What is the immediate treatment for a needle prick injury?

Immediate Treatment for Needle Prick Injury

Immediately wash the needle-stick site thoroughly with soap and water, flush mucous membranes with water or saline if exposed, report the incident to your supervisor, and seek emergency medical evaluation within 1 hour to initiate post-exposure prophylaxis if indicated. 1, 2, 3

First Actions at the Site of Injury (Within Minutes)

• Wash the wound immediately with soap and water for percutaneous injuries 1, 2, 3
• Do not squeeze or apply pressure to increase bleeding, as this can cause additional tissue trauma 3, 4
• Flush with clean water or saline for 15 minutes if blood splashed into eyes, nose, or mouth 1, 3
• Allow the wound to bleed freely without manipulation 5
• Apply 70% alcohol and/or 10% povidone-iodine using a circular rubbing motion, allowing povidone-iodine to dry for 2-3 minutes for full bacteriostatic action 4

Immediate Reporting and Documentation (Within 1 Hour)

• Report to your supervisor immediately and document the exposure details including date, time, type of device involved, depth of injury, and amount of blood exposure 1, 2, 3
• Identify the source patient if possible, as this information is critical for risk assessment and prophylaxis decisions 1, 2
• Seek emergency medical evaluation within 1 hour, as timing is critical for post-exposure prophylaxis effectiveness, particularly for HIV where efficacy drops dramatically after 72 hours 3

Source Patient Testing (Immediate Priority)

• Test the source patient for HIV, HBsAg, and anti-HCV as soon as possible with appropriate consent 1, 2, 3
• Use rapid HIV testing to expedite decision-making about post-exposure prophylaxis 2, 3
• Do not test discarded needles or syringes for virus contamination, as results are unreliable 2

Baseline Testing for Exposed Healthcare Worker

• HIV antibody or antigen/antibody combination test 2, 3
• Hepatitis B serology (HBsAg, anti-HBs, anti-HBc) and document vaccination history 1, 2
• Hepatitis C antibody (anti-HCV) and baseline ALT 2, 3
• Pregnancy test for all women of childbearing age whose pregnancy status is unknown 2

Post-Exposure Prophylaxis Initiation (Within 1-2 Hours)

For HIV Exposure:

• Start HIV PEP immediately (ideally within 1 hour, absolutely within 72 hours) even before confirming source patient HIV status if high-risk exposure 3
• Preferred regimen: Bictegravir/emtricitabine/tenofovir alafenamide (single tablet once daily) or dolutegravir plus tenofovir/emtricitabine for 28 days 3
• The risk of HIV transmission from a single needlestick with infected blood is approximately 0.3-0.36%, but PEP reduces this risk by approximately 81% when started promptly 1, 3

For Hepatitis B Exposure:

• If unvaccinated or incompletely vaccinated and source is HBsAg-positive: Administer HBIG (0.06 mL/kg; maximum 5 mL) intramuscularly immediately and begin hepatitis B vaccine series 1, 3
• If previously vaccinated with documented adequate response (anti-HBs >100 IU): No treatment necessary 1, 2
• If vaccination status unknown or inadequate response: Give hepatitis B vaccine booster immediately 1
• The risk of HBV transmission without prophylaxis may exceed 30% after exposure to HBeAg-positive blood 1, 3

For Hepatitis C Exposure:

• No post-exposure prophylaxis is available for hepatitis C 2, 3
• Early identification through testing is the primary approach, with average transmission risk of 1.8% per percutaneous exposure 2, 3

Follow-Up Testing Schedule

• HIV testing: At baseline, 6 weeks, 3 months, and 6 months post-exposure 2, 3
• Hepatitis C testing: HCV RNA at 4-6 weeks (for earlier diagnosis) and anti-HCV plus ALT at 4-6 months 2, 3
• For those receiving PEP: Monitor for drug toxicity with CBC and renal/hepatic function tests every 2 weeks, with evaluation within 72 hours of starting PEP 2, 3

Critical Precautions During Follow-Up Period

• Use barrier protection during sexual activity for 6 months post-exposure 3
• Do not donate blood, plasma, organs, tissue, or semen during the follow-up period 3
• Seek immediate medical evaluation for any acute illness during follow-up, as this may indicate acute retroviral syndrome 2, 3

Common Pitfalls to Avoid

• Delaying wound washing: Must be done immediately, not after reporting or documentation 1, 3, 4
• Recapping needles: Never recap by hand; if necessary, use one-handed technique or mechanical device 4
• Missing the 72-hour window for HIV PEP: Effectiveness diminishes dramatically after this timeframe 3
• Inadequate follow-up: Ensure a system is in place to encourage return for all scheduled follow-up tests 2
• Testing discarded needles: This is not recommended and results are unreliable 2

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