What labs and work restrictions are recommended for a dental worker filing a Labor and Industry (L&I) claim after a needle stick injury at their workplace?

Management of Needle Stick Injury in Dental Workers

For a dental worker with a needle stick injury filing an L&I claim, you should immediately draw blood for hepatitis B, hepatitis C, and HIV testing, and implement work restrictions only if the worker has exudative lesions or weeping dermatitis on their hands. 1

Immediate Management

• Ensure the exposed employee has followed these immediate steps:

  • Wash needle-stick site with soap and water 1
  • If splashes to eyes, nose, or mouth occurred, flush with water or saline 1
  • Document the type of injury, involvement of blood, source of blood, and extent of injury 1

• As the treating physician, you should:

  • Document the type of injury and involvement of blood 1
  • Identify the source patient if possible and assess likelihood of HIV, hepatitis B, or hepatitis C infection 1
  • Ensure follow-up for the exposed employee 1

Laboratory Testing

• Draw blood for baseline testing of the dental worker:

  • Hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) 1
  • Hepatitis C antibody 1
  • HIV antibody (with consent) 1

• If the source patient is known, obtain permission to test for:

  • Hepatitis B virus 1
  • Hepatitis C virus 1
  • HIV (rapid testing is available) 1

Post-Exposure Prophylaxis Considerations

Hepatitis B Prophylaxis

• For unimmunized workers:

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

• For immunized workers who responded to vaccine:

  • No treatment necessary 1

• For immunized workers who did not respond to vaccine:

  • If source is HBsAg-positive: administer HBIG immediately and in 1 month, or HBIG and initiate reimmunization 1
  • If source is HBsAg-negative: no treatment 1
  • If source is unknown: consider HBIG or HBIG and HBV reimmunization for high-risk sources 1

HIV Prophylaxis

• Consider prophylaxis against HIV if appropriate 1
• Antimicrobial prophylaxis should be initiated as soon as possible but within 24 hours of exposure 1
• Options include:
  • "Basic regimen": 4-week course with 2 anti-HIV drugs 1
  • "Expanded regimen": 3 anti-HIV drugs for exposures with increased transmission risk 1

Work Restrictions

• Work restrictions are only necessary if the dental worker has exudative lesions or weeping dermatitis, particularly on the hands 1
• In such cases, the worker should refrain from direct patient care and handling dental patient-care equipment until the condition resolves 1
• For standard needle stick injuries without skin conditions, no work restrictions are necessary on the Activity Prescription Form (APF) 2

Follow-Up Care

• Schedule follow-up testing as appropriate:

  • For hepatitis B: test for anti-HBs 4-6 months later if indicated 1
  • For hepatitis C: follow standard protocols for monitoring 1
  • For HIV: follow established monitoring protocols if prophylaxis was initiated 1

• Document that the worker has been educated on:

  • Safe handling of sharp instruments and needles 1
  • Proper use of personal protective equipment 1
  • Importance of reporting any symptoms of infection 2

Common Pitfalls to Avoid

• Underreporting of needle stick injuries is common among dental professionals (27.5% reported having an NSI in a 12-month period) 3
• Fear of being blamed is a common reason (29.09%) for failure to report needle stick injuries 3
• Dental students and inexperienced practitioners are at highest risk for needle stick injuries 4, 5
• Recapping needles using two hands is a major cause of injuries and should never be done 1

By following these guidelines, you can provide appropriate care for dental workers with needle stick injuries while properly documenting for their L&I claim.