From the Guidelines
After an accidental needlestick injury, immediately wash the wound thoroughly with soap and water for at least 15 seconds and report the incident to your supervisor and seek medical attention promptly, ideally within 2 hours. This immediate action is crucial in reducing the risk of bloodborne pathogen transmission, including HIV, Hepatitis B, and Hepatitis C, as emphasized in the guidelines for infection prevention and control in pediatric ambulatory settings 1.
The steps to be taken after a needlestick injury include:
- Washing the wound with soap and water
- Flushing the area with water if the exposure involves a splash to the nose, mouth, or skin
- Irrigating the eyes with clean water, saline, or sterile irrigants if the exposure involves a splash to the eye
- Reporting the incident to the supervisor and seeking medical attention promptly
A healthcare provider will assess the risk of bloodborne pathogen transmission based on the source patient's status and may initiate post-exposure prophylaxis (PEP) 1. For HIV exposure, PEP typically includes a 28-day course of antiretroviral medications like tenofovir/emtricitabine plus dolutegravir, which should be started as soon as possible. For Hepatitis B exposure in non-immune individuals, hepatitis B immune globulin and vaccination may be recommended. Blood tests will be performed at baseline and during follow-up periods to monitor for potential infections.
Prompt action is crucial because PEP effectiveness decreases significantly after 72 hours, and immediate wound cleaning can substantially reduce the risk of pathogen transmission by removing infectious material before it enters the bloodstream 1. The Centers for Disease Control and Prevention recommend TDF/emtricitabine plus twice-daily raltegravir or once-daily dolutegravir as the preferred regimen for PEP, with TDF/emtricitabine with boosted darunavir or TDF/emtricitabine/cobicistat/elvitegravir as reasonable alternatives 1.
It is essential to note that the management of an exposure should be based on the likelihood of exposure, considering the source of the needle and the type of exposure, and that all employees should know how to access the policy for management of an exposure 1. Additionally, education on safe handling of sharps, immunization, standard precautions, and safe work habits should be provided to the exposed person 1.
In terms of follow-up, repeat serologic testing for hepatitis C and HIV should be performed at 6 months after the potential exposure, and repeat serologic testing for hepatitis B (HBsAg and anti-HBs) should be performed at 6 months if the exposed person was not previously documented to be anti-HBs-positive 1.
Overall, the key to preventing bloodborne pathogen transmission after a needlestick injury is prompt reporting, immediate wound cleaning, and timely initiation of PEP, as well as education on safe handling of sharps and standard precautions.
From the FDA Drug Label
For greatest effectiveness, passive prophylaxis with Hepatitis B Immune Globulin (Human) should be given as soon as possible after exposure (its value beyond 7 days of exposure is unclear). In all exposures, a regimen combining Hepatitis B Immune Globulin (Human) with hepatitis B vaccine will provide both short- and long-term protection, will be less costly than the two-dose Hepatitis B Immune Globulin (Human) treatment alone, and is the treatment of choice. For inadvertent percutaneous exposure, a regimen of two doses of Hepatitis B Immune Globulin (Human), one given after exposure and one a month later, is about 75% effective in preventing hepatitis B in this setting.
The immediate course of action after an accidental needlestick injury is to administer Hepatitis B Immune Globulin (Human) as soon as possible, ideally within 24 hours of exposure, and to start the hepatitis B vaccine series. This combined regimen provides both short- and long-term protection against hepatitis B virus infection 2 2.
- The dose of Hepatitis B Immune Globulin (Human) is 0.06 mL/kg of body weight, administered intramuscularly.
- The hepatitis B vaccine series typically consists of three doses, with the first dose given within 7 days of exposure, and the second and third doses given 1 and 6 months later, respectively.
From the Research
Immediate Course of Action After Accidental Needlestick Injury
- The provided studies do not directly address the immediate course of action after an accidental needlestick injury 3, 4, 5, 6, 7.
- However, it is generally known that immediate action after a needlestick injury involves encouraging the wound to bleed, washing the affected area with soap and water, and reporting the incident to a supervisor or healthcare professional.
- The risk of transmission of bloodborne pathogens, such as HIV or hepatitis B, is a concern after a needlestick injury, and post-exposure prophylaxis (PEP) may be recommended in some cases 4, 7.
- It is essential to follow established protocols and guidelines for managing needlestick injuries, which may include testing for bloodborne pathogens and providing PEP if necessary.
- The studies provided focus on the treatment of HIV and hepatitis B infection, rather than the immediate response to a needlestick injury 3, 5, 6, 7.