What is the initial treatment and investigation for a needle prick injury?

Initial Treatment and Investigation for Needle Prick Injury

Immediate action for a needle prick injury should include washing the wound with soap and water, reporting the incident, and following a structured protocol for post-exposure prophylaxis based on source patient status. 1

Immediate Steps After Exposure

1. Immediate wound care:

   • Wash needle-stick site or cut thoroughly with soap and water
   • If splashes to nose, mouth, or skin occur, flush involved area with water
   • If splashes to the eye occur, irrigate with clean water, saline, or sterile irrigants 1

2. Reporting and documentation:

   • Report the incident to supervisor immediately
   • Seek medical treatment without delay
   • Document the type of injury including involvement of blood, source of blood, and extent of injury 1

Medical Assessment and Investigation

The physician should follow this structured approach:

1. Document exposure details:

   • Type of injury (depth, gauge of needle)
   • Involvement of blood or body fluids
   • Procedure being performed when injury occurred 1

2. Source patient assessment:

   • Identify the source patient if possible
   • Obtain permission consistent with local statutes
   • Test source patient for:
     • Hepatitis B surface antigen (HBsAg)
     • Hepatitis C virus antibodies
     • HIV antibodies (rapid testing is available) 1, 2

3. Exposed person assessment:

   • Determine immunity status of the exposed person
   • Check hepatitis B vaccination history and antibody status
   • Test for baseline antibodies to hepatitis C
   • Obtain consent and test for baseline HIV antibodies 1

Post-Exposure Prophylaxis (PEP)

Hepatitis B Prophylaxis

Management depends on the exposed person's vaccination status and the source patient's HBsAg status:

1. For unvaccinated exposed persons:

   • If source is HBsAg-positive: Administer HBIG (0.06 mL/kg; maximum 5 mL) intramuscularly AND begin hepatitis B vaccine series
   • If source is HBsAg-negative: Begin hepatitis B vaccine series
   • If source is unknown/untested: Begin hepatitis B vaccine series 1, 2

2. For vaccinated exposed persons who responded to vaccine:

   • No treatment necessary 1, 2

3. For vaccinated exposed persons who did not respond to vaccine:

   • If source is HBsAg-positive: HBIG immediately and again in 1 month OR HBIG and initiate revaccination
   • If source is HBsAg-negative: No treatment
   • If source is unknown: Consider HBIG if high-risk source 1, 2

4. For vaccinated persons with unknown response:

   • If source is HBsAg-positive: Test exposed person for anti-HBs
   • If positive, no treatment
   • If negative, give one dose of HBIG and one dose of vaccine 1, 2

HIV Prophylaxis

• Initiate antiretroviral prophylaxis as soon as possible, ideally within 24 hours of exposure 1
• The decision to start PEP should be based on the risk assessment of the exposure and source patient status
• Two regimens are available:
  • "Basic regimen": 4-week course of 2 anti-HIV drugs
  • "Expanded regimen": 3 anti-HIV drugs for exposures with increased transmission risk 1

Hepatitis C Management

• No proven post-exposure prophylaxis for HCV
• Monitor for seroconversion with follow-up testing
• Early identification allows for prompt treatment if infection occurs 3

Follow-Up Monitoring

1. Schedule follow-up testing:

   • Hepatitis B: Test at appropriate intervals based on prophylaxis given
   • Hepatitis C: Test at 4-6 weeks and 4-6 months
   • HIV: Test at 6 weeks, 3 months, and 6 months 1

2. Counseling:

   • Provide counseling regarding risk of transmission
   • Discuss precautions to prevent secondary transmission during follow-up period
   • Address psychological concerns related to the exposure 1

Prevention Strategies

• Use devices with engineered safety features (safer syringes, blunt suture needles) 1, 4
• Place sharps in appropriate puncture-resistant containers located as close as possible to the area of use 1
• Never recap needles using both hands 1
• Ensure all healthcare personnel receive hepatitis B vaccination 1

Important Considerations

• The risk of transmission varies by pathogen: HBV (up to 30% without prophylaxis if source is e-antigen positive), HCV (approximately 1.8%), and HIV (approximately 0.3%) 1, 3
• The volume of blood transferred during a needlestick varies with needle gauge - larger gauge needles (20G) transfer significantly more blood than smaller gauge needles (27G) 5
• Prompt initiation of PEP is critical - efficacy decreases markedly if treatment is delayed beyond 48 hours 2
• Complete reporting of needlestick injuries is essential for identifying risky procedures and ensuring optimal treatment 3