Virtual Mentor. October 2005, Volume 7, Number 10.
Management of Needlestick Injuries in the Health Care Setting
Health care providers should be aware of the risks, tests, and treatments necessary in the event of a needlestick injury.
Needlesticks are a common occurrence in the health care profession. It is estimated that 600 000 to 800 000 needlestick injuries occur per year in the United States . Of these, many, if not most, go unreported . In response to the risk of exposure, institutions have focused on primary prevention as a means of reducing the incidence of needlesticks and thereby decreasing the number of bloodborne pathogen transmissions. Needlestick injuries still occur, however, and it is important that individuals in the health care field become well informed about the exposure risks and educated regarding the appropriate response.
What are the primary pathogens transmitted?
1. Human Immunodeficiency Virus (HIV): The average risk of seroconversion after a needlestick injury from a confirmed HIV source is approximately 0.3 percent without post-exposure therapy . Certain factors contribute to elevated risk :
2. Hepatitis B Virus (HBV): The risk of acquiring hepatitis secondary to HBV percutaneous exposure varies based on the serological status of the patient. In the worst case scenario, if the patient has active replication of the virus (indicated by HBeAg-positive blood ) then the risk of developing clinical hepatitis is as high as 31 percent . When the patient has HBsAg-positive blood but is HBeAg-negative (indicating a less infective state), the risk is significantly lower, about 1 to 6 percent .
3. Hepatitis C Virus (HCV): The risk of HCV seroconversion after a needlestick injury from a patient infected with HCV is approximately 1.8 percent . Unfortunately, there is little evidence to support postexposure treatment as a means to decrease the risk of infection.
Role of Vaccination
Of these 3 infections, vaccination is available only for HBV. In the 1970s, the risk of acquiring HBV was 10 times greater in health care workers than in the general population . This risk has significantly declined, due in part to an aggressive vaccination campaign geared toward hospital staff .
Facts about the vaccine :
What protocol should be followed after any needlestick?
First, do not panic. Protocols are in place to minimize the risk of infection after exposure. Second, do not ignore the exposure. Acting within outlined timeframes can lead to a significant decrease in the transmission rate of certain infections. The following measures also should be taken :
Virus-specific Post-exposure Management
1. HIV: Use of post-exposure prophylaxis can help to reduce the risk of contracting HIV. Maximal benefit can be obtained by initiating treatment within hours of exposure. Guidelines include the following :
A few additional considerations regarding HIV exposure management:
There is the possibility of toxicity with antiretrovirals, so use should be restricted to exposures in which reasonable risk of transmission is present.
2. HBV: The treatment after exposure varies based on the vaccination status of the exposed individual and the HBV status of the patient :
3. HCV: No treatment has been shown to prevent infection for workers exposed to HCV. Recommendations center on following workers after the injury and monitoring for HCV RNA in the serum. Recommendations include :
Josiah Penalver is a fourth-year medical student at the University of Washington. He plans to pursue a specialty in pediatrics.
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