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Working As Dialysis Nurse. Blood Came Out From Pt Arterial Line. When Tried To Rinse Back Pt Blood To Catheter. Worried About HIV Infection?
Question: Hello, I am a Registered Nurse with several years of exp at Med Surge floor at hospital. I recently started working as a dialysis nurse (currently orienting with PCT about machine). Yesterday around 1345, I tried to rinse back pt blood to catheter, but because we recently changed our clinic protocol to rinse back patient, I forgot to clump the arterial side of the clip, and accidentally, almost 8oz of blood came out from pt arterial line. Blood splashed on the machine, floor and spilled a lot on my hands. I was wearing gloves, but I could feel the warmth of pt blood. As I remember, I was also wearing face shield, and gown. (but I honestly do not remember about face shield because I was slightly panic, and it is natural habit to wear face shield. But I did not feel or sense something got into my eyes. For sure, I was wearing regular mask because I had a cold. I took off the gloves, and washed my hands with soap. I do not remember if I had blood on my hands. I did not have any big open wound except I accidentally poked myself with clean needle in the morning, and I wore bandage for short period of time. Once blood is stopped, I stopped wearing bandage, and when the pt blood splashed on me, I was not wearing bandage, but I was wearing gloves.
Pt blood was on the floor, and I found some blood splash on my gown. I changed my gown, but I did not change my scrubs because our clinic does not prepare extra scrubs and shower room like OR. I was wearing high sock to cover my thigh (kind like compression socks) underneath of my scrubs. I have some scratches on my legs because I have very dry skin. My hands does not have any open big wound except the puncture happening of the needle from the morning. Pt is Hep C positive, and possible HIV. I was not sure if my situation is called I exposure to pt Blood because I was wearing gloves, I did not feel anything splash to my eyes, and I was wearing gowns. However, there is big possibility that I go blood on my scrubs where gown is not covering. That is why I did not talk to my supervisor about the issue.
In this situation, is there possibility I get infected with Hep C or HIV? If so, what can I do now? I plan to take test hcv) Rna Pcr Qualitative and HIV by PCR test but I still have to wait 28 days. Should I go to ER and explained to the doctor and get some emergency meds for HIV? I am not sure what I should do, and I feel sick by thinking about many things about it. Usually, I do have a RN preceptor with me during orientation, but I did not have RN preceptor or even PCT preceptor with me on the floor yesterday. Should I claim to the clinic about it? I feel just I want to cry now, and I cannot concentrate anything right now. Could you please help....
Pt blood was on the floor, and I found some blood splash on my gown. I changed my gown, but I did not change my scrubs because our clinic does not prepare extra scrubs and shower room like OR. I was wearing high sock to cover my thigh (kind like compression socks) underneath of my scrubs. I have some scratches on my legs because I have very dry skin. My hands does not have any open big wound except the puncture happening of the needle from the morning. Pt is Hep C positive, and possible HIV. I was not sure if my situation is called I exposure to pt Blood because I was wearing gloves, I did not feel anything splash to my eyes, and I was wearing gowns. However, there is big possibility that I go blood on my scrubs where gown is not covering. That is why I did not talk to my supervisor about the issue.
In this situation, is there possibility I get infected with Hep C or HIV? If so, what can I do now? I plan to take test hcv) Rna Pcr Qualitative and HIV by PCR test but I still have to wait 28 days. Should I go to ER and explained to the doctor and get some emergency meds for HIV? I am not sure what I should do, and I feel sick by thinking about many things about it. Usually, I do have a RN preceptor with me during orientation, but I did not have RN preceptor or even PCT preceptor with me on the floor yesterday. Should I claim to the clinic about it? I feel just I want to cry now, and I cannot concentrate anything right now. Could you please help....
Brief Answer:
Post Exposure Prophylaxis as early as possible
Detailed Answer:
Hi XXXXXX,
Welcome to XXXXXXX
Thanks for posting your query.
You had your universal work precautions.
At the same time you had a considerable amount of exposure to blood of a patient whose HIV status not known and you had a needle prick injury. Your exposure not crossed 24 hours I believe. You are an ideal candidate for Post occupational exposure prophylaxis for HIV. It will take care for both HIV and HBV infections. You have to take triple combination of ART drugs for 4 weeks without any interruption. It will be likely to abort both HIV and HBV if there is any possibility. Regarding HCV you just follow the guidelines of your ER doctors. Immediately rush to ER and also report to your hospital authorities. It is safe for you.
Good luck to you.
DR S.Murugan
Post Exposure Prophylaxis as early as possible
Detailed Answer:
Hi XXXXXX,
Welcome to XXXXXXX
Thanks for posting your query.
You had your universal work precautions.
At the same time you had a considerable amount of exposure to blood of a patient whose HIV status not known and you had a needle prick injury. Your exposure not crossed 24 hours I believe. You are an ideal candidate for Post occupational exposure prophylaxis for HIV. It will take care for both HIV and HBV infections. You have to take triple combination of ART drugs for 4 weeks without any interruption. It will be likely to abort both HIV and HBV if there is any possibility. Regarding HCV you just follow the guidelines of your ER doctors. Immediately rush to ER and also report to your hospital authorities. It is safe for you.
Good luck to you.
DR S.Murugan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr XXXXXXX
I just saw the answer from you, It has been already more than 24 hours since I exposure to the patient blood. I was not sure if I had to go, so that is the reason, I asked answers from the doctors here.
So now since it has been over 24 hours, should I still able to take the prep meds?
I am very confused because other doctors say different things.
Thank you very much for your responses.
I just saw the answer from you, It has been already more than 24 hours since I exposure to the patient blood. I was not sure if I had to go, so that is the reason, I asked answers from the doctors here.
So now since it has been over 24 hours, should I still able to take the prep meds?
I am very confused because other doctors say different things.
Thank you very much for your responses.
Brief Answer:
PEP recommended even if it is late.
Detailed Answer:
Hi XXXXXX,
Welcome back.
The risk for HIV by exposing to blood splash when you were having adequate work precautions is very low. But as a health care provider it is better to have a post exposure prophylaxis.
Theoretically speaking, HIV will take not less than 72 hours to establish the disease inside one's body. That is, it finds a place inside the T4 lymphocytes (WBCs) to multiply further if infection took place. This period is called as window of opportunity. That is, we had time to interrupt and abort the disease. But as per recommendation PEP has to be taken as early as possible that is within 6- 12 hours. Anyhow it is better for you to take PEP even though it is already late. So that we would not repent in future.
This is my suggestion.
DR S.Murugan
PEP recommended even if it is late.
Detailed Answer:
Hi XXXXXX,
Welcome back.
The risk for HIV by exposing to blood splash when you were having adequate work precautions is very low. But as a health care provider it is better to have a post exposure prophylaxis.
Theoretically speaking, HIV will take not less than 72 hours to establish the disease inside one's body. That is, it finds a place inside the T4 lymphocytes (WBCs) to multiply further if infection took place. This period is called as window of opportunity. That is, we had time to interrupt and abort the disease. But as per recommendation PEP has to be taken as early as possible that is within 6- 12 hours. Anyhow it is better for you to take PEP even though it is already late. So that we would not repent in future.
This is my suggestion.
DR S.Murugan
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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