Needlestick injuries

Recognition of the potential risk of breach of skin integrity (HIV, hep B)

  • 0.3% for percutaneous exposure to HIV-infected blood.
  • 0.1% for mucocutaneous exposure to HIV-infected blood.
  • 0.5-1.8% for percutaneous exposure to HCV-infected blood with detectable RNA.
  • 30% for percutaneous exposure of a non-immune individual to an HBeAg positive source.

risk assessment

higher risk fluids (ew.)

  • blood
  • Internal body fluids
  • Semen/vaginal secretions
  • Saliva (as for dentists)

higher risk injuries

Any injury that breaks the skin is significant.

  • Splash exposure to broken skin, abrasions, wounds, eczema etc.
  • Splash exposure to mucous membranes, most commonly the eye.

But these carry higher risk:

  • deep injury
  • visible blood on device that caused injury
  • injury with needle that has been placed in donor's artery/vein
  • Terminal HIV-related illness in the source.
    (Source: Culver et al 1997...)

higher risk source patient

  • Obv if they have previous results for HIV, hepatitis C, or hepatitis B then it's higher risk

The following factors would place the source in a high risk category:

  • Intravenous drug user.
  • Sex industry worker.
  • Originally from sub-Saharan Africa.
  • Regularly has unprotected sex with any of the above.
  • If the source is a child, they are high risk if their mother has HIV.
  • The source has, or is under investigation for, an AIDS defining illness.

clinical

  • bleed, wash, dress
  • occupational health - but often will refer to ED out of hours
  • obtain donor serology:
    • HbSAg, HCV antibody, HIV antibody
    • the source patient should not be approached by the healthcare worker who was exposed!
  • assess high vs low risk exposure (see above)
  • PEP
  • discharge advice:
    • barrier contraception
    • avoid sharing razors/toothbrushes
    • do not donate blood until results are back
    • exposure prone procedures → can continue doing with normal PPE
    • contact local occupational health if via work, or via ???
      • GP vs sexual health service? - need to know local arrangement

#infectious-diseases #pathology

https://litfl.com/osce-needlestick-injury/
https://www.hse.gov.uk/healthservices/needlesticks/index.htm
https://www.rcemlearning.co.uk/modules/needlestick-injury/lessons/management-healthcare-workers/topic/hepatitis-b-post-exposure-prophylaxis/
https://www.rcemlearning.co.uk/modules/needlestick-injury/lessons/management-healthcare-workers/topic/hiv-post-exposure-prophylaxis/
See also BASHH
Cardo DM, Culver DH, Ciesielski CA, et al. A Case–Control Study of HIV Seroconversion in Health Care Workers after Percutaneous Exposure. N Engl J Med 1997; 337(21):1485-1490.