Needle Stick (Postexposure Prophylaxis)

Presentation

An employee presents for evaluation and treatment after an accidental needle stick injury to the hand obtained in the process of providing patient care. The employee requests postexposure prophylaxis (PEP).

This chapter will discuss the risk of transmission and appropriate PEP of three bloodborne pathogens after accidental occupational needle stick injuries: hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).

What to Do

• It is important to obtain the following historical components from the patient: time of injury, tetanus status, source patient (if known), needle type (hollow bore vs. nonhollow bore).

• Determine the medical employee’s HBV vaccination status.

• The type of body fluid that was potentially transmitted by needle stick (if known) should be determined. Urine, saliva, feces, vomitus, sweat, tears, and respiratory secretions are not known to transmit HBV, HCV, or HIV unless they are visibly bloody.

• If source patient consents for testing , obtain the following: HIV antibody/antigen (Ab/Ag), HCV ribonucleic acid (RNA) (preferred), or HCV Ab, HBV surface Ag.

• For medicolegal reasons , consider testing the employee per institutional policy with the same test panel as for the source patient. Please note: This does NOT detect transmission/seroconversion but only documents these infectious diseases were not preexisting in the employee.