What is the immediate course of action for a lab worker who experiences an accidental needle stick injury?

Immediate Management of Accidental Needle Stick Injury in Laboratory Workers

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

Immediate First Aid (Within Minutes)

• Wash the wound thoroughly with soap and water for at least 1 minute using a scrubbing motion—do not squeeze or apply pressure to make it bleed more, as this causes tissue damage without proven benefit. 1, 3
• If blood splashed into eyes, nose, or mouth, flush immediately with clean water, saline, or sterile irrigants. 4, 2, 3
• Do not use bleach, hydrogen peroxide, or other caustic agents on the wound—these damage tissue without reducing transmission risk. 3
• After washing, apply 70% alcohol and/or 10% povidone iodine using a circular rubbing motion, allowing 2-3 minutes for full bacteriostatic action. 3
• Never recap, bend, or break the needle after injury. 4, 2

Immediate Reporting and Documentation (Within 1 Hour)

• Report to your supervisor immediately—timing is critical for determining PEP eligibility. 1, 2
• Document immediately: exact time of injury, date, type of device involved, depth of injury, whether blood was visible, body fluid involved, source patient details (if known), and condition of your skin (intact vs. non-intact). 4, 1, 3
• Seek emergency medical evaluation within 1 hour—this is essential because HIV PEP must be started as soon as possible, ideally within the first hour and absolutely within 72 hours. 1, 2

Source Patient and Baseline Testing (Within Hours)

• Identify and test the source patient for HIV antibody, hepatitis B surface antigen (HBsAg), and hepatitis C antibody (anti-HCV) with appropriate consent as soon as possible. 4, 2, 3
• Draw baseline blood from yourself for HBsAg, anti-HBs (hepatitis B antibody), hepatitis C antibody, and HIV antibody with consent—this should occur within hours of injury. 2, 3
• If the source patient cannot be identified or tested, treat as high-risk exposure and proceed with prophylaxis based on local epidemiology. 3

HIV Post-Exposure Prophylaxis (Start Within 1-2 Hours, No Later Than 72 Hours)

• Start HIV PEP immediately if presentation is within 72 hours, even before confirming the source's HIV status for substantial exposures. 1, 2
• 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, 2
• PEP effectiveness drops dramatically after 72 hours—time is absolutely critical. 1, 2
• The preferred PEP regimen is bictegravir/emtricitabine/tenofovir alafenamide (single tablet once daily) for 28 days. 1, 2
• Complete the full 28-day course—stopping early eliminates protection. 1, 2

Hepatitis B Management (Within 24 Hours)

• 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. 1, 2, 3
• Begin the hepatitis B vaccine series immediately if unvaccinated. 1, 2, 3
• The risk of HBV transmission without prophylaxis can exceed 30% after exposure to HBeAg-positive blood—this is dramatically higher than HIV risk. 1, 2
• If you are vaccinated with known adequate antibody levels (anti-HBs >10 mIU/mL): No treatment needed. 1, 3

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
• If HCV seroconversion occurs, refer immediately to a hepatology specialist for evaluation of early antiviral therapy, as treatment may be beneficial when started early in acute HCV infection. 1

Follow-Up Testing Schedule

• For HIV: Testing at 6 weeks, 3 months, and 6 months post-exposure. 1, 2, 3
• For Hepatitis C: Baseline anti-HCV and ALT testing, then follow-up testing at 4-6 weeks and 4-6 months post-exposure. 1, 2, 3
• For Hepatitis B (if you received vaccine): Anti-HBs testing 1-2 months after the last vaccine dose. 1, 3
• Monitor for drug toxicity every 2 weeks during the 28-day course of HIV PEP with complete blood count and renal/hepatic function tests. 2

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—this may indicate acute retroviral syndrome. 1, 2

Critical Pitfalls to Avoid

• Do not delay seeking medical evaluation—the 1-hour window for optimal HIV PEP initiation is critical, and the 72-hour absolute deadline cannot be missed. 1, 2
• Do not squeeze the wound or apply pressure to increase bleeding—this is not evidence-based and may cause additional tissue damage. 1, 3
• Do not recap needles—this causes 8.5% of injuries and should never be done. 3, 5
• Do not stop HIV PEP early—completing the full 28-day course is essential for protection. 1, 2
• Do not assume low risk based on source patient appearance—92 of 449 index patients (one in five) in one study was infected with at least one blood-borne pathogen. 6