Patient Presentation
A 23-month-old male’s mother called to the clinic after she had found her son holding a single razor blade near a garbage can in a park. He dropped the blade and the mother immediately checked his hands. She says that he appeared to have no cuts or scratches on his hands or other body parts. She immediately used an alcohol-based hand sanitizer gel on his hands to wash them, then brought him home and washed his hands with soap and water. She had picked the razor blade up herself with tissue and discarded it after wrapping it in several other layers of tissue and putting it into an open tin can in the trash. She was now calling because she was worried that he might contract Human Immunodeficiency Virus. The resident taking the phone call ascertained that he did not have any area of his skin where it was broken such as a hang-nail, or rash, that he was otherwise well and that he was current with his immunizations. The mother said that the razor blade was triangular and looked more like a utility razor blade than a rectangular single- or double-sided blade used for shaving. She also noted that it had some rust on it. The diagnosis of a potential exposure to a blood-borne infection was made. After talking with her attending physician, the resident counseled the mother that as the child had intact skin, it was very unlikely that any contagion had been passed from the razor blade to the child. The child also had an extra layer of protection as he had been immunized for tetanus and Hepatitis B. HIV and Hepatitis C were potential risks but felt to be very low given the circumstances. The mother was comfortable with this and said she would call if she saw any skin cuts that she hadn’t seen before.
Discussion
Blood-borne infections are always a risk for anyone. Some occupations pose higher risks than others such as health care workers, emergency responders, public safety personnel, sex-trade workers and body art professionals. These workers can be exposed to body fluids by sharps, mucous membrane and skin exposures. Personal safety equipment and universal precautions should be utilized properly, consistently every time there is the possibility of an exposure. Accidental exposures still occur and the CDC has recommendations for proper management and possible post-exposure prophylaxic medication use. The main concerns are for Hepatitis B, Hepatitis C and human immunodeficiency virus (HIV).
Learning Point
HIV basically cannot survive outside the human body for long. The main transmission risk is from direct contact with infectious fluids. Drying of fluids dramatically decreases the infectivity. In laboratory studies with high concentrations of HIV, the amount of live virus was reduced to 90-99% after a few hours. The initial high concentrations were more than the usual concentration within a human body. Therefore, once the body fluid is dry, the risk of transmission is essentially zero.
One concern with medical needles is that the fluid within the hollow needle may not be dried, and therefore would contain live virus.
Questions for Further Discussion
1. What are the risks of death by traveling in a car, motorcycle or airplane?
2. What are the potential health risks for receiving a tattoo or body piercing?
Related Cases
- Disease: HIV/AIDS
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Age: Toddler
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: HIV/AIDS
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
Centers for Disease Control. HIV and AIDS: Are You at Risk? Available from the Internet at http://www.cdc.gov/hiv/resources/brochures/at-risk.htm (rev. 8/1/2007, cited 4/18/2011).
Centers for Disease Control. Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B, Hepatitis C. Available from the Internet at http://www.cdc.gov/niosh/topics/bbp/ (rev. 10/27/2010, cited 4/18/2011).
Centers for Disease Control. Hepatitis C FAQs for Health Professionals. Available from the Internet at http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm (rev. 12/17/2010, cited 4/11/2011).
Centers for Disease Control. Hepatitis B FAQs for Health Professionals. Available from the Internet at http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm (rev. 4/4/11, cited 4/18/11).
University of San Francisco. HIVInSite. Can HIV Survive Outside the Body: Is This a Hoax? Available from the Internet at http://hivinsite.ucsf.edu/insite?page=ask-05-11-09 (cited 4/18/2011).
Personal phone call. CDC-INFO. 1-800-CDC-INFO (232-4636). 4/18/2011.
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
4. Patient management plans are developed and carried out.
5. Patients and their families are counseled and educated.
8. Health care services aimed at preventing health problems or maintaining health are provided.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
sitivity and responsiveness to patients’ culture, age, gender, and disabilities are demonstrated.
23. Differing types of medical practice and delivery systems including methods of controlling health care costs and allocating resources are known.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital
Pediatric Education 