What are the immediate steps to take after an accidental needle poke with a potentially contaminated needle in a healthcare setting?

Immediate Management of Accidental Needlestick Injury

Immediately wash the puncture site thoroughly with soap and water without squeezing or applying pressure to increase bleeding, then report the incident to your supervisor within 1 hour and seek emergency medical evaluation to initiate HIV post-exposure prophylaxis (PEP) within 72 hours—ideally within the first hour—as effectiveness drops dramatically after this window. 1

First Aid at the Point of Injury

• Wash the wound immediately with soap and water for at least 30 seconds without squeezing, rubbing, or applying pressure to increase bleeding 1
• If blood splashes into eyes, nose, or mouth, flush the involved area immediately with clean water, saline, or sterile irrigants 1
• Do not recap, bend, or break the contaminated needle after injury 1
• Document the exact time of injury immediately, as timing is critical for PEP eligibility 1

Immediate Reporting and Source Patient Assessment

• Report the incident to your supervisor within 1 hour of the injury occurring 1
• Identify the source patient if possible and arrange immediate testing for HIV antibody, hepatitis B surface antigen (HBsAg), and hepatitis C antibody (anti-HCV) 1
• The source patient testing should occur as soon as possible, even while you are being evaluated 1

HIV Post-Exposure Prophylaxis (PEP)

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

• The preferred regimen is bictegravir/emtricitabine/tenofovir alafenamide (single tablet once daily) for 28 days 1
• The risk of HIV transmission from a percutaneous needlestick with HIV-infected blood is approximately 0.36% (3-4 per 1,000 exposures), and PEP reduces this risk by approximately 81% when started promptly 1
• Completing the full 28-day course is essential—stopping early eliminates protection 1
• PEP effectiveness drops dramatically after 72 hours, making the first hour critical 1

Hepatitis B Prophylaxis

If you are unvaccinated or incompletely vaccinated and the source is HBsAg-positive, administer hepatitis B immune globulin (HBIG) 0.06 mL/kg intramuscularly as soon as possible, ideally within 24 hours, and begin the hepatitis B vaccine series. 1, 2

• The risk of HBV transmission without prophylaxis may exceed 30% after exposure to HBeAg-positive blood 1
• A regimen combining HBIG with hepatitis B vaccine is about 75% effective in preventing hepatitis B after needlestick exposure 2
• HBIG provides immediate short-term protection while the vaccine series provides long-term immunity 2

Hepatitis C Management

• No post-exposure prophylaxis exists for hepatitis C—early identification through testing is the primary approach 1
• The risk of HCV transmission is approximately 1.8% (range 0-7%) per percutaneous exposure 1
• Baseline testing should be performed immediately, with follow-up at 4-6 weeks and 4-6 months post-exposure 1

Baseline and Follow-Up Testing

Obtain baseline testing before starting any prophylaxis: 1

• HIV antibody or antigen/antibody combination test
• Hepatitis B serology
• Hepatitis C antibody
• Alanine aminotransferase (ALT)

Follow-up testing schedule: 1

• HIV testing at 6 weeks, 3 months, and 6 months post-exposure
• Hepatitis C testing at 4-6 weeks and 4-6 months post-exposure
• Monitor for drug toxicity every 2 weeks during the 28-day PEP course with complete blood count and renal/hepatic function tests

Precautions During the Follow-Up Period

During the 6-month follow-up period: 1

• Use barrier protection during sexual activity
• Do not donate blood, plasma, organs, tissue, or semen
• Seek immediate medical evaluation for any acute illness, as this may represent acute HIV or hepatitis infection

Critical Pitfalls to Avoid

• Never delay seeking medical evaluation—the first hour is critical for initiating PEP, and effectiveness drops dramatically after 72 hours 1
• Never squeeze or apply pressure to increase bleeding at the puncture site, as this does not reduce infection risk and may cause additional tissue damage 1
• Never recap the contaminated needle after injury, as this creates additional exposure risk 3, 1
• Never stop PEP early—incomplete courses eliminate protection against HIV 1
• Needlestick injuries are widely underreported; always report even seemingly minor exposures, as more than 20 pathogens can be transmitted through small amounts of blood 4