Occupational injury and HIV Risk

Dear Ask The Doctor: Hi, I am a dental student working as an intern in a clinic in Guatemala. Today, during a cleaning, the patient flinched, and I pricked myself with a dental explorer. Unfortunately, there was lots of blood on the explorer. I immediately pulled the glove off to look for signs of a puncture and I did not see any. I had on latex gloves and I was not bleeding. HIV is not a big risk in this area of Guatemala. My attending dentist said to wash it off and not worry about it. The HIV status of the patient is unknown. What should I do? How can I not worry about it? What are my risks for contracting HIV or any other blood borne pathogen? Should I ask to start an antiretroviral? I will be back in the states on Saturday. Should I get tested then? I really have no idea what to do. Again, I am not sure if my skin was even broken. I definitely felt the poke, but I do not know if my gloves were penetrated. How resistant are latex gloves to puncture? What is your recommendation? Thanks for your help.

Dear Mm: Latex gloves provide some barrier between you and the patient, and that is one reason why the medical and dental profession wear them. There will be a small puncture wound visible if the dental explorer broke the skin, however this may be tiny and easy to miss. If there is no puncture wound, HIV or other blood borne infections (Hep B or Hep C) could not have passed through the skin barrier. If there is a puncture wound, however small there is a small risk you could be infected with HIV or another blood borne infection. Therefore if the skin has been broken, you must contact your university or college occupational health department for further advice, and a full risk assessment with appropriate blood sampling should be obtained, with consent from the patient.