What bloodwork is needed after a healthcare provider gets stuck by a contaminated needle?

Bloodwork After Needlestick Injury

Immediately obtain baseline testing for HIV antibody, hepatitis B serology (HBsAg and anti-HBs), and hepatitis C antibody (anti-HCV) from both the exposed healthcare worker and the source patient, with follow-up testing at 6 weeks, 3 months, and 6 months for HIV, and at 4-6 months for HCV. 1

Immediate Baseline Testing (Day 0)

For the Exposed Healthcare Worker:

• HIV antibody test (rapid testing preferred to expedite PEP decisions) 1, 2
• Hepatitis B serology: HBsAg and anti-HBs to document immune status 1
• Hepatitis C antibody (anti-HCV) 1
• Alanine aminotransferase (ALT) baseline 3, 1
• Pregnancy test for all non-pregnant women of childbearing age with unknown pregnancy status 3, 1

For the Source Patient:

• HIV antibody test (rapid testing if available) 1, 2
• Hepatitis B surface antigen (HBsAg) 1, 2
• Hepatitis C antibody (anti-HCV) 1, 2

Critical caveat: Never test the discarded needle itself—this is unreliable and not recommended 1, 2. Always attempt to test the source patient directly.

Follow-Up Testing Schedule

HIV Monitoring:

• 6 weeks post-exposure: HIV antibody testing 3, 1
• 3 months post-exposure: HIV antibody testing 3, 1
• 6 months post-exposure: HIV antibody testing 3, 1
• Additional testing if any illness compatible with acute retroviral syndrome occurs during follow-up 1

Hepatitis C Monitoring:

• 4-6 weeks post-exposure: Consider HCV RNA testing if earlier diagnosis is desired 1, 2
• 4-6 months post-exposure: Anti-HCV antibody and ALT testing 3, 1
• Confirmatory testing: Use supplemental tests (such as RIBA) for repeatedly reactive anti-HCV enzyme immunoassays 1

Hepatitis B Monitoring:

• 1-2 months after last vaccine dose: Anti-HBs testing for those who received hepatitis B vaccine (note: cannot be accurately determined if HBIG was received in the previous 3-4 months) 1
• 6 months post-exposure: HBsAg and anti-HBs if the exposed person was not previously documented to be anti-HBs-positive 3

Additional Monitoring If PEP Is Initiated

If HIV post-exposure prophylaxis is started:

• Baseline labs: Complete blood count, renal function tests, hepatic function tests 3, 1
• Every 2 weeks during PEP: Monitor for drug toxicity with repeat CBC and renal/hepatic function tests 1, 2
• Within 72 hours of exposure: Clinical evaluation for adherence and toxicity assessment 3, 1

Understanding the Risk Context

The actual transmission risks help contextualize the urgency of testing:

• HIV: Approximately 0.3-0.36% per percutaneous exposure to infected blood 1, 2
• Hepatitis C: Average 1.8% (range 0-7%) per percutaneous exposure 1, 2
• Hepatitis B: May exceed 30% without prophylaxis if source is HBeAg-positive 1, 2

Common Pitfalls to Avoid

Failing to test the source patient: This is critical for risk assessment and management decisions—always attempt to identify and test the source 1. If the source is unknown, assess the epidemiologic risk based on where the exposure occurred (e.g., higher risk in areas with high HIV/HCV prevalence) 3.

Inadequate follow-up: Ensure a system is in place to encourage exposed healthcare workers to return for all scheduled follow-up tests, as many infections may not be detectable immediately 1. The exposed worker should seek immediate medical evaluation for any acute illness during the 6-month follow-up period 3, 2.

Delayed documentation: Document all exposure details immediately, including date, time, type of device, severity of exposure, and source patient information, as this affects management decisions 1, 2.