What is the immediate action and treatment after a needle stick injury during a blood draw?

Immediate Management of Needlestick Injury During Blood Draw

Immediately wash the puncture site thoroughly with soap and water without squeezing or applying pressure to increase bleeding, report the incident to your supervisor within the hour, and seek emergency medical evaluation within 1 hour to initiate HIV post-exposure prophylaxis (PEP) if needed—the sooner PEP starts, the more effective it is, with effectiveness dropping dramatically after 72 hours. 1, 2

Immediate First Aid (Within Minutes)

• Wash the puncture site thoroughly with soap and water without squeezing or applying pressure to increase bleeding 1, 2
• If blood splashed into eyes, nose, or mouth, flush the involved area immediately with clean water or saline 1, 2
• Document the exact time of injury immediately, as timing is critical for PEP eligibility 1, 2

Immediate Reporting and Documentation (Within 1 Hour)

• Report to your supervisor immediately and document the following details: 3, 1, 2

  • Date and time of exposure
  • Type of device involved (gauge of needle)
  • Depth and severity of injury
  • Procedure being performed at time of injury
  • Source patient information (if known)
  • Condition of skin (intact vs non-intact)

• Seek emergency medical evaluation within 1 hour to initiate PEP if needed, as effectiveness drops dramatically after 72 hours 1, 2

Source Patient Testing (Immediate Priority)

The source patient should be tested as soon as possible for: 1, 2, 4

• HIV antibody (rapid testing preferred to expedite PEP decisions)
• Hepatitis B surface antigen (HBsAg)
• Hepatitis C antibody (anti-HCV)

Critical caveat: Do not test discarded needles or syringes for virus contamination—this is not recommended and results are unreliable 4

Baseline Testing for Exposed Healthcare Worker

Before starting any prophylaxis, obtain baseline testing including: 1, 2, 4

• HIV antibody or antigen/antibody combination test
• Hepatitis B serology (document vaccination history and immune status)
• Hepatitis C antibody (anti-HCV)
• Alanine aminotransferase (ALT)
• Pregnancy test for women of childbearing age whose pregnancy status is unknown

HIV Post-Exposure Prophylaxis (PEP) Decision

Start PEP immediately if presentation is within 72 hours, even before confirming the source's HIV status for substantial exposures. 1, 2

Understanding the Risk Context

• The risk of HIV transmission from a percutaneous needlestick with HIV-infected blood is approximately 0.36% (3-4 per 1,000 exposures) 1, 2, 4
• PEP reduces this risk by approximately 81% when started promptly 1, 2

Preferred PEP Regimen

Bictegravir/emtricitabine/tenofovir alafenamide (single tablet once daily) for 28 days 1, 2

Alternative regimen: Dolutegravir plus (tenofovir alafenamide or tenofovir disoproxil fumarate) plus (emtricitabine or lamivudine) 1, 2

Critical caveat: Completing the full 28-day course is essential—stopping early eliminates protection 1, 2

Hepatitis B Management

The approach depends on your vaccination status: 1, 2, 5

If Unvaccinated or Incompletely Vaccinated and Source is HBsAg-Positive:

• Administer Hepatitis B Immune Globulin (HBIG) 0.06 mL/kg intramuscularly as soon as possible, ideally within 24 hours 5
• Begin hepatitis B vaccine series (first dose within 7 days, second and third doses at 1 and 6 months) 5

If Previously Vaccinated with Known Adequate Response:

• No treatment is necessary 1, 2

If Previously Vaccinated with Inadequate or Unknown Antibody Response:

• Test for anti-HBs immediately
• If inadequate antibody, give HBIG (0.06 mL/kg) immediately plus vaccine booster dose 5

Understanding the risk: The risk of HBV transmission without prophylaxis may exceed 30% after exposure to HBeAg-positive blood 3, 4

Hepatitis C Management

No post-exposure prophylaxis exists for hepatitis C—early identification through testing is the primary approach 1, 2, 4

• The risk of HCV transmission is approximately 1.8% (range 0-7%) per percutaneous exposure 2, 4
• Baseline and follow-up testing is essential for early detection

Follow-Up Testing Schedule

For HIV:

• Baseline testing before starting PEP 1, 2, 4
• Follow-up testing at 6 weeks, 3 months, and 6 months post-exposure 1, 2, 4
• Additional testing if illness compatible with acute retroviral syndrome occurs 4

For Hepatitis C:

• Baseline anti-HCV and ALT testing 1, 2, 4
• HCV RNA testing at 4-6 weeks post-exposure for earlier diagnosis 2, 4
• Anti-HCV and ALT testing at 4-6 months post-exposure 2, 4
• Repeatedly reactive anti-HCV enzyme immunoassays should be confirmed with supplemental tests 4

For Hepatitis B (if vaccine given):

• Anti-HBs testing 1-2 months after the last vaccine dose 2, 4
• Note that anti-HBs response to vaccine cannot be accurately determined if HBIG was received in the previous 3-4 months 4

Monitoring During PEP

For those taking antiretroviral PEP: 1, 4

• Evaluate within 72 hours after exposure
• Monitor for drug toxicity every 2 weeks during the 28-day course
• Perform complete blood count and renal/hepatic function tests 4

Precautions During Follow-Up Period (6 Months)

• Use barrier protection during sexual activity 1, 2
• Do not donate blood, plasma, organs, tissue, or semen 1, 2
• Seek immediate medical evaluation for any acute illness, as it may indicate acute retroviral syndrome 1, 2, 4

Common Pitfalls to Avoid

• Never recap needles—this is a major cause of needlestick injuries and should be completely avoided 3
• Do not delay seeking medical evaluation—PEP effectiveness drops dramatically after 72 hours and is most effective within the first hour 1, 2
• Do not test discarded needles—results are unreliable and waste valuable time 4
• Ensure complete follow-up testing—many exposed healthcare workers fail to return for all scheduled tests 4
• Do not stop PEP early—completing the full 28-day course is essential for protection 1, 2