Possibility of getting HIV, Hepatitis from a fingernail scratch?

[Dreamer323]

Posted this in an old topic, but this should probably be its own topic. I was taking care of a patient that happened to have HIV, chronic Hepatitis C, and at least had Hepatitis B at one point. She accidentally gouged through my hand with her ridiculously long fingernails (I was wearing gloves) and at least removed a small portion of the epidermis (no blood that I saw, but I also didn't bleed it, unfortunately). I didn't know at the time that she had Hep C, possibly B, and didn't report it, thinking it would be considered a joke (and I didn't think it got in my blood, not so sure now).

Having read some articles saying Hepatitis B at least can be on someone's fingernails, up to 72% according to this article, I am wondering if I should still report it, even a few days later. Would there be less chance of discipline with such a irregular exposure? Of course I have up-to-date Hep B vaccines, unsure about her. Too late for HIV PEP of course, but I probably could not have been convinced to use it with such a low risk scenario, even though she is HIV positive (not likely to have her blood all over her fingernails). Unfortunately she is from out of state and there was no idea what her viral load is, though she has been on antiretrovirals for at least a week straight.

Also, how do you feel about not being told a pt's status? I probably would not have been wearing gloves if I hadn't known about the HIV, since I was only getting VS at the time. Another nurse I got report from was quite upset that he wasn't informed. I couldn't really find much information on transmission rates for this kind of thing, unsurprisingly. I certainly wish that discussion over patient's fingernails and disease transmission was a little more prominent than it is, I must say!

[Rose_Queen, BSN, MSN, RN]

Universal precautions dictate that you treat all patients as though they may have a bloodborne disease. If you expect to come in contact with body fluids, wear gloves. If you expect splashes, and goggles and/or mask with face shield. So no, I would not be upset if I weren't informed a patient had something because I treat all patients with universal precautions. What if it's not in the chart because the patient was never tested? It's not a guarantee they don't have anything. Thus, I use appropriate precautions on all patients. There is nothing in addition to universal precautions that is required for a patient with hepatitis or HIV.

As for whether you should report or not, all exposures should be reported according to the policies of the facility. Should you report? Yes. Does that mean this many days later that anything will happen? Well, that's up to the organization, but you've now allowed in an element of doubt about a workplace exposure.

[Rionoir, ADN, RN]

You are not going to get HIV taking vital signs. ?‍♂️ And you probably weren't informed because anything you would've been doing that has any chance of transmitting HIV to you, you should already be wearing gloves regardless of their HIV status.

[Meriwhen, ASN, BSN, MSN, RN]

20 hours ago, Rose_Queen said:

Universal precautions dictate that you treat all patients as though they may have a bloodborne disease.

This. Treat everyone from the sketchy looking guy you suspect is a drug addict to the little old lady calling everyone dear to the cute neonate as though they have every disease in the book...because you don't know what they have. In fact, THEY might not know what they have.

And you'd be surprised who has what. It might be the little old lady that has Hep C and the neonate has HIV, while Sketchy's blood is pristine.

As far as your patient's status, while it would have been nice to hear this in the report, the information would be in the patient's chart. So it's not as though it was being kept from you. Now if it wasn't in the patient's chart/EMR, that's another issue.

As far as your risk of contracting something, keep in mind that the chances of contracting a bloodborne pathogen from a needlestick are less than 0.5%. Logic would suggest that the odds would be even smaller from a superficial fingernail scratch with no visible blood...but I'm not an infection control specialist.

Of course, that's small comfort if you are on the other end of the fingernail.

You could report it to your occupational health department and see what they recommend. But as Rose Queen already said, the delay in your reporting may not work in your favor. They may decide not to treat.

You could also see your PCP and follow his/her advice.

Best of luck.

[traumaRUs, MSN, APRN]

This is absolutely an off health issue. We can’t answer this. Take care