Question on risk of HIV exposure/infection

I just recently started home health as a second job. The client I have been assigned to is HIV positive. Client is trached and does not tolerate deep suctioning. Client has a very productive cough. PC asks that nurse grab inner cannula at the height of the cough and pull it out, thereby catching the bulk of the secretions in the cannula. The only PPE's I have been provided with by the agency is gloves (we get one box a month of which I used 20 the first night alone as client coughs up moderate amounts of phlegm frequently). What are the risks of HIV transmission through phlegm, droplet exposure? I know when a person coughs droplets can land as far as 15 feet away. Am I at risk if it lands in my eyes or if I inhale freshly expelled microscopic droplet via mouth or nose? I don't want to go in there in a bio suit, but this is my first HIV pt and i do want to take appropriate precautions. Client is taking HIV meds at this time. Thanks for any info or links in advance guys!
I would use goggles and a mask as well as gloves to be on the safe side!

1) they need to give you more gloves.2) transmission from secretions such as you describe is very, very low. blood is your main concern. of course you can have small amts of blood in anything, so you always use universal precautions to prevent exposure to any body fluids. 3) intact skin is an effective barrier. don't worry if a goober lands on your intact skin. watch out for hangnails or rashes or open bugbites, though.4) i have never heard of airborne droplet transmission in hiv, though i'm willing to be corrected if i'm wrong. but many folks c hiv have tb-- and that is droplet-borne. i'd wear a mask anyway, just for that. it'll make you feel more secure about droplets anyway.5) if s/he really sprays a lot, consider eyewear. learn to stand out of the way.6) not a big hiv expert, but i understand that when people are adherent to their meds their infectivity goes waaaaay down too. anyone else?i'm not really a fan of pulling out the inner cannula for the reason you describe. too easy to dislodge the whole thing. doesn't your agency have a protocol for trach care that includes cleaning the inner cannula daily/prn?

Quote from bugsy2902I would use goggles and a mask as well as gloves to be on the safe side!

Your chances of contracting it is extremely low, I am not an RN, but I know a heck of a lot about HIV, and I can tell you unless there is blood in the phlegm and that blood makes contact with a subcutaneous cut in the skin in a high enough viral load occurs then there would be risk of transmission, otherwise risk is slim to none. Therefore, unless you have a gaping wound on your body (that is not covered) the chances are next to none.FTR, you should check out http://www.thebody.com/ you can expect to find good advise there.

Even if the chance is extremely low as previously stated, that implies there is still a chance. I would definitely use more precautions than just gloves.

I make sure I always stand to the side when when client coughs. Client rcv's 30 inner cannula's a month and is not vent dependent and as a matter of fact right now the client does not even have a spare trach! Protocol for cleaning the cannula is rinse it with tap water and reinsert. This client has been like this for 4 years and has only had one infection (amazing). I glove, secretions are very thick and yellow which is considered the norm for this client. Client does not have TB. I am a converter, though for the life of me I don't know where I was exposed to TB as I have never had a pt with TB. Thanks for the info, I feel more comfortable now.

I understand that the caregiver should be provided with whatever level of precautions they feel are necessary for their safety but...Aren't standard precautions designed to protect from HIV transmission?I would use the same precautions for this patient as I would for any other patient in the same situation regardless of HIV status.Also, if HIV was transmitted by droplet, we would all be in a lot of trouble.But you do need to get more gloves!

Quote from SweetseRNI understand that the caregiver should be provided with whatever level of precautions they feel are necessary for their safety but...Aren't standard precautions designed to protect from HIV transmission?I would use the same precautions for this patient as I would for any other patient in the same situation regardless of HIV status.Also, if HIV was transmitted by droplet, we would all be in a lot of trouble.But you do need to get more gloves!

I realize I am still a newbie and still living in the idealistic world of school...However, I think it's a slippery slope if we start adding PPE just because of HIV status. In all reality, you could very well have an HIV+ patient, on no meds with an enormous viral load, and you might never even know it. So I guess my point is that yes, the OP definitely needs to have the equipment available but she shouldn't feel it's necessary just because of the HIV status.

There is no risk. HIV dies as soon as it comes into contact with the air, unlike HBV which can actually live outside of the body for short periods of time. Even if you were to stick yourself with a needle contaminated with the pt's blood, your risk of becoming HIV positive is less than 0.1%. Since the pt is on ARVs, the risk of transmission is even lower. If you happen to know what his viral load is (ideally non-detectable) you can further calculate the risk. Personally, I find all phelm absolutely disgusting, so I would wear PPE just because of that. However, you really do not need to worry about exposure to HIV via this route. Former HIV nurse

BTW - if HIV could be transmitted via mucus membranes, we would all be HIV positive by now!

PPE beyond standard precautions is unnecessary. It offends me that so many nurses don't know better.