Blood On Your Hands

I find it interesting that the term, "you have blood on your hands" means to be responsible for someone's death. Certainly, you can get blood on your hands harming someone, but you can also get blood on your hands helping someone. And it's the latter that I'll discuss this week.

As a PA in the emergency department, I am always exposed to bodily fluids, and blood is probably the most benign one that I encounter. I don't want any of these fluids on me and I take precautions against that happening, with gloves, face shield, gowns and other protective equipment, depending on what I'm doing. In fact, over the years, I've gotten into the habit of wearing gloves with just about every patient interaction--too many people marinate in their own juices--which is of course in addition to hand sanitizer and/or washing my hands. 

There's a visceral reaction when blood, or one of the *other* fluids gets on you, an instant "ick" emanates from the soul. But the reality is that the chance of getting a disease from some of these fluids, especially blood, is quite small. 

Here are some facts--germs (bacteria, viruses, even fungi) cover just about every surface we touch, and we have more bacterials cells (by number) in and on our bodies than we do human cells. It's impossible to avoid germs, and going to great lengths in an attempt to avoid exposure isn't healthy. Instead, I recommend a measured approach--avoid germs--especially bad ones--when possible, but don't try to live in a plastic bubble (assuming a normal immune system!).

And while I'd try to not inhale the air around someone with a respiratory infection, I don't get freaked out about blood, and here's why.

I often treat patients who have been exposed to blood or other fluids as part of their jobs; police get bitten, nurses get spit on, and just about anyone in healthcare can accidentally get jabbed with a dirty needle. When we run the numbers and calculate the exposure risk for HIV, the vast majority of time, no post exposure medications are recommended.  The chance of disease transmission is low.

So, if you're ever concerned about administering first aid on someone--and you might get blood on you, be reassured; intact skin should protect you. 

Don't take my word for it, according to UpToDate: 

• "Intact skin is an effective barrier against HIV infection, and contamination of intact skin with blood or other potentially contaminated fluids is not considered an exposure and does not require PEP." [Post Exposure Prophylaxis]; and
• "There are no confirmed cases of HIV transmission in HCP [Health Care Personnel] with skin abrasions, cuts, sores, or other breaches in skin integrity, but a theoretical risk is estimated at 1/1000."

I also found: 

• "Anytime there is blood-to-blood contact with infected blood or body fluids, there is a potential for transmission. Unbroken (intact) skin forms an impervious barrier against bloodborne pathogens; therefore, blood getting on intact skin is not considered an exposure risk," states Brigham Young University--Hawaii. 
• "Exposure to INTACT skin is not regarded as a significant risk," stated on University of Connecticut's web site. 
• "The risk should be absent if it occurred with intact skin or any other physical barrier," from an article on Salon.

So, I think the take home messages are:

• It's okay if you get some blood on your hands as long as your skin is intact.
• You can still use whatever you can to limit your exposure to blood if helping someone--cycling gloves or a t-shift for example, just don't use something that's obviously contaminated as to not spread disease to the injured person.
• BE CAREFUL NOT TO RUB YOUR EYES OR GET BLOOD IN YOUR MOUTH!
• Wash your hands as soon as possible with soap and water.

I need to point out that this is all in regard to blood on intact skin. If you get blood on an open wound--or your mucus membranes (such as you mouth or your eyes)--then that's a different story. You still need to clean the area as much as possible, and you should get evaluated right away. That probably means an emergency department.

I also want to point out that you catching a disease from exposure to blood is only one half of the story; the other person is also at risk as he/she is the one with the open and bleeding wound. That's the main reason we wash our hands so much and use gloves in the hospital, that's to prevent spreading anything to our patients. Accordingly, be careful when helping someone.

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