Needlesticks and Sharps Injuries

Management

• Wash affected site with soap and water without scrubbing

• Encourage bleeding

• Reassure patient risk of viral infection is very low

• Obtain information about and blood from the sharps victim and the source person (source of body fluid); ?Hepatitis B and C or HIV +ve

• Consider exposed person’s wishes after discussing risks and benefits of treatment, including adverse effects

Note: It takes up to 3 mths to seroconvert with HIV.

Known Hepatitis B carrier source person If injured person immune—no further action.

If non-vaccinated and non-immune:

• give hyperimmune Hepatitis B gammaglobulin (within 48 h)

• commence course of Hepatitis B vaccination within 24 h

Known Hepatitis C carrier source person Follow-up HCV RNA tests at 4–6 wks and anti-HCV AB and ALT levels at 4–6 mths.

Known HIV-positive source person Refer to consultant about relative merits of drug prophylaxis and serological monitoring.

Options: double or triple antiretroviral prophylaxis within 1–2 h (check with consultant) and then for 28 days.

Unknown risk source person Take source person’s blood (if consent is given) and sharps victim’s blood for Hepatitis B (HBsAg and anti-HBs), Hepatitis C (HCV AB), HIV AB and baseline ALT testing. Begin Hepatitis B vaccination if not vaccinated.

Note: Informed consent for testing and disclosure of test results for involved person should be obtained.