[Question #9039] Surface Wounds / Contamination
36 months ago
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Thanks for this forum. Apologies if this is a silly question, but I do suffer from mild OCD so sometimes look for reassurance on things.
I was at a clinic today and I'd had an IV drip done in my arm. When I was leaving I realised that the IV wound had not clotted well and was still bleeding down my arm so went back to the nurse. The nurse had just finished a blood draw on another patient. She removed the plaster, wiped the area with a cleaning wipe, applied gauze. She briefly stuck a new plaster on her glove while removing the gauze before applying the new plaster. Now, I know this is probably highly paranoid, but afterwards I got worried as I don't think she had changed her gloves after conducting the blood draw on the other patient. So I became worried in case somehow there had been some blood on the gloves and somehow via the plaster or when she was changing the plaster it could have come into contact with the puncture wound. I know this is probably a totally irrational concern, but is there anything to worry here in terms of blood-borne diseases? I don't think surface contamination of a small wound is normally a concern? Is that right? And this would have required any virus to survive outside the body for at least a few seconds as well. It may not be relevant, but I also live in a jurisdiction with very low HIV prevalence due to government mandated testing, so probably even lower a risk. Can I simply ignore this event?
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H. Hunter Handsfield, MD
36 months ago
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Welcome back to the forum.
I'm glad you recognize that your OCD is an important aspect of your concerns. As discussed by Dr. Hook in your previous thread, massage without sex is risk free. Your current concern is similar. The thing to keep in mind about HIV is that there simply are no exceptions to the need for sex (penile penetration) or substantial blood exposure for HIV to be transmitted. Superficial blood contact, of the sort that in theory might have occurred with the events you describe, simply is not risky at all. Common fears to the contrary probably are partly the fault of public health and other advice resources, where "blood contact" often is listed as a risk factor, without specifying the details.
Anyway, even if you assume all the unlikely possibilities: that the nurse has HIV or other blood borne virus, that her other patient has such an infection, that she didn't change her gloves, you still would not be at risk for HIV -- even if somehow a bit of the other person's blood came into contact with your skin, or with your venipuncture site.
To be explicit: "is there anything to worry here in terms of blood-borne diseases?" No, not at all. "I don't think surface contamination of a small wound is normally a concern? Is that right?" Yes, correct. Virus survival? Irrelevant; whether or not the virus remained viable has no bearing on your risk. "...mandated testing, so probably even lower risk." Also correct. "Can I simply ignore this event?" By all means, yes!
I hope these responses are helpful. Let me know if anything isn't clear.
HHH, MD
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36 months ago
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Thank you Doctor. I really appreciate your quick reponse and reassurance. Unfortunately with OCD, events that are slightly out of the ordinary can become very disruptive, even when I am conscious of it.
Just two more quick questions if that is OK to close things out:
So, just to summarise, basically when 'blood exposure' is listed as a risk factor, this really is only talking about quite drastic situations where blood might be injected quite deeply into tissues, such as a needle stick or sharing needles? It simply doesn't apply to potential surface contamination of small wounds/grazes like paper cuts, small scratches or (in this case) a venipuncture site? Or anything you might normally encounter in a medical setting with blood draws/IVs etc? I read on another site after my post that even needle sticks are seen as only a 1% risk (not sure if that is accurate).
I'm up-to-date on my Hepatitis vaccinations, but presumably the same guidance applies to Hepatitis as well?
Will do my best to put this behind me quickly. Thank you.
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H. Hunter Handsfield, MD
36 months ago
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Yes, your summary is exactly right. The 1% risk with an overt needle stick (with a needle containing HIV+ blood) is correct. And yes, all this applies to the blood borne hepatitis viruses as well.
Glad to hear you're up to date on hepatitis A and B immunizations!
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