From the Guidelines
After an accidental needle stick injury, immediately wash the wound thoroughly with soap and water, and report the incident to your supervisor or occupational health department to initiate post-exposure prophylaxis (PEP) as soon as possible, ideally within 24 hours, as recommended by 1. The immediate steps to take after an accidental needle stick injury include:
- Washing the needle-stick site or cut with soap and water
- Flushing involved areas with water if splashes occur to the nose, mouth, or skin
- Irrigating eyes with clean water, saline, or sterile irrigants if splashes occur to the eye
- Reporting the incident to your supervisor and immediately seeking medical treatment
- Documenting the type of injury, including the involvement of blood, the source of the blood, and the extent of the injury These steps are crucial in reducing the risk of acquiring bloodborne infections, as prompt cleaning reduces pathogen load at the injury site, and timely medical intervention can significantly reduce the risk of infection through pharmaceutical prophylaxis before viruses establish systemic infection, as supported by 1. For high-risk exposures, such as from a needle used on an HIV-positive patient, HIV PEP typically includes a combination of antiretroviral medications, started within 72 hours and continued for 28 days, while hepatitis B prophylaxis may include hepatitis B immune globulin and vaccination if you're not already immune, as outlined in 1. Blood tests should be conducted to establish baseline status for HIV, hepatitis B, and hepatitis C, with follow-up testing necessary at intervals determined by your healthcare provider, typically at 6 weeks, 3 months, and 6 months post-exposure, as recommended by 1. It is essential to follow these guidelines to minimize the risk of morbidity, mortality, and to improve quality of life, as the risk of acquiring bloodborne infections can be significantly reduced with prompt and appropriate medical intervention, as emphasized by 1.
From the FDA Drug Label
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. Administration of Hepatitis B Immune Globulin (Human) either preceding or concomitant with the commencement of active immunization with Hepatitis B Vaccine provides for more rapid achievement of protective levels of hepatitis B antibody, than when the vaccine alone is administered. Rapid achievement of protective levels of antibody to hepatitis B virus may be desirable in certain clinical situations, as in cases of accidental inoculations with contaminated medical instruments.
The immediate steps to take after an accidental needle stick injury include administering Hepatitis B Immune Globulin (Human) as soon as possible, followed by a second dose a month later, and initiating the hepatitis B vaccine series. This regimen is about 75% effective in preventing hepatitis B in the setting of percutaneous exposure 2.
From the Research
Immediate Steps After Accidental Needle Stick Injury
- Report the incident to the supervisor or occupational health department immediately 3
- Wash the affected area with soap and water 3
- Seek medical attention as soon as possible for post-exposure prophylaxis (PEP) evaluation 3, 4
- Provide information about the source patient, including their HIV and hepatitis status, if known 3
Post-Exposure Prophylaxis (PEP)
- PEP with antiretroviral medications can reduce the risk of HIV transmission by 80% 3
- The choice of PEP regimen may depend on various factors, including the source patient's viral load and resistance profile 5, 6
- Raltegravir-based regimens have been shown to be effective and well-tolerated for PEP 6, 7