What are the implications of a percutaneous injury, specifically a needle stick injury (NSI), in a healthcare setting?

From the Guidelines

A needle stick injury is a serious issue because it can expose healthcare workers or others to bloodborne pathogens that may cause life-threatening infections, with a risk of HBV infection after a needlestick injury involving an HBV-positive source being 23%--62% 1.

Key Considerations

When a contaminated needle punctures the skin, pathogens like HIV, Hepatitis B, and Hepatitis C can be transmitted from the source patient to the injured person.

• Immediate action is essential following a needle stick injury, including washing the wound thoroughly with soap and water and reporting the incident to a supervisor and seeking medical evaluation promptly.
• Post-exposure prophylaxis (PEP) may be necessary depending on the source patient's infection status, with guidelines for management of potential occupational exposure to bloodborne pathogens outlined in the literature 1.

Management and Prevention

For HIV exposure, medications like tenofovir/emtricitabine plus dolutegravir should be started within 72 hours (ideally within 2 hours) and continued for 28 days.

• For Hepatitis B exposure in non-immune individuals, Hepatitis B immune globulin and vaccination may be recommended, with the specific steps for hepatitis B prophylaxis after percutaneous or permucosal exposure outlined in the literature 1.
• Blood tests should be conducted at baseline and at regular intervals (6 weeks, 3 months, and 6 months) to monitor for potential infections.
• Needle stick injuries are preventable through proper handling and disposal of sharps, using safety-engineered devices, following standard precautions, and maintaining awareness during procedures involving needles.

Important Steps

The following steps should be taken after a needle stick injury:

• Wash the wound thoroughly with soap and water
• Report the incident to a supervisor and seek medical evaluation promptly
• Determine the status of the source patient and the immunity of the employee
• Follow established policies for management of an exposure, including post-exposure prophylaxis (PEP) if necessary
• Educate the exposed person regarding risks of exposure, safe handling of sharps, immunization, standard precautions, and safe work habits.

From the FDA Drug Label

Acute Exposure to Blood Containing HBsAg After either parenteral exposure, e.g., by accidental “needlestick” or direct mucous membrane contact (accidental splash), or oral ingestion (pipetting accident) involving HBsAg-positive materials such as blood, plasma or serum For inadvertent percutaneous exposure, a regimen of two doses of Hepatitis B Immune Globulin (Human), one given after exposure and one a month later, is about 75% effective in preventing hepatitis B in this setting.

A needle stick injury is an issue because it can lead to parenteral exposure to blood containing HBsAg, which can result in hepatitis B infection. The risk of infection is significant, and prompt treatment with Hepatitis B Immune Globulin (Human) and hepatitis B vaccine is necessary to prevent the infection. The effectiveness of the treatment is about 75% in preventing hepatitis B in the setting of percutaneous exposure 2.

• Key points:
  • Needle stick injury can lead to parenteral exposure to HBsAg-positive blood
  • Prompt treatment with Hepatitis B Immune Globulin (Human) and hepatitis B vaccine is necessary
  • Effectiveness of treatment is about 75% in preventing hepatitis B infection 2

From the Research

Overview of Needle Stick Injuries

• Needle stick injuries are a significant concern in the healthcare industry due to the risk of transmission of blood-borne pathogens such as hepatitis B and C viruses and HIV 3, 4.
• These injuries are considered to be widely underreported, with estimates suggesting that between 600,000 and 1 million needle sticks and other sharps injuries occur every year in the United States alone 4.

Risks Associated with Needle Stick Injuries

• The most common cause of healthcare work-related exposure to bloodborne pathogens is through needle sticks, accounting for 80% of blood contacts 4.
• More than 20 pathogens can be transmitted through small amounts of blood, including HIV, hepatitis B and C, and other forms of hepatitis 4.
• Hepatitis B is the most common infectious disease transmitted through work-related exposure to blood, with 5,100 healthcare workers becoming infected each year in the United States 4.

Prevention and Costs

• Research shows that 83% of needle stick injuries can be prevented through the use of needles with safety features or needleless systems 4.
• The cost of follow-up for a high-risk exposure can be almost $3,000 per needle stick injury, even when no infection occurs 4.
• Safe needle devices cost about 28 cents more than standard devices, highlighting the need for healthcare facilities to invest in preventive measures 4.

Legislative Progress and Implementation

• The Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens Standard has contributed to a decline in needlestick injuries in the United States, from an estimated one million exposures per year in 1996 to 385,000 per year in 2000 5.
• The use of safer needle devices, sharps collection boxes, gloves, and personal protective gear, as well as universal precautions, has been instrumental in reducing the risk of needle stick injuries 5.