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Needlestick Injuries

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Guidelines for management of needlestick injuries in healthcare workers are available1 via the ADHB intranet, occupational health. This document pertains to needlestick injuries from discarded needles in the community, from an unknown source: the risks of blood-borne pathogen transmission are very much lower.

Consider potential for infection with HIV, Hepatitis B, Hepatitis C, Tetanus.

Wound Care

Thoroughly clean with soap and water.

Administer tetanus toxoid or tetanus immune globulin (TIG) according to usual guidelines2.

Hepatitis B Virus (HBV)

HBV is the hardiest pathogen, surviving several days on surfaces, maybe over a week. Follow table below.

Administration of hepatitis immune globulin (HBIG) is not indicated if the child has completed a standard three-dose regimen of hepatitis B vaccination.

TABLE 1 : Hepatitis B Prophylaxis after Percutaneous Exposure to Blood (modified from3)

Exposed person   Treatment when  source is:  
   HbsAg-Positive  HbsAg-negative  Unknown
Unvaccinated or only one dose of vaccine Administer HBIG, 1 dose, and commence/continue vaccine schedule Commence/continue vaccine schedule Commence/continue vaccine schedule
Previously fully vaccinated:      
Known responder  No treatment No treatment  No treatment 
Known non responder HBIG 1 dose and initiate revaccination; or HBIG 2 doses one month apart No treatment If known high-risk source, treat as if source were HbsAg-positive
Response unknown  Test for anti-HBs
· If <10mIU/ml, give 1 dose HBIG and initiate revaccination
· If >10mIU/ml, no treatment
No treatment As for source HbsAg-positive

Hepatitis C Virus (HCV)

HCV viability on fomites is poor, so risk of transmission from discarded needles is low. No post-exposure prophylaxis known to be effective4.

Human Immunodeficiency Virus

The risk of HIV transmission from a needlestick injury from a person with known HIV infection to a healthcare worker is 0.3%. Risk from a discarded needle in the community is much lower because:

  1. HIV does not survive well outside the body. Drying HIV reduces concentrations by 90-99% within several hours.
  2. the prevalence of HIV in intravenous drug users in NZ is very low

Therefore post-exposure HIV prophylaxis is not routinely recommended in this situation5.

NB: If features suggest substantially increased risk (e.g. deep injury, large bore needle, fresh blood) please discuss with on-call paediatric infectious diseases consultant regarding need for post-exposure prophylaxis. If required, this should be started within hours of the injury. HIV testing of the syringe blood (if available) is not practical or reliable and is not recommended.

Summary of Procedure

  1. Local wound care.
  2. Take blood for HIV, HBV and HCV at baseline and arrange follow-up bloods at 6 weeks, 3 months and 6 months.
    N.B. Seroconversion would be grounds for ACC claim.
  3. Assess need for tetanus and HBV prophylaxis, and initiate.
  4. Assess risk level for HIV: this will be extremely low but if in doubt discuss with paediatric ID consultant.
  5. Counsel family regarding need for these measures.

References

  1. CDC.MMWR Recommendations and Reports; 2001; 50 (RR-11): 1-52.
  2. Immunisation Handbook 2006; NZ ministry of Health: p94.
  3. American Academy of Pediatrics Hepatitis B; In Pickering; LK, et al. eds. Red Book 27th edition; 2006, pg 354
  4. Chadwick E. Pediatric Infectious Diseases Journal 1998; 18(1): 69 -70.
  5. Havens PL and Committee on pediatric AIDS: Pediatrics 2003;111: 1475-1489.

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Document Control

  • Date last published: 01 August 2008
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Infectious Diseases, Infection Control
  • Author(s): Elizabeth Wilson
  • Editor: Greg Williams
  • Review frequency: 2 years

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