Lancet use on homeless patient risk

[bass]

Hello,
This is my first post so please bare with me. I'm an RN volunteer at a homeless clinic and Monday night, I checked a gentleman's blood sugar with a lancet. It did not retract as I expected and somehow I got stuck in the palm of my hand (after sticking him). He's a boomer and has used IV drugs in the past. All these things put him in a higher risk group for hcv.

My question is, how soon can I be tested? (already did my baseline Monday) and how worried should I be? I'm hoping minimal exposure since it was a tiny lancet not a hollow bore needle.

Thank you!

[Lynn K]

It normally takes up to 12 weeks for sufficient antibodies to develop to be detectable with the hepatitis c antibody test. However if your immune compromised it can take as long as 6 months for antibodies to rise to detectable levels. The more expensive antibody test I believe would be detectable in maybe as little as a week after exposure but that test is normally not done until after a positive antibody test. I take it you weren’t gloved while treating this patient? Was the patient not tested for hep c? That would be a standard protocol under the circumstances.

I’m kind of surprised as you work in healthcare you apparently haven’t received training on blood borne infections. The risk of infection for a healthcare worker experiencing a needle stick involving a patient with known hep c is about 1.8%

Here is some info from the CDC for healthcare professionals about hep c

https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#f5

https://www.cdc.gov/hepatitis/hcv/pdfs/hcv_flow.pdf

[Lynn K]

https://www.ncbi.nlm.nih.gov/books/NBK92024/

Hepatitis C Training Programs for Substance Abuse Treatment Program Staff

[Mugwump]

What Lynn has posted is the bare facts. Worry and all the other associated effects of a possible accidental exposure to HCV are the other aspects that are much harder to deal with. Firstly don't start imagining symptoms, most people who are infected feel absolutely no initial reaction to being exposed to HCV. And this is why the disease is difficult to understand for most people.


If you have had your flu shot this year then only become suspicious of an HCV infection if you develop inexplicable flu like symptoms.


However there are huge differences between HCV infection and the flu and the biggest one is respiratory troubles. HCV infection does not progress to respiratory the way many of the worst deadly flu infections do. Unlike the flu HCV infection takes years to progress in severity in the vast majority of healthy individuals.

Most importantly follow through on testing in six months for HCV antibodies and if at that time you find that you have been infected and have verified viral load of a known HCV genotype, push for treatment as soon as possible.


Take Care
Eric

[Lynn K]

What can I say Eric I’m a just the facts kinda gal.

[Mugwump]

Good thing you are Lynn, I am far too prone to not jumping to conclusions. And this trait is most of the reason why at first when a Doctor other than my regular doc suspected that I may have HCV: I foolishly ignored filling the req for a test. That was in 1992, in 1993 my family doctors hand shook as he wrote the new req for an antibody test, because in ignorance the both of us had missed something obviously very important. He because he suspected nothing more than my being a chronic alcoholic, me because I though he might very well be correct.....lol Such is life.


It does seem that the risks factors here for bass do indicate that a greater degree of vigilance in testing for an exposure to HCV is prudent.


Getting a confirmation retest for the absence of antibodies at 6 months past the incident is equally prudent because the certainty of not being infected is a very beautiful thing. At least IMO   

[bass]

Lynn
First, let me thank you for replying and dedicating your time to this site. Second, I am very happy that you are HCV free! What a relief that must be.

Here is the most recent study on transmission of HCV. The actual risk of seroconversion following needlestick is lower than previously thought. This is good news! Given the fact that my needle was solid and not hollow bore and I was wearing gloves (it poked through), my risk should be very very low. Still, I will get tested at 3, 6 months.

I have had training (though a refresher might be in order : ) I was primarily going to your forum for support and reassurance. We are a small non-profit, without a lab, so testing this individual was not an option at the time of occurence. However, we are hoping he returns and we can encourage him to be tested.

I wish you continued good health!

https://www.ajicjournal.org/article/S0196-6553(17)30209-2/fulltext

[Lynn K]

Bass thanks for all the hard work you do in your clinic. Just to add to be on the kinder gentler reassuring side yes the risk is relatively low but not zero so testing at 12 weeks and again at 6 months is prudent. However, hep c is not that easily transmitted and does in most cases take decades to cause real harm and not everyone infected even if for decades will develop liver disease. Guess I’m just lucky like that. Also the majority have little to no symptoms of either initial or chronic infection which is why hep c is called a silent illness. For most with chronic infection the most common symptom is tiredness.

And the best news of all is that with the recently approved next generation DAA medicines hep c is now almost entirely curable. The new meds boast cure rates of 98% or higher for most patients so even if you do become infected treatment could be as simple as one pill a day for 8 or 12 weeks and you can be cured kinda like taking a course of antibiotics almost.

Yes thanks it was an unbelievable lifting of weight from my shoulders being cured. When I was diagnosed with liver cirrhosis there was no treatment available  I hadn't tried so basically until these new meds were approved I was kinda waiting to develop decompensated cirrhosis and die. So basically these new meds truly saved my life.

Best of luck hopefully the odds will be forever in your favor

[bass]

HI again,

Any reason (besides cost) that you can think of why I should not just get the early HCV PCR test? The qualitative one that gives a "detected" or "not detected"?

My doctor said she would not recommend it, and just has me on the "watchful waiting" schedule of 3.6. months. I was negative post exposure with the antibody test.

I may just pay for it myself. I know I am being impatient, but....

Thanks and sorry I didn't start a new thread. I thought I should just add to this one.

--Sara

[Mugwump]

I think your doctor is being as cautious as need be given the circumstances of a possible exposure. The antibody tests are more accurate than they were in the past. If you do not develop antibodies to HCV then the possibility of having been exposed is almost zero.


The full rna by pcr tests are best used to ascertain the need for treatment not necessarily the exposure to HCV. However there is a level of rna testing that either confirms the presence of HCV or precludes it. The problem is that if the level of infection is at a stage that is not chronic and the virus is below the level of quantification then the test is not necessarily accurate and still leaves the question as to whether or not the individual will progress to a full blown infection. If the test is positive or negative.


So the test for just the presence of the virus are no longer commonly used in the diagnosis process.


When I was first infected the process was to first re-run the antibody test and if it confirmed the presence of antibodies then the test for the presence of the virus was then done. This did not indicate the level of virus present in the blood but only confirmed that the virus was present. Then when I decided to try interferon treatment the full expensive viral load tests were done and my treatment was based upon that data along with a genotype test.


Things have progressed greatly since the 2003 when I first went for interferon treatment. And the tests are more accurate than in the past.



All here on this forum certainly do understand your heightened concerns. Keep up the great work you are doing, if more people dedicated their time to the care of those less fortunate then the problems with diseases like HCV would no doubt be much less of a concern.


All my best.
Eric

[Lynn K]

While the test will provide the answer there is no reason to take the test at this point and I believe the cost is around $400.00. The test will not change your situation you will just know sooner that you might need treatment.

Even if the test was detected you would still have to wait at least 6 months to see if the infection resolved on its own meaning you don’t need treatment. If you wait the 6 months for the conclusive antibody test and if positive, then you would have the HCV RNA test and get set up to start treatment. If you have the HCV RNA now you would still wait six months and retest the HCV RNA test and if still detected then you would get set up to start treatment.

Having the HCV RNA test now would not change your possible treatment time line would not provide significant medical information and would not change anything in your life beyond making your wallet $400.00 lighter.

Your risk is relatively low, you have a negative antibody test. They is nothing to be gained in testing right now with the HCV RNA test. I understand it is hard to wait those six months but there is nothing to be done until it is known you are infected for at least six months. And that won’t be known until six months after this incident.

Hang in there best of luck. I’m reasonable confident you won’t end up becoming infected from this just try to keep your mind off of this for the time being. Worst case you do need to be treated. Treatment could be as simple as one pill a day for possibly as few as 8 weeks and you would be cured. Less than a year from now this will be entirely in your life’s rear view mirror.