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Child Health Guideline Identifier

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.

Management summary

  • 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

Wound care

Thoroughly clean with soap and water.

Tetanus

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 10,0002.

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.

ACC form

ACC45 Injury Claim form should be completed by the treating doctor.

References

  1. American Academy of Pediatrics Hepatitis B; In Kimberline, D et al eds. Red Book 30th edition; 2015
  2. ANZPID/ASID PEP HIV prophylaxis

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Document Control

  • 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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