What is the immediate course of action after a percutaneous exposure to a contaminated needle?

Immediate Management of Contaminated Needle Stick Injury

Immediately wash the needle-stick site with soap and water, encourage bleeding from the wound, and report the incident to your supervisor or designated emergency department within minutes to initiate post-exposure prophylaxis within 24 hours. 1, 2

Immediate Wound Care (First Minutes)

• Wash the puncture site thoroughly with soap and water – this is the single most important immediate action 1, 2
• Encourage bleeding from the wound by gentle pressure around (not on) the puncture site to help flush out potential contaminants 3
• Do NOT use bleach or hydrogen peroxide on the wound, as these caustic agents damage tissue without proven benefit in reducing transmission risk 2
• If splashes to eyes, nose, or mouth occurred, flush the involved area immediately with water or saline 1

Immediate Reporting and Documentation (Within Hours)

• Report the incident immediately to your supervisor and seek medical evaluation as soon as possible, ideally within 1-2 hours 1, 2
• Document the following details: type of injury, depth of penetration, whether blood was involved, source of the needle/blood, and extent of injury 1
• Identify the source patient if possible to assess likelihood of HIV, hepatitis B, or hepatitis C infection 1, 2

Source Patient Testing (Within Hours)

• Obtain consent and test the source patient for HBsAg (hepatitis B surface antigen), hepatitis C antibody, and HIV antibody using FDA-approved rapid testing methods when available 1
• If the source patient cannot be identified, base prophylaxis decisions on the likelihood of exposure considering the source of the needle and type of exposure 1

Exposed Healthcare Worker Testing (Baseline)

• Draw baseline blood from the exposed worker for HBsAg, anti-HBs (hepatitis B antibody), hepatitis C antibody, and HIV antibody (with consent) 1, 2
• Determine the exposed worker's hepatitis B vaccination status and response to prior immunization 1

Post-Exposure Prophylaxis Initiation (Within 24 Hours)

For Hepatitis B Exposure:

• If source is HBsAg-positive and worker is unvaccinated: Administer hepatitis B immune globulin (HBIG) 0.06 mL/kg IM immediately (ideally within 24 hours, though value beyond 7 days is unclear) AND initiate hepatitis B vaccine series 4
• If source is HBsAg-positive and worker is vaccinated: Test exposed worker for anti-HBs; if inadequate antibody response, give HBIG immediately plus vaccine booster dose 4
• If source is unknown or high-risk: Initiate hepatitis B vaccine series within 7 days of exposure 4

For HIV Exposure:

• Initiate antiretroviral post-exposure prophylaxis as soon as possible but within 24 hours if the source is HIV-positive or high-risk 1, 2, 5
• The standard regimen consists of a cocktail of antiretrovirals continued for 6 weeks 3, 5
• Do not delay PEP initiation while awaiting source patient test results if high-risk exposure occurred 5

For Hepatitis C Exposure:

• No post-exposure prophylaxis is currently available for hepatitis C 1
• Follow-up testing and monitoring are required 2

Common Pitfalls to Avoid

• Never recap needles using both hands or any technique directing the needle point toward your body – this is how many injuries occur 1
• Do not delay seeking medical evaluation – the effectiveness of post-exposure prophylaxis decreases significantly after 24 hours, and HBIG efficacy decreases markedly if delayed beyond 48 hours 4
• Do not assume the source is low-risk – in one study, one in five index patients was infected with at least one blood-borne pathogen 6
• Do not fail to report the injury – complete reporting is essential for optimal treatment and prevention of future injuries 6

Follow-Up Care

• Schedule follow-up testing for anti-HBs at 4-6 months if hepatitis B prophylaxis was given 2
• Monitor for hepatitis C and HIV according to standard protocols with serial testing at 6 weeks, 3 months, and 6 months post-exposure 2
• Work restrictions are only necessary if the exposed worker develops exudative lesions or weeping dermatitis, particularly on the hands 1, 2
• Document that the worker has been educated on safe handling of sharps, proper PPE use, and importance of reporting symptoms 2