Immunology & Infection: Needle-Stick Injury & Postexposure Prophylaxis

Needle-Stick Injury

Highest Risk Healthcare Workers

  • Nurses #1
  • Surgeons
  • Surgery Technologists
  • Emergency Medical Technicians
  • Laboratory Personnel

Most Common Devices

  • Disposable Syringe (27%)
  • Suture Needle (25%)
  • Scalpel Blade (6%)
  • IV Stylet (3%)
  • Winged Steel Needle (2%)
  • *Hollow-Bore Needles are Higher Risk than Solid Needles

Needle Resheathing/Recapping

  • Historically, Majority of Needle-Stick Injuries were from Resheathing Needles
  • Resheathing No Longer Recommended
  • Not Resheathing, However, Increases Risk for Cleaners & Other Staff

Most Important Organisms

  • Hepatitis B Virus (HBV)
  • Hepatitis C Virus (HCV)
  • Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS)
  • *Hepatitis is Generally Considered the Greater Risk After Needle-Stick than HIV

Seroprevalance in the General Population

  • HBV: 0.42%
  • HCV: 1.8%
  • HIV: 0.31-0.42%

Postexposure Risk of Seroconversion

  • HBV Needlestick: 6-30%
  • HCV Needlestick: 1.8%
  • HIV:
    • Blood Transfusion: 70%
    • Needle Stick: 0.3%
    • Mucous Membrane Exposure: 0.09%

Evaluation

  • Baseline Physical Examination
  • Note Vaccination Status of Healthcare Worker
  • Bloodwork of Source Patient: HIV, HBV & HCV
  • Bloodwork of Healthcare Worker: CBC, Electrolytes, LFT’s, HIV, HBV & HCV

Postexposure Prophylaxis (PEP)

HBV Postexposure Prophylaxis

  • Vaccinated with Complete Response: Nothing
  • Otherwise:
    • HBIG if Source Patient Positive/Unknown
    • Vaccinate if Unvaccinated/Incompletely Vaccinated

HCV Postexposure Prophylaxis

  • No Effective Postexposure Prophylaxis
  • Further Testing:
    • If Source Patient HCV Negative: Nothing
    • If Source Patient HCV Positive/Unknown: Test at 4-6 Months

HIV Postexposure Prophylaxis

  • Indications for PEP:
    • Source Patient HIV Positive
    • Source Patient HIV Unknown While Awaiting Testing
    • Source Patient Cannot Be Identified & A High-Risk Setting
  • Generally Consists of a 3-Drug Regimen for 4-Weeks