What is the protocol after a needle stick injury?

Protocol After a Needle Stick Injury

After a needlestick injury, immediately wash the wound with soap and water, document the incident, and report it to a supervisor or occupational health service for proper risk assessment and management. 1

Immediate Response Steps

1. Wound Care:

   • Immediately wash the wound thoroughly with soap and water 1
   • If there are splashes to eyes, nose, or mouth, rinse abundantly with clean water 1

2. Documentation:

   • Document the type of injury, including the type of needle used and the procedure performed 1
   • Record details about the source patient if known 1

3. Reporting:

   • Report the incident to a supervisor or occupational health service 1
   • Complete required incident report forms 2

Risk Assessment

The risk of transmission varies by pathogen 1:

• Hepatitis B: up to 30% without prophylaxis if source is e-antigen positive
• Hepatitis C: approximately 1.8%
• HIV: approximately 0.3%

Source Patient Testing

• Test the source patient for HBV, HCV, and HIV (if consent can be obtained) 1, 3
• Approximately 86.5% of source patients can be tested for bloodborne pathogens 3
• In some cases, source patients may receive first diagnoses of bloodborne infections after the testing 4

Post-Exposure Prophylaxis (PEP)

For Hepatitis B Exposure:

• If exposed person is not immunized and source is HBsAg positive: administer HBIG 0.06 mL/kg IM immediately and initiate vaccine series 1
• If exposed person has documented immunity (antibody levels >100 IU), no further action needed 1
• If antibody levels are 50-100 IU, consider a booster dose within one year 1
• If antibody levels are 10-50 IU, administer a booster dose immediately 1

For HIV Exposure:

• If source patient is HIV positive, initiate antiretroviral prophylaxis preferably within the first 24 hours 1
• Basic regimen: 2 anti-HIV drugs for standard exposures 1
• Expanded regimen: 3 anti-HIV drugs for exposures with increased transmission risk 1
• Studies show high compliance rates, with 85.1% of healthcare workers starting HIV-PEP within 2 hours and another 12.8% within 10 hours 4

For Hepatitis C Exposure:

• No proven post-exposure prophylaxis is available 1
• Early identification and treatment of acute infection is the current approach 1

Follow-Up Monitoring

• Attend all recommended follow-up examinations (97.4% compliance reported) 4
• Undergo serological monitoring as recommended by CDC 1
• Follow institutional protocols for follow-up testing schedule 1

Prevention of Future Injuries

Healthcare facilities should implement a bloodborne pathogens exposure-control plan that includes 2:

• Written policies readily available to all staff
• Regular review of protocols
• Education of personnel
• Implementation of practices to avoid recapping, bending, or breaking needles
• Evaluation of safer medical devices with input from staff members
• Proper disposal of needles into impermeable and puncture-proof containers
• Policies consistent with state and local regulations for removal and sterilization

Psychological Considerations

• Recognize that needlestick injuries cause significant anxiety (75% of healthcare workers report feeling concerned, with 12.2% being very concerned) 4
• Provide appropriate psychological support and counseling as needed 1

Common Pitfalls to Avoid

• Delaying wound washing or reporting the incident
• Failing to document the incident properly
• Not completing the full course of post-exposure prophylaxis when indicated
• Missing follow-up appointments
• Recapping needles, which is a major cause of needlestick injuries 2, 1
• Overfilling sharps containers or placing them where young children can reach them 2

With proper management and follow-up of needlestick injuries, transmission rates of bloodborne pathogens can be kept very low in occupational settings 4.