What are the immediate steps after a needle prick injury?

Immediate Management of Needle Prick Injury

After a needle prick injury, immediately wash the wound thoroughly with soap and water, report the incident to your supervisor, and seek medical treatment without delay. 1

Immediate Steps

1. Wound Care:

   • Wash needle-stick site or cut thoroughly with soap and water 1, 2
   • If splashes to nose, mouth, or skin occur, flush involved area with water 1
   • If splashes to the eye occur, irrigate with clean water, saline, or sterile irrigants 1

2. Reporting and Documentation:

   • Report the incident to your supervisor immediately 1, 2
   • Document the type of injury including:
     • Involvement of blood
     • Source of the blood
     • Extent of injury (e.g., deep injection, blood spill onto intact skin) 1

3. Medical Evaluation:

   • Seek immediate medical treatment 1
   • The physician should document the injury and identify the source patient if possible 1

Post-Exposure Management Protocol

Source Patient Assessment

1. Identify the source patient if possible 1, 2
2. Obtain permission consistent with local statutes to determine serologic status for:
   • Hepatitis B virus (HBsAg)
   • Hepatitis C virus
   • HIV 1, 2
3. If source identification is not possible, base actions on likelihood of exposure considering the source of needle and type of exposure 1

Exposed Person Assessment

1. Determine immunity status:
   • Check hepatitis B vaccination history
   • Test for anti-HBsAg if response to immunization is unknown
   • Test for baseline antibodies to hepatitis C
   • Obtain consent and test for HIV antibodies 1, 2

Post-Exposure Prophylaxis (PEP)

For Hepatitis B:

• If exposed person is unimmunized:

  • Source HBsAg-positive: administer HBIG (0.06 mL/kg; maximum 5 mL) intramuscularly and begin hepatitis B vaccine series 1, 3
  • Source HBsAg-negative: begin hepatitis B vaccine series 1
  • Source unknown: begin hepatitis B vaccine series 1

• If exposed person previously vaccinated with known response:

  • No treatment needed regardless of source status 1, 3

• If exposed person previously vaccinated with unknown response:

  • Test for anti-HBs and follow appropriate protocol based on results 1, 3

For HIV:

• Initiate antiretroviral prophylaxis as soon as possible, ideally within 24 hours of exposure 2
• Basic regimen: 2 anti-HIV drugs for lower risk exposures
• Expanded regimen: 3 anti-HIV drugs for higher risk exposures 2

For Hepatitis C:

• No proven post-exposure prophylaxis
• Perform baseline and follow-up testing to detect infection early 2

Risk of Transmission

• Hepatitis B: Up to 30% risk without prophylaxis if source is e-antigen positive 1, 2
• Hepatitis C: Approximately 1.8% 2
• HIV: Approximately 0.3% (0.36%) 1, 2

Prevention Strategies

• Use devices with engineered safety features 2
• Avoid recapping needles 1
• Place sharps in puncture-resistant containers located close to area of use 1
• All healthcare workers should be immunized against hepatitis B 1, 2

Common Pitfalls to Avoid

1. Delayed reporting: Delays can compromise the effectiveness of post-exposure prophylaxis, especially for HIV where treatment should ideally begin within 24 hours
2. Recapping needles: This is a common cause of needlestick injuries and should be avoided 1
3. Inadequate follow-up: Many healthcare workers (more than 50%) fail to complete follow-up after needle stick injuries 4, 5
4. Using the same syringe for multiple patients: Even if the needle is changed, the syringe should never be reused for multiple patients 1

Remember that prompt action following a needlestick injury is crucial for preventing potential transmission of bloodborne pathogens and reducing anxiety associated with such incidents.