II. Background

  1. Needlestick related transmission risks (if source positive)
    1. Hepatitis B: 6% (up to 25-30% if HBeAg positive)
    2. Hepatitis C: 1.8% on average (up to 7% in some studies)
    3. HIV: 0.3% (up to 0.5% in some studies)

III. Step 1: Initial Management

  1. Wash wounds with copious soap and water
  2. Flush exposed mucous membranes with water

IV. Step 2: Evaluate Source of Exposure

  1. Avoid testing discarded needles or syringes
  2. Test known source
    1. Hepatitis B Surface Antigen
    2. Hepatitis C Virus Antibody
    3. HIV Test
      1. Rapid HIV Testing is available at many centers
      2. Some centers will also test p24 antigen (identifies early HIV Infection)
    4. Liver Function Tests
      1. Aspartate Aminotransferase
      2. Alanine Aminotransferase
      3. Alkaline Phosphatase
  3. Assess risk of exposure if source unknown
    1. Hepatitis B Risk

V. Step 3: Evaluate Exposed Patient

  1. Assess Hepatitis B Immune Status
    1. Prior Vaccination
    2. Vaccine response
  2. Initial labs
    1. Anti-HCV RNA
    2. Hepatitis B Surface Antibody
    3. Hepatitis B Surface Antigen
    4. HIV Test
    5. See labs specific to HIV Postexposure Prophylaxis
  3. Follow-up labs
    1. Anti-HCV RNA
      1. Consider testing at 2, 4 and 8 weeks after exposure
      2. Repeat at 4-6 months after exposure
    2. HIV Test
      1. Repeat at 6 months after exposure

VI. Step 4: Management of the exposed patient

  1. Postexposure Prophylaxis
    1. See HIV Postexposure Prophylaxis
    2. See Hepatitis B Postexposure Prophylaxis
  2. Prevent transmission of possible infections
    1. Use protection from Sexually Transmitted Disease
    2. Consider Immunization of close contacts

VII. Prevention: Pre-exposure

  1. Healthcare workers should be immunized with Hepatitis B Vaccine
  2. Use retractable syringe needles and have readily available sharps containers
  3. Avoid re-capping needles

VIII. References

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Ontology: Needlestick Injuries (C0085178)

Definition (MSH) Penetrating stab wounds caused by needles. They are of special concern to health care workers since such injuries put them at risk for developing infectious disease.
Concepts Injury or Poisoning (T037)
MSH D016602
SnomedCT 283596007
LNC LA7323-4
English Injuries, Needle-Stick, Injuries, Needlestick, Injury, Needle-Stick, Injury, Needlestick, Needle Stick Injuries, Needle Sticks, Needle-Stick, Needle-Stick Injuries, Needle-Stick Injury, Needle-Sticks, Needlestick, Needlestick Injuries, Needlestick Injury, Needlesticks, NEEDLESTICK INJ, INJ NEEDLESTICK, Needlestick Injuries [Disease/Finding], needle stick injuries, needle-stick, needlestick injury, needle stick, needlestick injuries, Injury;needle stick, needle sticks, needle-stick injuries, needle-stick injury, needlestick, needlesticks, Needlestick injuries, Needle stick, Needle prick injury, Needle stick injury, Needle stick injury (disorder), needle stick injury
French Blessures par piqûre d'aiguille, Lésions post-traumatiques accidentelles dues à une piqûre d'aiguille, Piqûres d'aiguille, Traumatismes accidentels dus à une piqûre d'aiguille, Plaies par instrument piquant
Swedish Nålsticksskador
Czech poranění bodné jehlou, zranění injekční stříkačkou
Finnish Neulanpistovammat
Russian RANY PRONIKAIUSHCHIE, IGLOI, TRAVMY MEDRABOTNIKOV OT IN"EKTSIONNOI IGLY, РАНЫ ПРОНИКАЮЩИЕ, ИГЛОЙ, ТРАВМЫ МЕДРАБОТНИКОВ ОТ ИНЪЕКЦИОННОЙ ИГЛЫ
Polish Przypadkowe zranienie igłą, Zakłucie się igłą, Zranienia igłą
Japanese 注射針刺傷(チュウシャシンシショウ), 注射針刺傷
Norwegian Nålestikkskader, Sprøytestikkskader, Nålestikk
Portuguese Traumatismos Penetrantes Produzidos por Agulha, Ferimentos Penetrantes Produzidos por Agulha
Spanish lesión por pinchazo con aguja (trastorno), lesión por pinchazo con aguja, Lesiones por Pinchazo de Aguja
German Injektionsnadelverletzungen, Stichverletzungen, Injektionsnadel-, Verletzungen, Injektionsnadel-
Italian Ferite da aghi
Dutch Accident, prik-, Accidenten, prik-, Prikaccident, Prikaccidenten

Ontology: Blood borne transmission (C1636665)

Definition (HL7V3.0) <p>Communication of an agent to a living subject through direct contact with blood or blood products whether the contact with blood is part of a therapeutic procedure or not.</p>
Concepts Functional Concept (T169)
SnomedCT 420014008
HL7 BLDTRNS
Spanish transmisión sanguínea (calificador), transmisión sanguínea
English blood borne transmission, Blood borne transmission (qualifier value), Blood borne transmission, Bloodborne transmission