What is the management plan for an accidental needle stick injury?

Management of Accidental Needle Stick Injury

Immediate management of a needle stick injury requires washing the wound with soap and water, reporting the incident, assessing the source patient's infection status, and initiating appropriate post-exposure prophylaxis within 24 hours if indicated. 1

Immediate Actions Following Needle Stick Injury

1. Immediate wound care:

   • Wash the wound thoroughly with soap and water 1
   • If there are splashes to eyes, nose, or mouth, rinse abundantly with clean water 1
   • Do not squeeze or scrub the wound

2. Documentation and reporting:

   • Complete required incident report forms documenting:
     • Type of injury
     • Type of needle used
     • Procedure being performed
   • Report to supervisor and occupational health service immediately 1

Risk Assessment

Assess the risk of bloodborne pathogen transmission based on:

• Source patient status: Test source patient (if known) for HIV, HBV, and HCV 1
• Type of exposure: Hollow-bore needles pose higher risk than solid needles
• Exposure severity: Deep punctures pose higher risk than superficial injuries
• Exposure material: Blood carries higher risk than other body fluids

Transmission Risk Rates

Pathogen	Risk of Transmission
Hepatitis B	Up to 30% without prophylaxis if source is e-antigen positive
Hepatitis C	Approximately 1.8%
HIV	Approximately 0.3%

1

Post-Exposure Prophylaxis (PEP)

For HIV Exposure

• If source patient is HIV positive or status unknown with high-risk factors:
  • Initiate antiretroviral prophylaxis preferably within first 24 hours
  • Basic regimen: 2 anti-HIV drugs for low-risk exposures
  • Expanded regimen: 3 anti-HIV drugs for high-risk exposures 1

For HBV Exposure

• If exposed person is not immune and source is HBsAg positive:
  • Administer HBIG 0.06 mL/kg IM immediately
  • Initiate HBV vaccine series if not previously vaccinated 1
• If exposed person has documented immunity (antibody levels >100 IU):
  • No further action needed 1
• If antibody levels are 50-100 IU:
  • Consider booster dose within one year 1
• If antibody levels are 10-50 IU:
  • Administer booster dose immediately 1

For HCV Exposure

• No proven post-exposure prophylaxis
• Early detection through follow-up testing is essential for prompt treatment if infection occurs 1

Follow-up and Monitoring

• Attend all recommended follow-up examinations
• Undergo serological monitoring as recommended:
  • Baseline testing
  • Follow-up testing at 6 weeks, 3 months, and 6 months
• Early detection of infection allows for prompt treatment 1

Prevention Strategies

Healthcare facilities should implement comprehensive prevention programs:

1. Written policies for prevention of needle-stick injuries 2
2. Staff education on proper handling and disposal of sharps 2
3. Safe practices:
   • Never recap, bend, or break needles 2, 1
   • Never remove needles from syringes by hand 2
   • Dispose of needles immediately in puncture-proof containers 2, 1
4. Safety devices:
   • Evaluate and implement safer medical devices with engineered safety features 2
   • Use blunt suture needles when possible 1
5. Proper disposal:
   • Place sharps containers close to areas of use 1
   • Never overfill sharps containers 2
   • Keep containers out of reach of children 2

Common Pitfalls to Avoid

• Delayed reporting: Delays can compromise effectiveness of post-exposure prophylaxis
• Inadequate source patient testing: Always attempt to test the source patient when possible
• Neglecting follow-up: Complete all recommended follow-up testing
• Improper sharps disposal: Always use designated containers
• Recapping needles: This is a major cause of needle stick injuries 1

By following these guidelines, healthcare facilities can minimize the risk of bloodborne pathogen transmission following accidental needle stick injuries and ensure appropriate care for affected healthcare workers.