Thursday, July 16, 2009

Occupational Exposure

Once again one of Pi's posts got me recollecting another one of my stories.
(This may not be exactly the same thing- themewise. But the context is the same--Med Students.)
A couple of days ago an intern (let's call him S) was assisting in a laceration repair in the Surgery Mini-Op Theatre (MOT, for us)
He was standing there, helping out the resident working on the wound. When all of a sudden there was a gush of blood and he felt a searing pain.
The resident had placed a scalpel cut on one of his fingers.
There was severe bleeding.

The scalpel had punctured through the gloves and cut over the PIP joint of one of his fingers.
While everyne rushed to help him out and bandage the wound, the bleeding continued for a whole fifteen minutes.
It stopped eventually.
He came back to the hostel.

After he was back and settled for once, did it dawn on him that he had been in contact with potentially contagious fluid.
He called up some friends to check-on what to do. He talked to some doctors.

He visited the hospital again to get details of the patient. But to his horror-it being a OPD patient, just the mention of the name and colony was found in the records.
Apparently, the patient was supposed to return three days later to get the stitches off.

He visited the ART incharge next.He was counselled and given a box of post-exposure prophylaxis, to be taken for about a month.
He starteed the meds, hoping that the patient would come back three days later for removal of stitches.

Three days later:
No sign of the patient. Apparently she decided to get the stitches removed someplace else!

Seven days later:
S stopped taking the meds coz of the horrible horrible side effects! Fever, abdominal pain, nausea, vomiting!
Twelve days later:
(ie today.)
S's absolutely fine just now. And I'm sincerely hoping it stays that way till an antibody test is done six months from now.

Things that I realised:
1. This entire episode, occured at a hospital full of doctors, residents and nurses. no one realised that it was a contact with potentially infectious fluid, and an assay of the patient was required.

(This was one case where the student at least bothered to go the ART centre and find out about the pros and cons of meds. There are hundreds of instances where the ever busy residents come in contact, and don't even bother to get the patient tested even though he's right there!!)

2. The concept of universal precautions- is not something that is very much followed here.
Heck, in the labour room, the residents have just one plastic apron to protect them from any kind of fluid. I've heard of instances where the resident came in contact with the patient's fluid in the form of spurts hitting the face and eyes!
(And oh, PPTCT is
optional for the women!!)
3. Doctors in general, tend to consider such a contact as a minor thing, and therefore tend to give you an option to take meds or not.
(Maybe its because they've been in contact with blood and all kinds of fluids since eons, and nothing's ever happened to them!)

4. Being a medico/doctor does nothing to improve your compliance for meds.
Its always the side-effects that win in the end.

On a lighter note:
*Thanks to CartoonStock!


  1. aw* We once had a nurse who punctured herself with a syringe and the patient turned out to be positive...imagine!

    Well, don't expect more being an intern, wanna have lots of fun? Come to my college, we actually don't have any other job other than writing dummies...

  2. love your blog's new look.....its real still stuck in the dark ages though...:-)

  3. thought provoking's a hilarious part...right after an awareness programme on ART n universal precaution one of my colleagues got 'extra careful'...not 24hours had passed wen he started 2 shout 'i've got a prick!!!!' after searchin 4 fifteen minutes v found nothin...n it took us another fifteen minutes 2 pacify de guy who was shoutin 4 art!!

  4. @drwiz: ha!intern at my college is totally about prep or fun or whateva! you might wanna venture a visit!

    @pi: thanks! :)

    @kochu: "better safe than sorry"
    tho we as medicos might tend to overdo it a bit. ::grin::

    kinda. i'd still have preferred the continuation of meds..

  5. That labour room thing? So true. I've seen a PG get hit in the face by a gush of amniotic fluid as the membranes ruptured for the second of twin. And I've seen people conduct delivery without even a glove on in cases of precipitate labour. That was some scary shit.

  6. @AP: yeah! ..its stuff like this that helped me make my transition from Ob/Gyn to Peds.. (err...that is if I get a choice..)



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