What should I do after sustaining a needle‑stick injury, including wound cleaning, reporting, baseline testing, and appropriate post‑exposure prophylaxis for HIV, hepatitis B, hepatitis C, and tetanus?

Needle-Stick Injury Management

Immediately wash the wound with soap and water, then initiate a systematic evaluation for HIV, hepatitis B, hepatitis C, and tetanus prophylaxis based on source patient testing and your vaccination history. 1

Immediate Wound Care (First 5 Minutes)

• Wash the puncture site thoroughly with soap and water – this is the single most critical step to reduce pathogen load and prevent transmission. 1, 2
• Do not squeeze or manipulate the wound, as this may increase tissue damage without proven benefit. 1
• If the injury involved mucous membrane exposure (splash to eyes, nose, mouth), flush immediately with water or saline. 1, 2

Source Patient Evaluation (Within 1-2 Hours)

• Test the source patient for HBsAg, anti-HCV, and HIV antibody as soon as possible – use rapid HIV testing when available to expedite decision-making. 1
• If the source patient is unknown or refuses testing, assess the epidemiologic risk of exposure to bloodborne pathogens based on the clinical setting. 1
• Do not test discarded needles or syringes for virus contamination – this is unreliable and should never guide management decisions. 1

HIV Post-Exposure Prophylaxis (Within 2 Hours, Ideally)

HIV PEP should be initiated as soon as possible after percutaneous exposure to blood from a known or suspected HIV-positive source, ideally within 2 hours and no later than 72 hours. 1

Basic PEP Regimen:

• Zidovudine (ZDV) 600 mg daily in 2-3 divided doses + Lamivudine (3TC) 150 mg twice daily (available as single-tablet Combivir twice daily). 1
• This regimen is associated with decreased HIV transmission risk in occupational exposures and is considered safe in pregnancy. 1
• Common side effects include nausea and fatigue, manageable with antiemetics and antimotility agents. 1

Critical Timing:

• Do not delay PEP administration waiting for source patient HIV test results – start immediately if exposure risk warrants it. 1
• PEP should be continued for 28 days if initiated. 1
• Evaluate the exposed person within 72 hours of starting PEP and monitor for drug toxicity for at least 2 weeks. 1

Follow-up HIV Testing:

• Perform HIV antibody testing at baseline, 6 weeks, 3 months, and 6 months post-exposure. 1
• Test immediately if any illness compatible with acute retroviral syndrome develops (fever, rash, lymphadenopathy). 1
• Advise precautions to prevent secondary transmission during the 6-month follow-up period. 1

Hepatitis B Prophylaxis (Within 24 Hours)

Your management depends entirely on your hepatitis B vaccination status and the source patient's HBsAg status. 1, 2

If You Are Unvaccinated or Incompletely Vaccinated:

• Administer hepatitis B immune globulin (HBIG) within 24 hours if the source is HBsAg-positive or unknown (can be given up to 7 days post-exposure, but earlier is better). 2
• Begin the hepatitis B vaccine series immediately. 2

If You Are Fully Vaccinated with Known Adequate Response (anti-HBs ≥10 mIU/mL):

• No treatment is needed regardless of source status. 1

If You Are Fully Vaccinated with Unknown Response or Known Non-Response:

• Test your anti-HBs level immediately. 1
• If anti-HBs is inadequate (<10 mIU/mL) and source is HBsAg-positive: give HBIG + vaccine booster. 1

Follow-up:

• Test for anti-HBs 1-2 months after the last vaccine dose to confirm response. 1
• Anti-HBs response cannot be accurately assessed if HBIG was given within the previous 3-4 months. 1

Hepatitis C Management

No post-exposure prophylaxis exists for hepatitis C – management focuses on early detection. 1, 2

Baseline and Follow-up Testing:

• Obtain baseline anti-HCV and ALT (liver enzyme) levels immediately. 1, 2
• Repeat anti-HCV and ALT testing at 4-6 months post-exposure. 1, 2
• If earlier diagnosis is desired, perform HCV RNA testing at 4-6 weeks (detects infection before antibody development). 1, 2
• Confirm any repeatedly reactive anti-HCV enzyme immunoassays with supplemental testing. 1

Tetanus Prophylaxis

Needle-stick injuries are tetanus-prone wounds requiring evaluation of your tetanus vaccination history. 1

If Last Tetanus Booster Was ≥5 Years Ago:

• Administer Tdap immediately (or Td if Tdap is unavailable). 1
• Tdap is preferred over Td for adults who have not previously received it. 1

If Last Tetanus Booster Was <5 Years Ago:

• No tetanus prophylaxis is needed for a clean needle-stick. 1

If Vaccination History Is Unknown or <3 Lifetime Doses:

• Administer both tetanus toxoid-containing vaccine AND tetanus immune globulin (TIG) 250 units IM at separate anatomic sites. 1, 3

Critical Consideration:

• Proper wound care and debridement are essential components of tetanus prevention regardless of vaccination status. 1, 3

Documentation and Reporting

• Document the exposure details: date, time, type of needle, depth of injury, amount of blood visible, and source patient information. 1, 2
• Report the incident to your occupational health service or designated exposure management team immediately. 1
• Ensure appropriate follow-up appointments are scheduled before leaving the emergency department or occupational health clinic. 1

Common Pitfalls to Avoid

• Never delay HIV PEP waiting for source testing – every hour counts, and PEP efficacy decreases significantly after 72 hours. 1
• Never assume you are immune to hepatitis B without documented anti-HBs levels – up to 40% of adults over 60 lack protective antibody levels. 3
• Never skip hepatitis C follow-up testing – early detection allows for highly effective antiviral treatment before chronic infection develops. 1, 2
• Never test discarded needles for bloodborne pathogens – this is explicitly not recommended and provides unreliable information. 1