II. Background
- Needlestick related transmission risks (if source positive)
- Hepatitis B: 6% (up to 25-30% if HBeAg positive)
- Hepatitis C: 1.8% on average (up to 7% in some studies)
- HIV: 0.3% (up to 0.5% in some studies)
III. Step 1: Initial Management
- Wash wounds with copious soap and water
- Flush exposed mucous membranes with water
IV. Step 2: Evaluate Source of Exposure
- Avoid testing discarded needles or syringes
- Test known source
- Hepatitis B Surface Antigen
- Hepatitis C Virus Antibody
- HIV Test
- Rapid HIV Testing is available at many centers
- Some centers will also test p24 Antigen (identifies early HIV Infection)
- Liver Function Tests
- Assess risk of exposure if source unknown
- Hepatitis B Risk
V. Step 3: Evaluate Exposed Patient
- Assess Hepatitis B Immune Status
- Prior Vaccination
- Vaccine response
- Initial labs
- Follow-up labs
- Anti-HCV RNA
- Consider testing at 2, 4 and 8 weeks after exposure
- Repeat at 4-6 months after exposure
- HIV Test
- Repeat at 6 months after exposure
- Anti-HCV RNA
VI. Step 4: Management of the exposed patient
- Postexposure Prophylaxis
- Prevent transmission of possible infections
- Use protection from Sexually Transmitted Disease
- Consider Immunization of close contacts
VII. Prevention: Pre-exposure
- Healthcare workers should be immunized with Hepatitis B Vaccine
- Use retractable syringe needles and have readily available sharps containers
- Avoid re-capping needles
VIII. References
- Orman and Moran in Herbert (2016) EM:Rap 16(4):16-7
- Moran (2000) Ann Emerg Med 35(1):47-62 [PubMed]
- (2001) Am Fam Physician 64(12):2012-14 [PubMed]