From the Guidelines
When a healthcare worker experiences a needle stick injury, immediate action is crucial, and the first step should be to wash the wound thoroughly with soap and water and report the incident to initiate proper documentation and risk assessment. The management of needlestick injury in healthcare workers involves several key steps to minimize the risk of transmission of bloodborne pathogens such as HIV, hepatitis B, and hepatitis C 1.
Initial Response
The initial response to a needlestick injury should include:
- Washing the wound thoroughly 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 treatment immediately
Risk Assessment and Testing
After the initial response, the next steps involve:
- Documenting the type of injury, including the involvement of blood, and the source of the blood
- Identifying the source patient, if possible, and determining the likelihood of HIV, hepatitis B, or hepatitis C infection
- Testing the source patient for HIV, hepatitis B, and hepatitis C, if possible, and testing the exposed healthcare worker for these infections as well 1
Post-Exposure Prophylaxis
Post-exposure prophylaxis (PEP) for HIV should be started ideally within 2 hours, but no later than 24 hours after exposure, and the standard PEP regimen typically includes a combination of anti-HIV drugs. For hepatitis B, if the healthcare worker is not immune, hepatitis B immune globulin (HBIG) and the hepatitis B vaccine series should be administered 1. Currently, there is no PEP for hepatitis C, but early detection through follow-up testing is important.
Follow-up Testing
Follow-up testing should occur at 6 months after the potential exposure to determine if the healthcare worker has seroconverted to HIV, hepatitis B, or hepatitis C 1. During this period, healthcare workers should practice safe sex and avoid blood donation.
Prevention of Future Injuries
To prevent future needlestick injuries, healthcare facilities should implement measures such as:
- Preparing a written policy for prevention of needle-stick injuries
- Educating personnel on safe handling of sharps
- Implementing a practice not to recap, bend, or break needles or remove needles from a syringe by hand
- Evaluating and implementing safer medical devices designed to reduce the risk of needle sticks 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 (its value beyond 7 days of exposure is unclear). If Hepatitis B Immune Globulin (Human) is indicated (see Table 1), an injection of 0. 06 mL/kg of body weight should be administered intramuscularly (see PRECAUTIONS) as soon as possible after exposure and within 24 hours, if possible. Table 1 summarizes prophylaxis for percutaneous (needlestick or bite), ocular, or mucous-membrane exposure to blood according to the source of exposure and vaccination status of the exposed person 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 approach to managing needlestick injury in healthcare workers involves:
- Immediate administration of Hepatitis B Immune Globulin (Human) as soon as possible after exposure, ideally within 24 hours
- Combination therapy with hepatitis B vaccine for both short- and long-term protection
- Dosing of 0.06 mL/kg of body weight of Hepatitis B Immune Globulin (Human) intramuscularly
- Follow-up dose of Hepatitis B Immune Globulin (Human) one month after the initial dose for inadvertent percutaneous exposure 2 2
From the Research
Approach to Managing Needlestick Injury
The approach to managing needlestick injury in healthcare workers involves several key steps, including:
- Immediate reporting of the incident to the infection control unit or occupational health department 3
- Post-exposure prophylaxis (PEP) with antiretroviral medications to reduce the risk of HIV transmission by 80% 4
- Follow-up monitoring and testing for blood-borne viruses, such as HIV, HBV, and HCV 5
- Provision of personal protective equipment and training on safe handling and disposal of sharps 4, 6
- Implementation of Universal Precautions and elimination of unnecessary injections 4
Prevention Strategies
Prevention strategies for needlestick injuries include:
- Eliminating needle recapping and disposing of sharps into a designated container immediately after use 4, 6
- Using safer devices, such as needles that sheath or retract after use 4
- Providing training on the risks and prevention of transmission 4, 3
- Ensuring adequate vaccination against HBV 7, 3
- Promoting awareness and education on needlestick injury prevention among healthcare workers 7, 3
Barriers to Reporting
Barriers to reporting needlestick injuries include:
- Fear of repercussions or disciplinary action 3
- Lack of time or being too busy at work 3
- Lack of awareness or knowledge about the importance of reporting 7, 3
- Perception that the injury is not serious or that the risk of transmission is low 7, 3
Importance of Reporting
Reporting needlestick injuries is crucial for: