Management of Accidental Needle Stick Injury
Immediate management of accidental needle stick injuries requires prompt wound washing, risk assessment, and appropriate post-exposure prophylaxis based on source patient status to prevent transmission of bloodborne pathogens. 1
Immediate Actions After Needle Stick Injury
Immediate wound care:
- Wash the wound thoroughly with soap and water
- Encourage bleeding from the wound site
- Do not squeeze or scrub the injury site
- Clean with antiseptic solution after washing
Report the incident:
- Notify supervisor or occupational health service immediately
- Complete incident report documenting:
- Type of needle/device involved
- Procedure being performed
- Depth of injury
- Whether gloves were worn
- Source patient information (if known)
Risk Assessment
Assess risk based on:
- Source patient status: Known or unknown HIV, HBV, HCV status
- Type of exposure: Hollow-bore needles pose higher risk than solid needles
- Depth of injury: Deep punctures pose higher risk than superficial injuries
- Type of body fluid involved: Blood carries highest risk
| 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% |
Post-Exposure Prophylaxis (PEP)
For Known Source Patient:
Hepatitis B:
- 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
- For previously vaccinated individuals with unknown antibody response, check anti-HBs and administer booster if needed
HIV:
- If source 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
- Continue for 4 weeks if indicated
Hepatitis C:
- No proven PEP available
- Baseline HCV testing and follow-up monitoring required
For Unknown Source:
- Risk assessment based on setting where injury occurred
- Consider PEP if high-risk setting (e.g., emergency department, dialysis unit)
- Hepatitis B vaccination if not previously immunized
Follow-up Testing and Monitoring
- Baseline testing: HIV, HBV, HCV serology of exposed person
- Follow-up testing schedule:
- 6 weeks post-exposure
- 3 months post-exposure
- 6 months post-exposure
- Additional monitoring:
- Monitor for adverse effects if on PEP
- Provide psychological support as needed
Prevention Strategies
- Use safer medical devices with engineered safety features
- Never recap, bend, or break needles
- Dispose of sharps immediately in appropriate containers
- Maintain comprehensive needle stick prevention programs
- Ensure all healthcare workers maintain current hepatitis B immunity
Common Pitfalls to Avoid
- Delayed reporting: Reporting delays can compromise effectiveness of PEP
- Inadequate source testing: Failure to test source patient when possible
- Incomplete follow-up: Many exposed individuals fail to complete recommended follow-up testing 2
- Improper disposal: Using overfilled sharps containers increases risk
- Recapping needles: This practice significantly increases risk of injury 3
By following this structured approach to needle stick injury management, healthcare facilities can minimize the risk of bloodborne pathogen transmission and ensure optimal care for affected healthcare workers.