What is the protocol for a needle stick injury?

Needle Stick Injury Protocol

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 of exposure. 1

Immediate Steps After Needle Stick Injury

1. Wound Care:

   • Wash the injury site thoroughly with soap and water
   • Do not squeeze or scrub the wound
   • If mucous membrane exposure occurred (eyes, mouth), flush with water or saline

2. Report the Incident:

   • Notify supervisor immediately
   • Complete an incident report form documenting:
     • Type of injury
     • Type of needle used
     • Procedure being performed
     • Details of exposure (depth, visible blood, etc.)

3. Source Patient Assessment:

   • Identify the source patient if possible
   • Test source patient for HBsAg, HCV antibody, and HIV (with consent)
   • Assess risk factors if source is unknown

Risk Assessment

The risk of transmission varies by pathogen:

• Hepatitis B: Up to 30% without prophylaxis if source is e-antigen positive
• Hepatitis C: Approximately 1.8%
• HIV: Approximately 0.3% 1

Higher risk exposures include:

• Hollow-bore needles (higher risk than solid needles)
• Deep punctures
• Visible blood on device
• Needle placed directly in patient's vein or artery

Post-Exposure Prophylaxis (PEP)

For Hepatitis B Exposure:

If exposed person is unvaccinated and source is HBsAg-positive:

• Administer Hepatitis B Immune Globulin (HBIG) 0.06 mL/kg IM immediately (within 24 hours if possible)
• Initiate HBV vaccine series 1, 2

If exposed person is vaccinated:

• Test for anti-HBs antibodies
• If inadequate antibody levels (<10 SRU), administer HBIG immediately plus HBV vaccine booster 2

For HIV Exposure:

If source patient is HIV positive or 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 Hepatitis C Exposure:

• No proven post-exposure prophylaxis
• Monitor for early detection of infection to allow prompt treatment

Follow-up Testing and Monitoring

1. Baseline Testing:

   • Test exposed person for HBV, HCV, and HIV at baseline

2. Follow-up Testing:

   • Follow-up testing at 6 weeks, 3 months, and 6 months
   • Additional testing at 12 months for HIV if source patient had HIV

3. Counseling:

   • Provide counseling about preventing transmission during follow-up period
   • Discuss symptoms of viral hepatitis and HIV seroconversion

Prevention Strategies

Healthcare facilities should implement:

• Comprehensive prevention programs
• Staff education on safe practices
• Use of safer medical devices with engineered safety features
• Proper sharps disposal (containers placed close to use areas, never overfilled)
• Never recap, bend, or break needles 1

Common Pitfalls to Avoid

• Delayed reporting: Effectiveness of PEP decreases significantly after 24-48 hours
• Inadequate source patient testing: Failure to test source patients can lead to unnecessary PEP or missed opportunities for prevention
• Improper wound care: Aggressive wound scrubbing can increase tissue trauma and potentially enhance viral entry
• Incomplete follow-up: Missing follow-up appointments can lead to delayed diagnosis of transmitted infections
• Recapping needles: This practice significantly increases risk of injury and should never be done 1

By following this protocol promptly and thoroughly, healthcare workers can significantly reduce the risk of infection transmission following needle stick injuries.