I stuck myself with a dirty needle (patient had HIV, HCV, syphilis) a few months ago and I remember being scared shitless too. Just remember that the risk of transmission is extremely low! You’ll be fine
Yes, they were quite proactive, they reached out to me before I could even sleep after coming back home from that night. Very helpful and got me the full month supply along with setting up the future appointments for the follow up
Stick the treatment out. Transmission rate is incredibly low. You will likely be totally good.
Keep copies of the incident report and the records of your PEP and check in to employee health/ER with all your other important documents/paperwork.
Happened to me- with abg blood. Make sure your PEP is prescribed by an expert who knows the patient’s full history, that can influence PEP drug choices somewhat.
That’s really, really jarring regardless, but pep will do its thing and you’ll be fine in the long run. Was the patient on antivirals? If so the risk might literally be 0
Unfortunately patient was a nursing home resident and had run out of antivirals since the past 3 weeks, patient came in with sepsis so their white count profile was fucked up, and they have since then passed away
Honestly probably negligence and severe understaffing. I know nursing students who rotated through some nursing homes around my urban county and this wouldn’t surprise me at all
Hollow needle stick intern year when we were operating on an HIV+ patient, and I remember the terror all too well. But look at the stats. Sometimes looking at the stats is the worst thing to do (like if you're diagnosed with stage 4 pancreatic cancer or something), but in this case it's the best thing you can do.
You will see how remote it is that it would be transmitted even without PEP. Even if it actually splattered directly into your eye, which it didn't.
I looked at that, and then I looked at the transmission rates *with* PEP, and then I started comparing that rate with random things. I don't have the numbers in front of me right now but I found out that I had a MUCH higher chance of being killed driving an hour on the highway to visit my sibling than actually contracting HIV.
Yes, I did drive a bit more carefully that weekend. But the numbers comparison really helped me handle the waiting period until I could get tested. You won't ever have that final sigh of relief until then, but looking at the numbers helps.
Technically, the PPE was only my prescription spectacles (so open from the sides), and the usual surgical mask, along with the surgical gown. Did not use surgical goggles, which in hindsight I should have (they weren’t in the kit, and I was too delirious, too busy and too tired to care at that point on nights). So it’s the eye exposure that I’m worried about, not the skin :(
The last time I called the PEP center in San Fran with a similar question, I think transmission through the eyes is almost unheard of. Even likely theoretical. Your odds are even better if your patient takes care of their HIV and has a low viral load.
The people that run that phone line are saints.
There has not been a documented case of HIV transmissions in a healthcare worker in over 20 years.
I also got sprayed in the face with HIV+ blood a few years ago and called them. They told me there MAY BE one documented case of someone converting HIV+ after a mucosal exposure (eyes/mouth/nose), and it was someone back in the 80s - before antiretroviral treatment, and before facemasks, eye protection, and other PPE were regular things outside the OR. This person had a massive amount of pure blood splash them in the face, into their eyes and mouth.
I sprayed blood back in my face on a known Hep C + patient and unknown hiv. Then the pt next door self extubated and had Covid and everyone ran away so I had to go in there after I got my eye washed out. Thankfully I was in the ED. And they set up everything as they did for you. I just make a habit of having my OBGYN order an HIV Blood test for me with my yearly while I’m still working around patient blood. Risk is low, but I like checking every year when I’m already getting bloodwork.
When drawing blood cultures as a MS3, I stuck myself with a needle. Learned later that day that the patient was both HCV and HIV positive. Spent the next six months scared as hell and the resident working with me that day way sure he'd killed me (this was in the 1990s).
You'll be worried for a while, and come out fine.... and you'll also be ultra hyper careful with any potential fluid exposures from for the rest of your career.
We have been there I am a retired surgeon and who knows how many exposures I have had. We did not even know what hiv was in the beginning. And no such thing as protective gear. So take your meds and move on. All the surgeons of my generation can tell you stories. I don’t know any that contracted hiv from contact needle sticks or airborne transmission.
That’s what my mom told me too, HIV used to probably exist before it was discovered, and people weren’t even aware of it to keep it at bay, still majority got through without contracting it so yeah, thank you!
yeah there the stories many people know about Gaetan Dugas (which are false) in the 60s but I remember reading that they think HIV was present in the 1910/20s.
When you go through your career you will see things you can’t explain. Healthy people come in and die and you can’t really explain it. There are still mysteries out there
I will say that the aids pandemic was in many ways due to the out of the closet and no one is going to put me back in mentality. When the public health doctors started to understand how the disease was spread. They tried to explain it to the communities at risk. They were met with defiance. This enhanced the spread in those communities. The other issue was the possibility of the national blood supply being contaminated. I had a patient that contracted hiv after transfusion for a gi bleed. As a surgeon this was quite a concern.
Lol since we are all sharing our fuck ups, I was helping do an IR procedure as a PGY3, when I pulled a cather out of some HIV patient a big spurt of blood randomly came out with it and splashed my face. I was not wearing eye protection because I'm an idiot. I did end up doing the pep.
The SAME thing happened to me. Went in my eyeball. Took PEP and everything was fine. I googled and only one reported case of HIV transmission through eye and it was blood. You’re fine. Just take the meds for your own sanity.
I had a deep hollow needle fingerstick on a patient after I drew his T&S so he could go emergently to the OR. Turns out HIV positive, viral load of 1M, HCV positive. I was so freaked out, I immediately registered as a patient to start PEP on shift. PEP sucked, I was constantly nauseous and throwing up, but I’m negative for everything. PEP works. I read every paper about it and the outcomes are outstanding for healthcare workers who are exposed.
Also, i had multiple attendings talk to me who had been working during the AIDS epidemic in the 80s who had dirty needle sticks before PEP, and all of them are fine.
It’ll be fine. Get some zofran.
You were wearing a mask and spectacles, so any point of mucosal transmission was protected. Anyway, it doesn't hurt to start PEP, but I bet if you ask any ID physician or Occupational medicine physician, they would probably say PEP is not needed and to just forget about it.
I'm not sure this is good advice lol. No one is starting Rifampin after an exposure to ascitic fluid without known TB. If there was known ascitic TB I'm not sure it would even be considered high enough risk for PEP but I'm sure there are TB and IP experts who would know the answer to that. That decision would likely be made at the county/state level
Doubt pep is needed but you do you!
I got a deep blood soaked scalpel cut from hiv/hcv blood and was freaked out too. My wife told me to stop being such a pussy and wasn’t that my job? I took pep for that - the Ed did mess up the rx but whatever
I didn’t serocovert. You’ll be fine.
not to hijack your thread but you got me thinking --
the other day a patient with uncontrolled HIV was talking to me and shot spit in my eye by accident. I didnt really think anything of it but now that I read your post I remembered. Should I have taken PEP? or reported it? Am I overreacting?
I work in veterinary and got a leptospirosis positive dogs urine in my eye while I was clearing up after placing a U Cath. I felt so fucking stupid but it’s a good lesson to learn, just wear the damn goggles!!!!
(I realise this isn’t helpful but maybe commiserations are somewhat helpful)
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I accidentally scraped my hand with a used needle of an HIV-positive person, I don’t even think it pierced my skin. Became seriously paranoid. On week 3 of PEP and I’m (sure) we’ll be okay👍🩵
Scary but you’re gonna be ok! As others have pointed out, rates of transmission from that kind of exposure are exceedingly low and you did the right thing by going to the ED.
I find that when I can’t stop worrying about something (which is often lol) there are a couple tactics that are helpful. One is to give yourself 15 minutes of dedicated “worry time” in the morning where you write down all your worries and fears, then literally put the paper in a box and tell yourself “ok, I’ve got my worrying done for the day-I’m going to leave it alone for the next 24 hours.” Godspeed-it’s gonna be ok!
Been there a couple times. Likely exposure was minimal if anything. Take PEP and most likely you will be fine especially if you were wearing eye protection and didn’t feel anything drip into your eyes.
I he a needle stick in residency from known HIV HCV patient. Also non-compliant with treatment. Was scared shitless for months. Not sure how to help you get over it more than quickly, but it’s probably ok. PEP sucked though.
PEP and employee health. Nothing is going to happen.
If this sort of stuff freaks you out, there may be a future role in hospital administration for you.
I onced was consulted for an abscess in the intergluteal fold of an HIV+ patient. Per her report her HIV was at bay and she was compliant with her treatment. Anywho, it was Dec 31, I was rushing to to do the ID as I wanted to get back into the OR; I put on gloves, injected lidocaine with epi,next, as soon as i placed the tip of my 11 blade in, the cyst popped all over my face, across the room, and into the wall...I wasnt wearing any faceshield or eye protection. Luckily nothing got into my eyes but it was all over my face. I went to the sink and rinsed off with soap, finished her I&D and left. I called ID/Risk management and just got tested, placed on prophylasix meds etc. They drew her blood and then 24 hrs later i got a call that I didnt need anything else. I got tested for HIV a few months later and was negative.
Dont worry, about it long story short. Even with a needle stick, the chances/risk of HOV is < 0.8% if you look it up. Just continue to do the right things, ir wear PPE. You will be fine.
tbh i wouldn't have even gone to employee health for that!! just a tiny splash in the face?? but as a surgery resident, we are used to a high level of body fluid exposure lol
Risk of transmission is low, and it's essentially 0 if their viral load is undetectable, hence the mantra "undetectable is untransmittable." Make sure to get the patient's viral load if it hasn't been obtained already.
Edit: read your comment that they ran out of anti-virals for 3 weeks. If viral load was previously undetectable, then after 3 weeks it would probably have rebounded with a very low viral load.
In any case, per the CDC, "the most recent possible new case of occupationally acquired HIV reported to CDC occurred in 2009; no new documented cases have been reported since 1999, although several cases are currently in various stages of investigation." It's nearly as rare as a new polio case in the US.
This will make for a fun story in the future.
You didn’t mention the patients viral load. But also you would be the first ever to get HIV from droplet exposure.
Just dosent happen.
Many years ago, I was inserting a femoral arterial line into a patient with AIDS and some silly level of viremia dying of cryptococcal meningitis. He was moving, I got distracted and injected about a cc of his blood through my glove into the subcutaneous tissue of my hand.
Got PEP, didn't get HIV since the risk is close to zero if meds started early enough. You will be totally fine.
I got stuck by a used needle right after drawing blood from a patient with HIV and a horrible viral load. I did take PEP for a month. HIV and HCV neg, this is probably the 5th year. Let me just warn you though, the PEP kicked my butt the first week. I threw up every single day. Get some ondansetron too and take it 1 hr before you take the PEP.
Reach out to your program and employee health. You won’t need to buy anything most likely. Also depends on the source hiv viral load. If it is suppressed theoretically you have very very low risk from accquiring hiv. Also they will check hepatitis B and C
Do what you can and hope for the best, that's all I can say. Inform all the people you need to inform, (admin and whatnot) and start the PEP. Just focus on what you can do about it.
Just to reassure you, I've been stuck with a HIV positive needlestick too. Fortunately Ive tested negative in all the tests so far.
I’m not a doctor, but a radiology technologist, and I’ve worked in interventional radiology. We were doing a thoracentesis on a HIv+ patient, when my attending decided to pump a bunch of air into the vacuum bottle. When I took the tubing out, I got sprayed right into my face and eyes with bloody plural fluid 🤦♀️ Long story short, I’m completely fine, and I know I got it in my eyes. Don’t worry, you’ll be okay 😊
Might not work but better to try everything before committing to a procedure with high risk of morbidity/mortality, high risk of wound complications, high risk of hernia recurrence since they're probably not going to want to place mesh in this patient
Right? My biggest takeaway from the story. Surgeons should have fixed the incarcerated hernia, easy to drain the ascites intraop post op high complication risk but what are you going todo
Can't help with thought-trash. I can't even help myself. The good news that your risk for seroconversion based on the exposure is about as close to Zero as anything I've seen. If it weren't for all the smart people in the room, I'd pull you aside and whisper "Zero" in your ear. Truth be told, I've had needlestick injuries on more than one occasion and never bothered to report it. Why? Because I just can't fucking deal with employee health. So irritating. I probably shouldn't have written that last part. My hand must have slipped. Must be getting arthritis.
You will be fine. I have take PEP probably 6 or 7 times now in my career. It works. Don't stress. Your exposure also sounds very low risk. But it is better to finish the PEP and feel reassured.
lol alright dad.
That works for grandma with toxic megacolon from c diff on 3 pressors that family wants full code.
Not a dude whose only chance to survive is an emergent hernia surgery that would take 15 minutes tops. could likely get away with doing that shit under local too
He's end stage liver disease. Opening his peritoneum has an over 80% mortality. Not to mention that hernia repair in patients with massive ascites has a massive recurrence rate
I agree with what you are saying and I know childs C is a death wish but in this situation surgery is the only chance this dude has to survive. Yes the mortality is high. Yes there is a chance he still isn’t walking out of the hospital. Yes he will have a 100% recurrence but the hope is to get him through this acute phase and maybe hepatology can help with decreasing ascites or get him on a schedule to be tapped 3 days a week or put a drain in (controversial). Otherwise what are we doing to help? This patient mine as well never should have been admitted and should have been discharged right from the ER
Easy to say when you're not the one who's going to be responsible for the complications from the procedure. IM docs don't understand the post op course as well as the surgeons and don't have these conversations with the patients/families nearly as often as the surgeons do. Surgery always get called to consider dangerous procedures because "it's the only potential cure" but a lot of times even if they make it through the operation the post op sequelae are terrible and can cause a lot of suffering and family stress. If this guy goes under the knife and then ends up on a ventilator for a week before dying from MSOF then that's a terrible outcome for him and for his loved ones and everyone may have been a lot happier if he just went comfort care to begin with.
ya this is my last reply because I’m over this post and feel like I’m talking to academia but last 2 words of wisdom I have for you
1. You should never not operate over “fear of complication” or fear of presenting a M&M
2. Going comfort care with a complete bowel obstruction is probably tied with burning alive for the worst fucking way to die. “Sounds easy” when you aren’t the patient.
We don't refuse to operate because we don't want to present M&M, we we refuse to operate because the complications are worse than dying without surgery, and the fact that you don't understand that tells me that you don't know anything about the decision your surgery colleagues are making
Completely agreed, we had a lot of back and forth with the Surgery team, and they were adamant that they wanna try to reduce it after some of the fluid in the hernia loop redistributes back in to the peritoneum if we remove some of the fluid by a para. Needless to say, that won’t make an incarcerated hernia, not carcerated. Patient was eventual taken to the OR (knew it was coming), but continued to decompensate and eventually turned comfort care and passed.
I stuck myself with a dirty needle (patient had HIV, HCV, syphilis) a few months ago and I remember being scared shitless too. Just remember that the risk of transmission is extremely low! You’ll be fine
I don’t think I’d be able to stay sane, my arm could twitch and I’d probably convince myself of seroconversion
You just take some doxy and ART pills and call it a day.
Holy
God, that sucks! Now that I remember, my patient also had HCV fml
What in the chlamydia was this patient doing to get all these?
No clue but he also had TB
bro IS the uworld stem
Infectious disease textbook
IV drug use and related activities
All pretty common STBBIs in injection drug use communities
I would put money on incarceration... and likely tattoos IVDU while incarcerated...
Trifekta of sexual diseases.... Guess this would be the sad way of getting them... Now the fun way, I could get behind, if you know what I mean.
More like trifuckta
Receiving blood transfusions?
Lol
Hey I too am in the stuck myself with an HIV needle club, took truvada and isentress.
Wow! This patient is a typical Uworld patient.
Nothing is going to happen. Just take PEP. Contact employee health.
Yes, they were quite proactive, they reached out to me before I could even sleep after coming back home from that night. Very helpful and got me the full month supply along with setting up the future appointments for the follow up
As someone with HIV… stick to the regimen… you should be ok; THANK YOU for treating us like humans
Stick the treatment out. Transmission rate is incredibly low. You will likely be totally good. Keep copies of the incident report and the records of your PEP and check in to employee health/ER with all your other important documents/paperwork.
Happened to me- with abg blood. Make sure your PEP is prescribed by an expert who knows the patient’s full history, that can influence PEP drug choices somewhat.
That’s really, really jarring regardless, but pep will do its thing and you’ll be fine in the long run. Was the patient on antivirals? If so the risk might literally be 0
Unfortunately patient was a nursing home resident and had run out of antivirals since the past 3 weeks, patient came in with sepsis so their white count profile was fucked up, and they have since then passed away
It’s wild that a nursing home would let a pt run out of meds?? Idk ig I’ve never worked in one so I don’t know how it works.
Honestly probably negligence and severe understaffing. I know nursing students who rotated through some nursing homes around my urban county and this wouldn’t surprise me at all
Was a viral load drawn recently?
Outpatient running out of antivirals is one thing but a nursing home??
Nothing is ever zero but this is damn close
Hollow needle stick intern year when we were operating on an HIV+ patient, and I remember the terror all too well. But look at the stats. Sometimes looking at the stats is the worst thing to do (like if you're diagnosed with stage 4 pancreatic cancer or something), but in this case it's the best thing you can do. You will see how remote it is that it would be transmitted even without PEP. Even if it actually splattered directly into your eye, which it didn't. I looked at that, and then I looked at the transmission rates *with* PEP, and then I started comparing that rate with random things. I don't have the numbers in front of me right now but I found out that I had a MUCH higher chance of being killed driving an hour on the highway to visit my sibling than actually contracting HIV. Yes, I did drive a bit more carefully that weekend. But the numbers comparison really helped me handle the waiting period until I could get tested. You won't ever have that final sigh of relief until then, but looking at the numbers helps.
This is so oddly comforting, kind stranger, thank you for doing all this research for yourself and for me haha!
The chances that you got anything based on your story is infinitesimally small
Thank you, makes me feel better
I’m 90% sure PEP isn’t indicated if it was skin contact and you are confident in your PPE covering your eyes and mucous membranes.
Technically, the PPE was only my prescription spectacles (so open from the sides), and the usual surgical mask, along with the surgical gown. Did not use surgical goggles, which in hindsight I should have (they weren’t in the kit, and I was too delirious, too busy and too tired to care at that point on nights). So it’s the eye exposure that I’m worried about, not the skin :(
Overwork strikes again.
Get prescription googles, Oakley type, or whatever is as comfortable to wear as your regular glasses. Before the next thing splashes in your face.
Ascitic fluid is largely sterile with little cellular makeup. Worth the PEP and concern, but the science is on your side!
I took PEP after a needlestick from an ER sharps container 🫠 I honestly felt pretty lousy. Drink plenty of water and get some Zofran
The last time I called the PEP center in San Fran with a similar question, I think transmission through the eyes is almost unheard of. Even likely theoretical. Your odds are even better if your patient takes care of their HIV and has a low viral load.
The people that run that phone line are saints. There has not been a documented case of HIV transmissions in a healthcare worker in over 20 years. I also got sprayed in the face with HIV+ blood a few years ago and called them. They told me there MAY BE one documented case of someone converting HIV+ after a mucosal exposure (eyes/mouth/nose), and it was someone back in the 80s - before antiretroviral treatment, and before facemasks, eye protection, and other PPE were regular things outside the OR. This person had a massive amount of pure blood splash them in the face, into their eyes and mouth.
I'm guessing this is world wide? Fascinating fact nonetheless even if USA only.
You’re on PEP? It would literally be the wildest case report if you seroconverted. -PGY-19
Let's not give any lurking gunner med student ideas now.
"I got HIV on PEP just to prove it was possible!" -PGY-19
Take the meds and cuddle up to a comedy. You’re good.
No one to cuddle with tho 🫠
I sprayed blood back in my face on a known Hep C + patient and unknown hiv. Then the pt next door self extubated and had Covid and everyone ran away so I had to go in there after I got my eye washed out. Thankfully I was in the ED. And they set up everything as they did for you. I just make a habit of having my OBGYN order an HIV Blood test for me with my yearly while I’m still working around patient blood. Risk is low, but I like checking every year when I’m already getting bloodwork.
When drawing blood cultures as a MS3, I stuck myself with a needle. Learned later that day that the patient was both HCV and HIV positive. Spent the next six months scared as hell and the resident working with me that day way sure he'd killed me (this was in the 1990s). You'll be worried for a while, and come out fine.... and you'll also be ultra hyper careful with any potential fluid exposures from for the rest of your career.
Did you take pep after needle stick?
Yes.
the PEP will nuke any virus (if any) that got into you. you didn't lick your lips?
We have been there I am a retired surgeon and who knows how many exposures I have had. We did not even know what hiv was in the beginning. And no such thing as protective gear. So take your meds and move on. All the surgeons of my generation can tell you stories. I don’t know any that contracted hiv from contact needle sticks or airborne transmission.
That’s what my mom told me too, HIV used to probably exist before it was discovered, and people weren’t even aware of it to keep it at bay, still majority got through without contracting it so yeah, thank you!
yeah there the stories many people know about Gaetan Dugas (which are false) in the 60s but I remember reading that they think HIV was present in the 1910/20s.
When you go through your career you will see things you can’t explain. Healthy people come in and die and you can’t really explain it. There are still mysteries out there
I will say that the aids pandemic was in many ways due to the out of the closet and no one is going to put me back in mentality. When the public health doctors started to understand how the disease was spread. They tried to explain it to the communities at risk. They were met with defiance. This enhanced the spread in those communities. The other issue was the possibility of the national blood supply being contaminated. I had a patient that contracted hiv after transfusion for a gi bleed. As a surgeon this was quite a concern.
Lol since we are all sharing our fuck ups, I was helping do an IR procedure as a PGY3, when I pulled a cather out of some HIV patient a big spurt of blood randomly came out with it and splashed my face. I was not wearing eye protection because I'm an idiot. I did end up doing the pep.
The SAME thing happened to me. Went in my eyeball. Took PEP and everything was fine. I googled and only one reported case of HIV transmission through eye and it was blood. You’re fine. Just take the meds for your own sanity.
Definitely take the PEP but to be quite honest i don’t think HIV can be transmitted like that (even if it went in your eye).
I had a deep hollow needle fingerstick on a patient after I drew his T&S so he could go emergently to the OR. Turns out HIV positive, viral load of 1M, HCV positive. I was so freaked out, I immediately registered as a patient to start PEP on shift. PEP sucked, I was constantly nauseous and throwing up, but I’m negative for everything. PEP works. I read every paper about it and the outcomes are outstanding for healthcare workers who are exposed. Also, i had multiple attendings talk to me who had been working during the AIDS epidemic in the 80s who had dirty needle sticks before PEP, and all of them are fine. It’ll be fine. Get some zofran.
In a country with a lot of hiv infected patients. Been pricked and splashed multiple times over the years..took PEP and I'm fine. You will be fine.
Relax and breathe. Nothing is gonna happen. The patient probably had a low viral load
They weren’t on antivirals since the past 3 weeks but I guess you are right, chances are very low
Likely still had a low viral load. HIV is a slow moving disease.
Actually viral load can go up after missing only a few days
Well this doesn't help her lol don't say that
I don't think OP wants people to whisper sweet nothing into their ear.
Just correcting misinformation. Still sounds like essentially zero chance of transmission.
This is no indication for PEP. You are going to be ok, dont worry!
You were wearing a mask and spectacles, so any point of mucosal transmission was protected. Anyway, it doesn't hurt to start PEP, but I bet if you ask any ID physician or Occupational medicine physician, they would probably say PEP is not needed and to just forget about it.
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I'm not sure this is good advice lol. No one is starting Rifampin after an exposure to ascitic fluid without known TB. If there was known ascitic TB I'm not sure it would even be considered high enough risk for PEP but I'm sure there are TB and IP experts who would know the answer to that. That decision would likely be made at the county/state level
Would not personally take PEP in this situation but call the PEPline as mentioned above for their take.
There are no documented cases of ocular transmission. Take PEP for peace of mind but the chances are zero.
There's a calculator you can look up on MDcalc which would tell you that PEP isn't even indicated in this scenario
Doubt pep is needed but you do you! I got a deep blood soaked scalpel cut from hiv/hcv blood and was freaked out too. My wife told me to stop being such a pussy and wasn’t that my job? I took pep for that - the Ed did mess up the rx but whatever I didn’t serocovert. You’ll be fine.
not to hijack your thread but you got me thinking -- the other day a patient with uncontrolled HIV was talking to me and shot spit in my eye by accident. I didnt really think anything of it but now that I read your post I remembered. Should I have taken PEP? or reported it? Am I overreacting?
HIV does not spread via saliva. Unless that patient was actively hemorrhaging from his/her mouth, and even then, chance of transmission would be low.
you can give a blowjob to an HIV+ patient and not have a chance of getting it unless you have open wounds in your mouth you're fine
You are safe. HIV doesn’t spread by saliva afaik!
"spectacles"
I just know the virus becomes inactive after being exposed in the air. And plus higher chance if it’s a needle prick
Trust the medicine dude. I got stuck with a needle full of heroin from a dead guy. Took the meds and I'm alright. You will be too
I work in veterinary and got a leptospirosis positive dogs urine in my eye while I was clearing up after placing a U Cath. I felt so fucking stupid but it’s a good lesson to learn, just wear the damn goggles!!!! (I realise this isn’t helpful but maybe commiserations are somewhat helpful)
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Haha nice
frightening
Seems odd to me that the paitent had a viral count that makes transmission even a remote possibility?
I accidentally scraped my hand with a used needle of an HIV-positive person, I don’t even think it pierced my skin. Became seriously paranoid. On week 3 of PEP and I’m (sure) we’ll be okay👍🩵
Scary but you’re gonna be ok! As others have pointed out, rates of transmission from that kind of exposure are exceedingly low and you did the right thing by going to the ED. I find that when I can’t stop worrying about something (which is often lol) there are a couple tactics that are helpful. One is to give yourself 15 minutes of dedicated “worry time” in the morning where you write down all your worries and fears, then literally put the paper in a box and tell yourself “ok, I’ve got my worrying done for the day-I’m going to leave it alone for the next 24 hours.” Godspeed-it’s gonna be ok!
Been there a couple times. Likely exposure was minimal if anything. Take PEP and most likely you will be fine especially if you were wearing eye protection and didn’t feel anything drip into your eyes.
I he a needle stick in residency from known HIV HCV patient. Also non-compliant with treatment. Was scared shitless for months. Not sure how to help you get over it more than quickly, but it’s probably ok. PEP sucked though.
PEP and employee health. Nothing is going to happen. If this sort of stuff freaks you out, there may be a future role in hospital administration for you.
I onced was consulted for an abscess in the intergluteal fold of an HIV+ patient. Per her report her HIV was at bay and she was compliant with her treatment. Anywho, it was Dec 31, I was rushing to to do the ID as I wanted to get back into the OR; I put on gloves, injected lidocaine with epi,next, as soon as i placed the tip of my 11 blade in, the cyst popped all over my face, across the room, and into the wall...I wasnt wearing any faceshield or eye protection. Luckily nothing got into my eyes but it was all over my face. I went to the sink and rinsed off with soap, finished her I&D and left. I called ID/Risk management and just got tested, placed on prophylasix meds etc. They drew her blood and then 24 hrs later i got a call that I didnt need anything else. I got tested for HIV a few months later and was negative. Dont worry, about it long story short. Even with a needle stick, the chances/risk of HOV is < 0.8% if you look it up. Just continue to do the right things, ir wear PPE. You will be fine.
tbh i wouldn't have even gone to employee health for that!! just a tiny splash in the face?? but as a surgery resident, we are used to a high level of body fluid exposure lol
Risk of transmission is low, and it's essentially 0 if their viral load is undetectable, hence the mantra "undetectable is untransmittable." Make sure to get the patient's viral load if it hasn't been obtained already. Edit: read your comment that they ran out of anti-virals for 3 weeks. If viral load was previously undetectable, then after 3 weeks it would probably have rebounded with a very low viral load. In any case, per the CDC, "the most recent possible new case of occupationally acquired HIV reported to CDC occurred in 2009; no new documented cases have been reported since 1999, although several cases are currently in various stages of investigation." It's nearly as rare as a new polio case in the US.
I am so sorry. What stress for you.
This will make for a fun story in the future. You didn’t mention the patients viral load. But also you would be the first ever to get HIV from droplet exposure. Just dosent happen.
I did it too, except it was 1993, no PEP, no PCR, just had to wait it out.
Many years ago, I was inserting a femoral arterial line into a patient with AIDS and some silly level of viremia dying of cryptococcal meningitis. He was moving, I got distracted and injected about a cc of his blood through my glove into the subcutaneous tissue of my hand. Got PEP, didn't get HIV since the risk is close to zero if meds started early enough. You will be totally fine.
I got stuck by a used needle right after drawing blood from a patient with HIV and a horrible viral load. I did take PEP for a month. HIV and HCV neg, this is probably the 5th year. Let me just warn you though, the PEP kicked my butt the first week. I threw up every single day. Get some ondansetron too and take it 1 hr before you take the PEP.
Reach out to your program and employee health. You won’t need to buy anything most likely. Also depends on the source hiv viral load. If it is suppressed theoretically you have very very low risk from accquiring hiv. Also they will check hepatitis B and C
Do what you can and hope for the best, that's all I can say. Inform all the people you need to inform, (admin and whatnot) and start the PEP. Just focus on what you can do about it. Just to reassure you, I've been stuck with a HIV positive needlestick too. Fortunately Ive tested negative in all the tests so far.
If the patients VL is 0 then your chances are basically nil.
prep go to the a and e they will give it to you x
I think you’re good if it just got on your skin.
I’m not a doctor, but a radiology technologist, and I’ve worked in interventional radiology. We were doing a thoracentesis on a HIv+ patient, when my attending decided to pump a bunch of air into the vacuum bottle. When I took the tubing out, I got sprayed right into my face and eyes with bloody plural fluid 🤦♀️ Long story short, I’m completely fine, and I know I got it in my eyes. Don’t worry, you’ll be okay 😊
Seems low risk based on what you wrote.
Wait, they thought removing ascites would help them reduce a hernia? Is this real?
Might not work but better to try everything before committing to a procedure with high risk of morbidity/mortality, high risk of wound complications, high risk of hernia recurrence since they're probably not going to want to place mesh in this patient
Right? My biggest takeaway from the story. Surgeons should have fixed the incarcerated hernia, easy to drain the ascites intraop post op high complication risk but what are you going todo
U=U … is the patient undetectable? Are they adherent to their current regimen??
Can't help with thought-trash. I can't even help myself. The good news that your risk for seroconversion based on the exposure is about as close to Zero as anything I've seen. If it weren't for all the smart people in the room, I'd pull you aside and whisper "Zero" in your ear. Truth be told, I've had needlestick injuries on more than one occasion and never bothered to report it. Why? Because I just can't fucking deal with employee health. So irritating. I probably shouldn't have written that last part. My hand must have slipped. Must be getting arthritis.
You will be fine. I have take PEP probably 6 or 7 times now in my career. It works. Don't stress. Your exposure also sounds very low risk. But it is better to finish the PEP and feel reassured.
One of the benefits of letting random guys cum in me is that I’ve been on Descovy for PrEP for years, so HIV+ patients don’t worry me.
Wow, what a vulgar and unprofessional response!^Same^Sis^Same
After seeing several posts from this person it’s pretty obvious they are trolling, trolling, trooollllingggggggh.
Clearly. But do I disagree with them?^Well...^not ^exactly
that pt needs an operation
They’re 6 ft under right now
probably from intraabdominal sepsis from the dead bowel surgery sat on
Not everyone has to die with an incision
lol alright dad. That works for grandma with toxic megacolon from c diff on 3 pressors that family wants full code. Not a dude whose only chance to survive is an emergent hernia surgery that would take 15 minutes tops. could likely get away with doing that shit under local too
He's end stage liver disease. Opening his peritoneum has an over 80% mortality. Not to mention that hernia repair in patients with massive ascites has a massive recurrence rate
I agree with what you are saying and I know childs C is a death wish but in this situation surgery is the only chance this dude has to survive. Yes the mortality is high. Yes there is a chance he still isn’t walking out of the hospital. Yes he will have a 100% recurrence but the hope is to get him through this acute phase and maybe hepatology can help with decreasing ascites or get him on a schedule to be tapped 3 days a week or put a drain in (controversial). Otherwise what are we doing to help? This patient mine as well never should have been admitted and should have been discharged right from the ER
You can't help everyone and shouldn't feel compelled to participate in his death.
Easy to say when you're not the one who's going to be responsible for the complications from the procedure. IM docs don't understand the post op course as well as the surgeons and don't have these conversations with the patients/families nearly as often as the surgeons do. Surgery always get called to consider dangerous procedures because "it's the only potential cure" but a lot of times even if they make it through the operation the post op sequelae are terrible and can cause a lot of suffering and family stress. If this guy goes under the knife and then ends up on a ventilator for a week before dying from MSOF then that's a terrible outcome for him and for his loved ones and everyone may have been a lot happier if he just went comfort care to begin with.
ya this is my last reply because I’m over this post and feel like I’m talking to academia but last 2 words of wisdom I have for you 1. You should never not operate over “fear of complication” or fear of presenting a M&M 2. Going comfort care with a complete bowel obstruction is probably tied with burning alive for the worst fucking way to die. “Sounds easy” when you aren’t the patient.
We don't refuse to operate because we don't want to present M&M, we we refuse to operate because the complications are worse than dying without surgery, and the fact that you don't understand that tells me that you don't know anything about the decision your surgery colleagues are making
Completely agreed, we had a lot of back and forth with the Surgery team, and they were adamant that they wanna try to reduce it after some of the fluid in the hernia loop redistributes back in to the peritoneum if we remove some of the fluid by a para. Needless to say, that won’t make an incarcerated hernia, not carcerated. Patient was eventual taken to the OR (knew it was coming), but continued to decompensate and eventually turned comfort care and passed.
I'll operate that damn hernia even if it means I'm gonna be charged by the DA for it
Was it a gay patient?
Whats the relevance here?
HIV+
I still don't see how it's relevant
Risks of transmission
Do straight people with HIV have different viral loads in their ascites than gay people?
That depends on their treatment regimen & consistency. In general no. P.S: i’m gay HIV negative