Exposed to HIV, HBV, HCV

1. My coworkers did not alert me to the dx and I answered a coworker's vent alarm without PPE. As I approached the pt the tubing disconnected spewing mist and blood tinged secretions in my face. 24 hrs later I learned of the patient's dx, and am obviously concerned. I've filed a report with my manager and surprisingly, employee health has NOT contacted me. We are NOT a WC facility (employer owned benefit plan...HCA) Any input from my wise friends at Allnurses? I do not necessarily trust my hospital to look after MY best interest here. Any input, comments, advice appreciated. Believe it or not this has never happened to me in 27 yrs.

   Last edit by mattsmom81 on Mar 10, '04
2. 

   About mattsmom81

   Joined: Jan '02; Posts: 5,673; Likes: 159

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3. 
   Mar 10, '04

   Occupation: RN-neonatal ICU Joined: Jul '03; Posts: 72; Likes: 8

   Seek medical attention outside of your facility, even if it means paying out of pocket. Maybe consider talking to an attorney. It sounds like your facility already was not watching out for your best interest.
4. 
   Mar 10, '04

   Occupation: SRNA Joined: Oct '02; Posts: 1,191; Likes: 28

   Wow, so sorry to hear this. Seek medical attention immediately, if you want to start the meds I know they have to be taken as soon after exposure as possible. Find out what the policy is at your workplace regarding exposure. I really hope everything turns out okay. Hugs to you.....
5. 
   Mar 10, '04

   Joined: Apr '00; Posts: 879; Likes: 40

   I'm so sorry mattsmom! You need to contact the infection control people at the hospital and receive immediate blood draws to establish your baseline status. The hospital is responsible for the expense of these labs. Secondly, the patient should be re-tested at the same time. Usually infection control contacts the physician and he/she orders the labs. Follow-up should occur for at least six months and you should be re-tested four to five times in that period.
   
   That being said, try not to freak out too much because seroconversion with needlesticks is extremely rare, therefore mucous membrane exposures almost never convert. HBV is the most virulent by a long shot and I'm hoping you're immune because you received the vaccine. An HBV titer can be drawn to check your immunity to the virus. HCV, which I was exposed to by a whole blood splash in the eye last year, is the second most virulent with only two documented cases from mucous membrane exposure on file with the CDC. I have to ask if you immediately flushed your eyes with a large amount of water? If you did that, you did exactly what your were supposed to and it significantly reduces your chances of infection. Lastly, HIV is the least virulent and cannot live for very long at all outside of a host. It is highly unlikely that you would convert with this type of exposure.
   
   The CDC website has a ton of information with regards to healthcare workers and exposure to communicable disease:
   
   http://www.cdc.gov
   
   The more I think about it, the more outraged I become about the lack of response from your facility. Because this patient is known to be infected, you should have already been assessed for potential anti-retroviral therapy and at least some counseling about your risk of contracting any of these viruses. :angryfire
   
   Again, keep in mind that your risk from that type of exposure is very small, even though I know you wish it was nonexistent. I'm happy to say that I'm Hep C free and now in the clear six months out. Another nurse I work with was exposed to Hep C the same way you were, and so far, she too is negative.
   (((((((((((((((((((((((((((mattsmom))))))))))))))) )))))))))))))))))))))))))
6. 
   Mar 10, '04

   Occupation: ER RN Specialty: ER,ICU,L&D,OR,ETC ; Joined: May '01; Posts: 5,588; Likes: 566

   I work for HCA also matts mom and when I got stuck with a needle from a pt with Pos for Aids and Hep c
   they were immediately on the case
   Initial set of labs drawn on me and seen by Infection Speicalist MD Immediately
   I was on triple Antiviral cocktail within an hour of exposure
   HCA footed the bill and supplied all the meds and reexaminations for a year.
   
   I am still testing negative over a year later
   
   That is HCA protocols for such exposures that are mandated at the corporate level
   
   You may need to contact corporate but get them immediately
   
   HCA does care for its employees
7. 
   Mar 10, '04

   Occupation: Home Health Patient Education Resource Nurse Specialty: 10 year(s) of experience in Hemodialysis, Home Health ; From: US ; Joined: Aug '02; Posts: 21,359; Likes: 7,204

   (((HUGS))) Mattsmom.
   
   What Elenaster said about flushing your eyes was my first thought as well. Also that the HBV would be the greatest concern.
   
   Please get the ball rolling asap and ensure you get all bases covered.
   
   Wish you the very best and that all will be ok.
8. 
   Mar 10, '04

   Occupation: icu nurse Joined: Jul '02; Posts: 10,260; Likes: 233

   (((((((((((hugs))))))))))))) can't add to the excellent advice except to take care and try not to worry too much.
9. 
   Mar 10, '04

   Occupation: RN Joined: Nov '00; Posts: 749; Likes: 50

   I'm sorry, and just want to add my support. Sounds like you got some answers straight from the horses mouth. Isn't this board great! With so many fellow nurses to throw our questions to, it is never long before we get just the help we need.
10. 
    Mar 10, '04

    Occupation: LPN @ SNF Specialty: 12 year(s) of experience in HIV/AIDS, Dementia, Psych ; From: US ; Joined: Mar '03; Posts: 1,527; Likes: 30

    I am sorry this happened to you. I know you must be worried sick. Please try and remember that you have a MUCH better chance of NOT contracting these diseases from this type of exposure. Get medical attention even if you have to go outside your facility.
11. 
    Mar 10, '04

    Occupation: CCU RN Joined: Sep '02; Posts: 1,039; Likes: 10

    I am so sorry this happened to you. It is certainly very frightening. I once had blood splash up into my face as well and actually some went into my eye. The patients status was unknown. The meds are awful to be on but certainly worth the side effects. I would follow up w/ your doc right away if your job won't help you... but they ought to. I would also follow up w/ OSHA and the BON if your place of employment won't reimburse you the cost.
    
    What I was told when I was exposed that skin and mucous membranes exposure have a very low probability of transmission. It is a less than one percent chance. I hope that can make you feel a little more comforted. A coworker is going through a similiar situation... however, she stuck herself w/ an 18gauge needle and it made a deep stick and the patient was also infected w/ alphabet soup. (AIDS, Hep C and B)
12. 
    Mar 10, '04

    Joined: Jan '02; Posts: 5,673; Likes: 159

    Thanks guys for all the support and info. I guess my biggest frustration is that my coworkers did not care enough to alert me before I entered this room unprotected. Next time someone asks me to answer their vent alarm I will think twice. Maybe I'm being unrealistic today, but I feel we all should have the choice to think twice and use care and extra PPE. I had to complain to the infection control nurse last time I cared for this type IV drug abuser/ 'alphabet soup' patient: all our goggles were broke and there were no eye shield masks on the unit. I also like to wear face protection for close care on infectious spitters, for some procedures (alines etc) AND on combative vented patient with infectious diseases, as that vent tubing tends to come apart at the wrong moment anyway doesn't it.
    
    I finally got a call (48 hrs later) from the health nurse and I'm getting irked again...they are looking at this as an on the job 'accident' and 'I' must come in for a drug screen...seems like their emphasis is in pointing the finger at the employee and/or trying to prove 'I' did something wrong here. I get exposed due to lack of info, so I must prove I'm not a drug user??? <sigh> Is it just me or does this seem like punishing the victim???
    
    Sorry for the rant/vent...bad week...<sigh> LOL!
    
    Thanks for all the kind thoughts friends. Lab monitoring next 6 months will be provided per my EHN at this point so I will continue to hope I'm in the minority that will NOT develop the viruses. I'm aware needlesticks are the worst and glad all of you with needlesticks are doing OK.
    
    The good nurses I've worked with have kept me on this job. Now we have lots of travelers and turnover, and nurses that don't seem to care for each other much. Maybe its time to move on. But I feel a bit stuck now...if I quit I will not be covered for this incident will I. GRRR.
    
    Any additional comments and advice greatly appreciated friends. We don't always think clearly when this stuff happens to us. Plus I'm feeling frustrated due to feelings I expressed in the last paragraph.
    
    Take care all. Tom perhaps I should come to your HCA hospital....mine has not treated its injured employees well. Glad you felt treated fairly. I asked about the antiviral cocktail and was told only for frank blood exposure. BUT I may ask my own PCP....great suggestion from ya'll.
    
    Thanks as always for listening to my ramblings guys...LOL! I do appreciate so much the camaraderie on this BB and the good people here.
13. 
    Mar 10, '04

    Joined: Apr '02; Posts: 38,763; Likes: 16,343

    ((((((((((((((mattsmom))))))))))))))))))))
    i am so very sorry. i have not a word of advice better than what you got here. I just wanted to voice my total support as a fellow nurse. You have my thoughts and prayers, mattsmom!!!
14. 
    Mar 10, '04

    Joined: Jan '04; Posts: 347; Likes: 13

    it sounds like you are not always stocked with the right ppe on your unit anyway, from what you are saying about the goggles, etc.
    call an atty , OSHA, JCAHO, the BON, anyone who will listen.
    I am surprised at this type treatment from HCA - I have never worked for them but thought they had a pretty good reputation.
    Maybe its just idiot management at your facility - if you go up the corporate ladder you might get some attention.
    Hugs & prayers

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