my eye but was close to it.

1. Do I need to be concerned about HIV infection from potential back flow of blood in the IV tubing that splashed me? I understand that the virus is inactivated when dried, but would it still be active in blood from disconnected tubing?

2. What are the limits of HIV exposure in a hospital setting for clinicians? I understand that the virus is fragile and is transmitted in very intimate ways, and not generally transmitted via objects unless they were just inside an HIV infected person (is that right?) Do discarded needles (not needle-sharing or being stuck right after sticking a patient), IV tubing, or splashes pose an actual risk for transmission?

Thank you so much for your help. I feel confident that having your words in my head will help me move beyond these fears, in addition to help from a counselor.

H. Hunter Handsfield, MD

42 months ago

Welcome back to the forum. Thank you for your kind words about our services.

I have two initial reactions to your situation. First, your hospital probably has established infection control procedures and an infection control team. You should inform them of this event. I do not know whether routine infection control procedures cover this sort of event. But if they do -- or if there is any doubt -- they will want to know about it. They also will then advise you about next steps, if any.

My second reaction is that this probably was a zero risk event or close to it -- but a bit more information is required to be certain. If the fluid that came in contact with your face came from the infusion line before it reached the patient, for sure there was little or no risk. However, if it came from an area that plausibly could have been contaminated with patient blood — the catheter itself or the last few inches of tubing that could have been exposed to backed up blood) then for sure the infection control team must know about it.

If the former scenario — no contact with the catheter itself or the patient end of the IV line — if I were on the infection control team, I might give advice about how used IV lines should be managed, but nothing more. On the other hand, if there was any chance of blood contamination of the portion of the line that was the source of your exposure, the infection control nurse or team might advise testing of the patient; and, if positive for a blood borne infection (or if testing isn't available, e.g. the patient refuses), perhaps they would recommend you be tested. However, the most likely outcome is that they will reassure you there was no risk and that nothing need be done other than maybe training about how used IV tubing is handled.

I stress that I am not an institutional infection control expert: if any of their advice differs from mine, follow theirs.

Finally, to the main question actually on your mind, "Do discarded needles (not needle-sharing or being stuck right after sticking a patient), IV tubing, or splashes pose an actual risk for transmission?" Probably no risk at all, or virtually none. Even direct patient blood contact with intact skin is risk free, and the same is surely true of IV fluid if contaminated with blood. To my knowledge, there has never been a reported case of HIV transmission in health care personnel other than by direct injury with a sharp instrument with visible blood. And if you think about it, regardless of infection control procedures, over the years there must have been millions events in which IV fluids, and even blood, came into contact with nurses', physicians', or other health workers' skin, yet no known cases of HIV. And maybe eyes as well. Anyway, certainly there is no risk from contact with IV fluid from high in the line, well before reaching the patient.

That's probably more advice than you were expecting. But let me know if anything isn't clear.

HHH, MD

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42 months ago

Thank you very much for your thoughts and advice on this.

I spoke to the nurse who was with me & she explained that she was pulling the spike out of the IV bag when I was splashed, so the patient end of the IV was not the source of the fluid I felt. That makes sense to me because we then drained what remained in the IV bag. I think that I don't feel as compelled to contact my infection control team knowing this, and that my fears got the better of me here.

Thank you for telling me that contact with fluid high in the line (or probably straight from the bag in my case!) would be zero risk, and for your comments on the zero risk event of contact with blood/contaminated IV fluid on intact skin.

A few last questions to follow up and provide me with some more resilience for the future:

I wondered if in your years of practice and involvement if there ever really was a confirmed case of someone contracting HIV via their eyes.

I also wondered how long blood inside an IV or a needle would be infectious once it is outside of a patient. It seems like it would need to be quite recent, but wanted to confirm this with you.

I truly love my work and don't want my fears to prohibit me from practicing. Can I be confident that if I continue to live my life in a committed, monogamous relationship, without IV drug use, and without being stuck with a needle or sustaining a cut with a sharp instrument that had visible blood, I don't really need to worry about contracting HIV? I'd like to limit the bizarre scenarios I might possibly come up with in the future!

And though I certainly don't want to waste tests on zero risk exposures, if I ever needed one, an antigen/antibody test would provide me with conclusive reassurance. They really are that trustworthy?

Thank you for helping me. It means a lot to have a voice I can trust to counteract my irrational worries.

H. Hunter Handsfield, MD

42 months ago

Thanks for the additional details of the IV fluids contact. Zero risk for HIV and all blood borne infections.

I'm not personally aware of any cases of HIV infection via eye exposure, or of any scientific reports. That doesn't mean there is no risk, but obviously it's extremely rare if it occurs at all.

Inside fluid intended for IV infusion, I imagine HIV would survive indefinitely -- at least several days.

The answer to your "Can I be confident" question is 100% yes: with those stipulations, you can be confident you will never catch HIV. (Of course assuming your sex partner is also uninfected and monogamous.)

Yes, the HIV AgAb tests are 100% trustworthy.

Thanks for the thanks. I'm glad to have been of help.

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42 months ago

Thank you so much, Dr. Handsfield.

Just to clarify, your statement: "Inside fluid intended for IV infusion, I imagine HIV would survive indefinitely -- at least several days" refers specifically to HIV survival inside blood intended for transfusion, right? That makes sense to me, but wanted to confirm and prevent an anxious reader of this forum from becoming fearful of IV fluid in general (or blood transfusions for that matter!)

I think my question that prompted that response was repetitive and not very clear. What I meant to ask was how long the patient side of an IV (or a needle), once removed from a patient, would be a risk for HIV infection. But looking back over our dialogue, you already addressed that in your first response to me ("Probably no risk at all, or virtually none.") and with the stipulations we've gone over, I don't think that's a necessary thing for me to worry about!

Anyway, thank you for taking this time to help me. It has been very useful and I feel that I have the information I need, and a better sense of proportion, so that HIV fears won't be such an issue. You have really helped me.

H. Hunter Handsfield, MD

42 months ago

There hasn't been a case of HIV transmitted by infusion in the US for many years. Current policies and testing have been 100% effective in eliminating all risk, so it's really not a relevant issue. That said, if somehow contaminated blood were collected, I imagine HIV would survive in it for at least the usual 90 days until the blood might be transfused into a patient. I imagine the same would be true for infected blood that backed up into IV tubing.

Without injury by a sharp instrument, while in the process of caring for a patient (large bore needle, bloody scalpel) you can be confident you will never be at risk for HIV in your work setting.

Thanks for the thanks; I'm glad to have helped. That concludes this thread. I do hope you understand (intellectually if not emotionally) that your work does not put you at significant risk of HIV. Safe sex is far more important for you to be concerned about!

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