Exposed Working In Medical Field...

[Mark2002]

I am a Firefighter/paramedic and was recently exposed to an HIV+ patient a week ago.  I was splashed in the eye with a very small smount of diluted blood from the end of some IV tubing.  I found out 10 minutes later that he had HIV and started to get  worried.  I flushed my eye/eyes about 15 minutes from time of exposure.  Long story short, I had about 5 docs advise me I have nothing to worry about, and that a needle stick from a large bore needle only has 0.0003% chance or something, and mine was way less due to circumstances of my exposure, still it's scary.  Today was the worst though, I was finally starting to feel a bit better about the whole situation and the hospital left me a voicemail saying some "tests" came back positive... so  I started flipping out of course.  Turns out she was talking about hep B, which I didn't even know the pt had.  My level of immune activity is 22, anything over a 9 means you should worry... so now I am freaked out about this.  I have my Hep B vaccine and all, but this whole entire situation has me really stressed and freaked out.  Thats about all I got for now, nice to have a place to come and talk about this stuff, only my brother and co-coworkers know whats going on, so I am limited on the people I can confide in.

-Mark

[Willy50]

Mark.  I'm very sorry to hear of your exposure.  I hope that the results prove to be simply a wake up call that there is an element of danger in your work; perhaps more than you believed until an accident occurs at work.  I know that many people use glasses to protect their eyes.  The statistics suggest that the infection rate is no greater for first responders than the regular population.  One can interpret this as meaning that they are are no greater risk.  I guess that I would suggest that this minimises the risk a bit.  I think the group should have a far lower risk that the regular populace since they are aware of protocols to prevent infection and may lead a healthier than average lifestyle to boot.  I believe that the nocosomial, at work exposures bring their infection rates up to the that of the regular populace.  First responders are just exposed to a lot more trauma than the regular populace by a tremendous margin.  Don't let the statistics lull you into compacency about protection.

I'm not sure what tests that they gave you.  If you have been given Hep A and B vaccines you should have antibodies due to the vaccine.  Are you saying that you have antibodies, or that you have the presence of active virus detected by a PCR?  Same deal with the HIV?  I would think that it may be too early to test for either if your exposure was just a week ago.

So far as the Hep B...... most people that have been exposed have no serious reaction.  Their immune sytem is able to defeat the virus or keep it in check.  I would watch my alcohol consumption or use of NSAIDS till I knew what was going on there.  They may order some liver function tests if they have not already.

You might also check out this site;

http://www.hepatitisneighborhood.com/

They have a good informational site on all types of hepatitis.  I like the bulletin board.  There is a forum called "ask the nurse", which also provides some answers to questions.  I think you'll find this site useful.

You have recieved good advice that your chances are slight.  I'm glad that you are still doing all the testing, of course.  Perhaps you can tell me.....when are they saying that you'll be "out of the woods" and will have all the test results?

Best wishes and good luck on all your tests,
Willy

[Willy50]

This text was inserted into one of my posts to delete the post origionators name.  In order to provide anonymity that post was deleted and the words of the post were cut and pasted into one of my posts.  It has jumbled the order somewhat, but the words are all here and a majority of the origional order is intact.  If it's a tad confusing......that's why. -Willy


"Thanks for your reply Willy.  It's comforting to hear more positve statistics from other people.  To answer some of your questions, my blood work came back with my Heo B activity/reactivity levels of 22.  The lad sheet says >9 no worries, <9 there's a problem.  I have had all my proper immunizations for Hep, the recombivac I believe it's called.  As far as the HIV goes, my first lab was all negative, which is good.  Alot of people I work with were saying my Hep B levels being elevated was probably due to my vaccine kicking in and fighting it off, I hope they are right.  Today I am going to my PMD who I am sure will want some labs drawn for more testing, and my work is setting me up through workman's comp to go to an infectious disease specialist.  As far as everything you said about healthcare workers is so true.  We dont take the precautions that should for how much trauma we are exposed to.  Of course we wear gloves on every call, and wear masks, and eye protection when called for.... but accidents due happen, and I was the 4th eye exposure this year... it has been a wake up call for many guys on my department.  For the rest of my career I am wearing my eye protection on every medical call, weather I am on the amublance or the fire engine.  My exposure and another exposure were pretty much 1 time freak accidents, the 2 others should have had protection on while they were dealing with a pt who was jsut inubated.  The other freak accident was so random too, he was getting an acucheck on a diabetic pt, just a pin prick in the tip of their pointer finger, and blood squirtedabout 3 ft into his eye.  And stuff like that can happen every shift for us.  Anyways, I jsut got home and need to get some grub, thanks again for all of the helpful info, I greatly appreciate it.  I am definitely going to checl out that hep m-board too, thanks again.

Marc"

[Willy50]

Marc,  I'm glad that the reply helped.  For me....... I am just less worried about the Hep B because you had been vaccinated prior, I am assuming all of your shots, right.  The vaccination works, therefore you should be protected, even if exposed.  Even if you had/have a reaction, it should be minimised.  Many people are able to overcome the virus and it poses them little problems even without the vaccination.

My worry would be the HIV.  The statistics can give one false confidence.  The needlestick statistics generally apply to the whole group of patients.  That means most the needlesticks are from UNinfected people.  In your case, the patient is positive for HIV and (I'm assuming)the blood was fresh and viable.  What I am trying to convey is that I'm not sure your worries are yet over.  If they test you for HIV antibodies, your immune system will take several weeks before you have the antibodies in sufficient quantity to measure.  If they test for actual presence of HIV RNA in the blood (often referred to as a PCR), the same thing applies.  I think you may be looking at a window of time there, too.  I'm not a HIV expert, (I only have HCV and help at this board), but I'm sure that you can get more answers to the hypothesis I've suggested.  I think you may have to wait 3 weeks to get a positive antibody test.  Some folks may produce antibodies slowly....... and may get a negative during the first test, but a positive later on.  The PCR would be the second step in proving infection.  I'm not up on the saliva test, nor how soon it could be administered after exposure.

I like to refer people to other sites.  I try to help as I can, but recognise that there are others with more knowledge and experience.  I like one at AIDSMEDS, where they have a specific forum that gives counsel to people that have been exposed.  

http://www.aidsmeds.com/Fusetalk/categories.cfm?catid=4


You'll find some good info there too and I'm sure other sites. (we have a list of links at this board too, I think some are listed in the alternative section)

http://www.hivanonymous.com/cgi-bin/yabb/YaBB.pl?board=alternative;actio n=display;num=1032181671

I will end up modifying this post and adding a few links to it.

PS...... As you mentioned anonymity in your first post, if you don't wish to see your complete name mentioned, let me know.  I would have you just LOG IN and post that you want it removed.  I would then cut and paste your "guest" post into that logged in post and then delete the guest post where you used your name.  I would have to do it that way since I can't alter guests or members names, just delete or modify their posts.  If you sign in in the future as a guest, (by not logging in.....) just leave off your last name.  Sorry if that is a little confusing, but there is a way that we can deal with it if you want.  

Well, I'll get this posted and hunt up a few links for you.

Best wishes,
Willy

[Mark2002]

Willy, thanks again for more helpful links.  I put my last name with the 2nd post by accident, not that it's a huge deal, but if you could get that off there that would be cool.  I am diving into all the sites you linked for me and really appreciate it bro.  You have been  great help.  I cannot thank you enough

Mark

(Read above posts and you will see that this has been done.  The last name is gone and the posts are more or less in the same order.  Best- Willy)

[Willy50]

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A few more links on the subject.  The chances of HIV transmission are slight; perhaps 1 in 1000.  Another source indicates even less.- Willy

http://www.thebody.com/Forums/AIDS/Labs/Archive/TestingHIV/Q61116.html

http://www.sfaf.org/aids101/transmission.html

Of all these people, only 21 show signs of being infected with HIV (as determined by the antibody test). One of these people was a nurse who had multiple needle stick accidents, including one where she tripped and fell on the depressor of a syringe full of blood, and the entire contents entered her body. Another was a lab worker who was working with a test tube of infected blood which broke and cut his finger, exposing the infected blood to his bloodstream. This study shows that AIDS is a difficult disease to get, and even the intimate exposure of these health care workers was not enough to infect them, except in the most extreme ca

http://www.avert.org/needlestick.htm

[nick]

Hey I have a few questions for my research paper........That being on should HIV infected medical professionals be allowed  to operate on patients........................Should doctors have to confess or inform patients that they are infected to ensure the safety of the patients..........Should ethnic responsiblities be able  to overweight the rights that protect m edical professional from informing of the medical history.........What procedures are taken to make sure that HIV may not be transfer from doctor to patient or vice versa........Thanks if you respond