Donna Moré writes:  I received a call from a dentist who experienced an
accidental needle stick.
She was tested immediately and will be tested at 6 weeks and 6 months. She
was advised by her pediatrician to stop breastfeeding her three month old
baby. Obviously she is devastated. I have searched and have found
conflicting viewpoints. Can someone share their wealth of knowledge with me?

~~~~~~~

As always, it comes down to weighing risks and benefits.  Are there risks to
BFing after a potential infectious exposure?  Yes.  But there are also risks
to weaning or even short-term use of AIM.  Assessing the comparative risks
is the key here.

I had a needle stick myself my first week back to work when my daughter was
just over 3 months old and exclusively BF.  The source patient consented to
testing, and was negative on testing for HIV and HCV, and immune (via
immunization) to HBV.  Patient denied any high risk behaviors which would
increase the possibility of her being infected but in the "window" before
testing positive.  The type of exposure was also low risk (small gauge
needle, no intravenous exposure [subcut. Allergy injection], through a
glove, shallow wound). 

Since the risk of seroconversion to HIV following occupational needle sticks
is less than 1%, and since I judged my risk (based on low-risk patient and
low-risk exposure) to be on the lower end of the range, I decided, after
reviewing with the occupational health provider, that the risks of using
AIM, both healthwise and emotionally, would be much greater.  So I continued
to BF, and all of my follow-up bloodwork was negative (as others have
mentioned, 6 wks, 3 months, 6 months).

If possible, the dentist in question should ask the source patient to be
tested.  A risk assessment of the patient's possible exposures (e.g. IV drug
use etc etc) and a risk assessment of the needle stick exposure should be
performed [solid suture needle less likely to transmit than hollow needle,
large bore needle more likely to transmit than smaller bore needle,
intravascular patient exposure more likely than subcutaneous, through a
glove less likely than no glove, splash on intact skin less likely than
splash on rashy or abraded skin or mucous membrane, etc etc].  And the
dentist should then weigh the risks of her options - continuing to EBF or to
use AIM.  She has every right to question the pediatrician's advice and
weigh that along with the other information at hand.

Best wishes to this woman from another mom who has unfortunately been there,
done that!

Spencer Joslin, MD, LLLL

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