What is the management for a staff nurse who experienced a needle prick injury?

From the Guidelines

The staff nurse who experienced a needle prick injury should immediately wash the injury site with soap and water, report the incident to their supervisor, and seek medical treatment to assess the need for post-exposure prophylaxis (PEP) against HIV, Hepatitis B, and Hepatitis C, as outlined in the management steps 1. The management of a needle prick injury involves several key steps to minimize the risk of transmission of bloodborne pathogens.

• The exposed employee should immediately wash the needle-stick site or cut with soap and water.
• If splashes to the nose, mouth, or skin occur, the involved area should be flushed with water.
• If splashes to the eye occur, the eyes should be irrigated with clean water, saline, or sterile irrigants.
• The incident should be reported to the supervisor, and medical treatment should be sought immediately.
• The type of injury, including the involvement of blood, the source of the blood, and the extent of the injury, should be documented. The physician should:
• Document the type of injury, including the involvement of blood.
• Identify the source patient, if possible, and assess the likelihood of HIV, Hepatitis B, or Hepatitis C infection.
• Have an established policy for managing exposures or arrange for immediate referral to a person or location with expertise in managing such exposures.
• Ensure follow-up for the potentially exposed employee.
• Ensure that all employees know how to access the policy. Management includes determining the status of the source patient, determining the immunity of the employee, and considering prophylaxis against HIV and Hepatitis B, as recommended by the Centers for Disease Control and Prevention (CDC) and other reputable health organizations, as cited in the study 1.
• For HIV prophylaxis, antimicrobial prophylaxis should be initiated as soon as possible, but within 24 hours of exposure.
• For Hepatitis B prophylaxis, the exposed person's immunity should be determined, and HBIG and vaccination may be needed if the person is not immune. Follow-up testing should occur at 6 weeks, 3 months, and 6 months post-exposure to monitor for the development of bloodborne pathogens, as recommended in the study 1.

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 If Hepatitis B Immune Globulin (Human) is indicated, an injection of 0.06 mL/kg of body weight should be administered intramuscularly as soon as possible after exposure and within 24 hours, if possible. A regimen combining Hepatitis B Immune Globulin (Human) with hepatitis B vaccine will provide both short- and long-term protection 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.

Management for a staff nurse who experienced a needle prick injury:

• Administer Hepatitis B Immune Globulin (Human) as soon as possible after exposure, ideally within 24 hours.
• The dose should be 0.06 mL/kg of body weight, administered intramuscularly.
• A hepatitis B vaccine series should also be initiated.
• A second dose of Hepatitis B Immune Globulin (Human) may be given one month after the first dose, depending on the specific circumstances of the exposure and the nurse's vaccination status. 2 2

From the Research

Management of Needle Prick Injury

• The management of a staff nurse who experienced a needle prick injury involves immediate action to minimize the risk of transmission of blood-borne pathogens 3, 4, 5, 6.
• The first step is to wash the wound with soap and water, and encourage bleeding to help remove any potential pathogens from the wound 3, 4, 5.
• The staff nurse should then report the incident to the emergency room or the designated person in charge, and provide information about the source of the injury, including the patient's identity and any relevant medical history 3, 6.
• Post-exposure prophylaxis (PEP) may be initiated, depending on the source of the injury and the staff nurse's vaccination status 3, 6.
• For example, if the source patient is positive for hepatitis B, the staff nurse may receive a booster hepatitis B immunization or a full course of immunization with hepatitis B immunoglobulin 3.
• If the source patient is positive for HIV, the staff nurse may receive immediate antiretroviral therapy (AZT) for six weeks 3.

Follow-up and Screening

• After a needle prick injury, the staff nurse should undergo follow-up screening for blood-borne pathogens, including hepatitis B, hepatitis C, and HIV 3, 5, 6.
• The screening should be done at regular intervals, typically at 6 weeks, 3 months, and 6 months after the injury 6.
• The staff nurse should also be monitored for any signs or symptoms of infection, and receive prompt treatment if necessary 6.

Prevention and Education

• To prevent needle prick injuries, healthcare workers should be educated on proper techniques for handling sharp instruments, including the use of needle cutters and safe disposal of sharps 7, 5.
• Healthcare workers should also be vaccinated against hepatitis B, and receive regular training on infection control and prevention of blood-borne pathogens 7, 5.
• The use of safety devices, such as needleless systems and sharps containers, can also help reduce the risk of needle prick injuries 7, 6.