Question on risk of HIV exposure/infection

brandy1017, ASN, RN · Aug 4, 2011

I would use goggles and a mask as well as gloves to be on the safe side!

nurseprnRN, BSN, RN · Aug 4, 2011

1) they need to give you more gloves.

2) transmission from secretions such as you describe is very, very low. blood is your main concern. of course you can have small amts of blood in anything, so you always use universal precautions to prevent exposure to any body fluids.

3) intact skin is an effective barrier. don't worry if a goober lands on your intact skin. watch out for hangnails or rashes or open bugbites, though.

4) i have never heard of airborne droplet transmission in hiv, though i'm willing to be corrected if i'm wrong. but many folks c hiv have tb-- and that is droplet-borne. i'd wear a mask anyway, just for that. it'll make you feel more secure about droplets anyway.

5) if s/he really sprays a lot, consider eyewear. learn to stand out of the way.

6) not a big hiv expert, but i understand that when people are adherent to their meds their infectivity goes waaaaay down too. anyone else?

i'm not really a fan of pulling out the inner cannula for the reason you describe. too easy to dislodge the whole thing. doesn't your agency have a protocol for trach care that includes cleaning the inner cannula daily/prn?

xtxrn, ASN, RN · Aug 4, 2011

I would use goggles and a mask as well as gloves to be on the safe side!

Your employer is obligated by OSHA to provide whatever PPE is felt necessary by the caregiver given the situation-- flying snot qualifies for goggles, a mask, and even a gown, along with the gloves :)

These links have some info (though there were more, some were downright gross, and didn't apply)

http://www.medhelp.org/posts/HIV-Prevention/HIV-in-sputum/show/20178

http://www.esem.wmich.edu/bbp.htm

If the phlegm is blood-free, the risk is negligible...:)

I got HIV+ slobber in my eyes about 12 years ago...it was at an detox/rehab facility, so very little anticipated risk... I haven't had any issues. :)

Thujone · Aug 4, 2011

Your chances of contracting it is extremely low, I am not an RN, but I know a heck of a lot about HIV, and I can tell you unless there is blood in the phlegm and that blood makes contact with a subcutaneous cut in the skin in a high enough viral load occurs then there would be risk of transmission, otherwise risk is slim to none. Therefore, unless you have a gaping wound on your body (that is not covered) the chances are next to none.

FTR, you should check out http://www.thebody.com/ you can expect to find good advise there.

samirish · Aug 4, 2011

Even if the chance is extremely low as previously stated, that implies there is still a chance. I would definitely use more precautions than just gloves.

LUV ALZ · Aug 5, 2011

I make sure I always stand to the side when when client coughs. Client rcv's 30 inner cannula's a month and is not vent dependent and as a matter of fact right now the client does not even have a spare trach! Protocol for cleaning the cannula is rinse it with tap water and reinsert. This client has been like this for 4 years and has only had one infection (amazing). I glove, secretions are very thick and yellow which is considered the norm for this client. Client does not have TB. I am a converter, though for the life of me I don't know where I was exposed to TB as I have never had a pt with TB. Thanks for the info, I feel more comfortable now.

SweetseRN · Aug 5, 2011

I understand that the caregiver should be provided with whatever level of precautions they feel are necessary for their safety but...

Aren't standard precautions designed to protect from HIV transmission?

I would use the same precautions for this patient as I would for any other patient in the same situation regardless of HIV status.

Also, if HIV was transmitted by droplet, we would all be in a lot of trouble.

But you do need to get more gloves!

xtxrn, ASN, RN · Aug 5, 2011

I understand that the caregiver should be provided with whatever level of precautions they feel are necessary for their safety but...
Aren't standard precautions designed to protect from HIV transmission?
I would use the same precautions for this patient as I would for any other patient in the same situation regardless of HIV status.
Also, if HIV was transmitted by droplet, we would all be in a lot of trouble.
But you do need to get more gloves!

Yes. :) But she'd only been given gloves....she needs more to at least be available :) The posts have included the risk being if there's blood (may not be visible) in the phlegm :)

SweetseRN · Aug 5, 2011

I realize I am still a newbie and still living in the idealistic world of school...However, I think it's a slippery slope if we start adding PPE just because of HIV status. In all reality, you could very well have an HIV+ patient, on no meds with an enormous viral load, and you might never even know it. So I guess my point is that yes, the OP definitely needs to have the equipment available but she shouldn't feel it's necessary just because of the HIV status.

mrr5745 · Aug 5, 2011

There is no risk. HIV dies as soon as it comes into contact with the air, unlike HBV which can actually live outside of the body for short periods of time. Even if you were to stick yourself with a needle contaminated with the pt's blood, your risk of becoming HIV positive is less than 0.1%. Since the pt is on ARVs, the risk of transmission is even lower. If you happen to know what his viral load is (ideally non-detectable) you can further calculate the risk. Personally, I find all phelm absolutely disgusting, so I would wear PPE just because of that. However, you really do not need to worry about exposure to HIV via this route.

Former HIV nurse :)

mrr5745 · Aug 5, 2011

BTW - if HIV could be transmitted via mucus membranes, we would all be HIV positive by now!