Community Needlestick Injuries
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This guideline pertains to needlestick injuries from discarded needles in the community, usually from an unknown source where the risks of blood-borne virus (BBV) transmission, i.e. Hepatitis B, Hepatitis C and HIV, are very low. Very rarely the source may be known, for example a relative/household member's diabetes needles.
Separate guidelines for management of needlestick injuries in healthcare workers are available via the ADHB intranet, occupational health: http://adhbintranet/OHS/BBFA.htm.
- Local wound care.
- Risk assessment:
- Source of needle/sharp: unknown vs known? Contact Paediatric Infectious Diseases if the source is known to be infected with a blood borne virus (HIV or Hepatitis B).
- Injury nature: superficial vs penetrating?
- Was the needle/sharp visibly contaminated with fresh or old blood?
- Take baseline blood for HIV, HBV and HCV antibody status, and arrange follow-up bloods at 3 months ( or 4-8 weeks after completion of Hep B vaccinations)
- Document the child's immunisation history and /or look up on National immunisation register: Assess need for tetanus and HBV prophylaxis, and initiate as below. Ensure the need for further vaccine doses (if applicable) is documented in the discharge letter to the GP.
- All patients should have an ACC form completed at presentation.
- Counsel family regarding need for these measures
Thoroughly clean with soap and water.
Administer tetanus toxoid +/- tetanus immune globulin (TIG) according to usual guidelines.(see https://www.health.govt.nz/system/files/documents/publications/imm-handbk-19-tetanus-dec16.pdf).
If child unimmunised, hexavalent DTaP-IPV - Hep B/Hib can be used up to and under age 10, and this will provide Hepatitis B immunisation as well.
Hepatitis B Virus (HBV)
HBV is the hardiest pathogen, surviving several days on surfaces, maybe over a week. Commencement or completion of active Hepatitis B immunisation should be initiated as soon as possible after injury (after blood obtained for baseline serology) and preferably within 48 hours. Hepatitis B immunoglobulin (HBIG) is not recommended for community needlestick injuries unless the source is a known Hepatitis B carrier.
|Child unimmunised||Give a dose of Hepatitis B vaccine
- either monovalent Hepatitis B (at any age)
- or hexavalent (especially if infant immunisations have been missed)
Hexavalent vaccines can be used up to and under age 10
Second and third doses should be given by the patient's GP
|Child partially immunised - only 1 prior dose or 2 prior doses but less than 4 months previously||Proceed as for unimmunised, above|
|Child partially immunised - 2 prior doses over 4 months previously||Give one further dose of Hepatitis B vaccine|
|Child fully immunised (documented 3 doses received) or child is known Hepatitis B carrier||No additional Hepatitis B vaccine required|
Hepatitis C Virus (HCV)
HCV viability on surfaces is poor, so risk of transmission from discarded needles is low. No post-exposure prophylaxis known to be effective1.
Human Immunodeficiency Virus (HIV)
This can be the greatest source of anxiety to parents.
The risk of HIV transmission from a needlestick injury from a person with known HIV infection to a healthcare worker is 0.3%. The risk from a discarded needle in the community is much lower because:
- HIV does not survive well outside the body. Drying HIV reduces concentrations by 90-99% within several hours.
- The prevalence of HIV in intravenous drug users in NZ is very low
Therefore post-exposure HIV prophylaxis is not
routinely recommended in this situation where risk is <1 in
If features suggest substantially increased risk (e.g. deep penetrating injury, needle or instrument visibly contaminated with blood), please discuss with the on-call Paediatric Infectious Diseases consultant regarding need for post-exposure prophylaxis (PEP). If required, this should be started as soon as possible, within hours of the injury. HIV testing of the needle/sharp is not practical, safe or reliable and is not recommended.
ACC45 Injury Claim form should be completed by the treating doctor.
- American Academy of Pediatrics Hepatitis B; In Kimberline, D et al eds. Red Book 30th edition; 2015
- ANZPID/ASID PEP HIV prophylaxis
Did you find this information helpful?
- Date last published: 08 January 2017
- Document type: Clinical Guideline
- Services responsible: Paediatric Infectious Diseases
- Author(s): Elizabeth Wilson
- Editor: Greg Williams
- Review frequency: 2 years
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