What should I do if I experience a needle stick injury at work as a healthcare worker?

What to Do After a Needlestick Injury at Work

Immediately wash the puncture site thoroughly with soap and water without squeezing or applying pressure, report to your supervisor within 1 hour, and seek emergency medical evaluation within 1 hour to initiate HIV post-exposure prophylaxis (PEP) if needed—effectiveness drops dramatically after 72 hours. 1, 2, 3

Immediate First Aid (Within Minutes)

• Wash the puncture site with soap and water immediately without squeezing or applying pressure to increase bleeding 1, 2, 3
• If blood splashed into eyes, nose, or mouth, flush the area immediately with clean water or saline 1, 2
• Do not recap, bend, or break the needle after injury 4, 2
• Document the exact time of injury immediately—timing is critical for determining PEP eligibility 1, 2

Report and Document (Within 1 Hour)

• Report to your supervisor immediately and document the date, time, type of device involved, depth of injury, source patient details, and condition of your skin (intact vs. non-intact) 1, 2, 3
• Seek emergency medical evaluation within 1 hour—this is essential because PEP must be started as soon as possible, ideally within the first hour and absolutely within 72 hours 1, 2, 3

Source Patient Testing (Immediate)

Your facility should obtain rapid testing of the source patient for: 1, 2, 3

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

HIV Post-Exposure Prophylaxis Decision

Start PEP immediately if presentation is within 72 hours, even before confirming the source's HIV status for substantial exposures. 1, 2, 3

Why PEP Matters:

• 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, 3
• PEP reduces this risk by approximately 81% when started promptly 1, 2, 3
• Effectiveness drops dramatically after 72 hours, so time is critical 1, 2, 3

Preferred PEP Regimen:

• Bictegravir/emtricitabine/tenofovir alafenamide (single tablet once daily) for 28 days 1, 2, 3
• Alternative: Dolutegravir plus (tenofovir alafenamide or tenofovir disoproxil fumarate) plus (emtricitabine or lamivudine) 1, 2
• Completing the full 28-day course is essential—stopping early eliminates protection 1, 2, 3

Hepatitis B Management

If you are unvaccinated or incompletely vaccinated and the source is HBsAg-positive: 1, 2, 5

• Administer Hepatitis B Immune Globulin (HBIG) 0.06 mL/kg intramuscularly as soon as possible, ideally within 24 hours 2, 5
• Begin the hepatitis B vaccine series immediately 1, 2, 5
• This regimen is 85-95% effective in preventing HBV infection 5
• The risk of HBV transmission without prophylaxis can exceed 30% after exposure to HBeAg-positive blood 4, 2, 3

If you are previously vaccinated with known adequate antibody response (>100 IU): 4

• No treatment is necessary 1

Hepatitis C Management

• No post-exposure prophylaxis exists for hepatitis C—early identification through testing is the primary approach 1, 2, 3
• The risk of HCV transmission is approximately 1.8% (range 0-7%) per percutaneous exposure 1, 2

Your Baseline Testing (Before Starting PEP)

You should have baseline testing for: 2, 3

• HIV antibody or antigen/antibody combination test
• Hepatitis B serology
• Hepatitis C antibody (anti-HCV)
• Alanine aminotransferase (ALT)
• Pregnancy test if applicable

Follow-Up Testing Schedule

For HIV: 1, 2, 3

• Testing at 6 weeks, 3 months, and 6 months post-exposure

For Hepatitis C: 1, 2, 3

• Baseline anti-HCV and ALT testing
• Follow-up testing at 4-6 weeks and 4-6 months post-exposure
• Consider HCV RNA at 4-6 weeks for earlier diagnosis

For Hepatitis B (if you received vaccine): 1

• Anti-HBs testing 1-2 months after the last vaccine dose

During PEP: 2, 3

• Monitor for drug toxicity every 2 weeks during the 28-day course
• Perform complete blood count and renal/hepatic function tests

Precautions During the 6-Month Follow-Up Period

• Use barrier protection during sexual activity 1, 2, 3
• Do not donate blood, plasma, organs, tissue, or semen 1, 2, 3
• Seek immediate medical evaluation for any acute illness—this may indicate acute retroviral syndrome 1, 2, 3

Common Pitfalls to Avoid

• Never squeeze or apply pressure to increase bleeding—this does not reduce infection risk and may cause harm 1, 2, 3
• Never delay seeking medical evaluation—waiting beyond 72 hours dramatically reduces PEP effectiveness 1, 2, 3
• Never stop PEP early—incomplete courses eliminate protection 1, 2, 3
• Never recap needles—this is a leading cause of needlestick injuries 4, 2