Needlestick injuries

Question 1

What is a needle stick injury?

Answer 1

A wound caused by a needle that accidentally punctures the skin.

Where the blood of patient comes into contact w/ blood of a Healthcare worker.

Question 2

What are the 3 types of exposure that are associated with risk from blood or body fluids?

Answer 2

Percutaneous injury
- e.g. from needles, sharp instruments, bone fragments, significant bites which break the skin.

Exposure of broken skin
- e.g. abrasions, cuts, eczema.
NOTE that intact skin is a safe protective barrier against blood borne virus transmission.

Exposure of mucous membranes
- including eyes & mouth.

Question 3

What is the most concerning type of virus in needle stick injuries?

Answer 3

Blood Borne Viruses (BBV): viruses which can be present in blood or other body fluids.
- i.e. Hepatitis B (HBV), Hepatitis C (HCV) & Human Immunodeficiency Virus (HIV).
- Have high potential for transmission to another person by direct contact w/ their blood or susceptible fluids.
- Hep B most infectious, then Hep C followed by HIV

Question 4

Give examples of infectious materials that are concerning in needle stick injuries.

Answer 4

• blood
• vaginal secretions
• semen
• human breast milk
• cerebrospinal fluid
• peritoneal fluid
• synovial fluid
• saliva
• any body fluid visibly blood stained
• urine
• vomit
• saliva
• faeces

Question 5

What should be done once someone has had a needle stick injury?

Answer 5

1. Care for wound:
   - Encourage wound to bleed, ideally by holding it under running water.
   - Wash wound using running water & soap.
   - Do not scrub wound whilst washing it.
   - Do not suck wound.
   - Dry wound & cover w/ waterproof plaster or dressing.
2. Post Exposure Prophylaxis (PEP):
   - Tenofovir disoproxil 245mg
   - Emtricitabine 200mg
   - Raltegravir 1200mg once daily
   - PEP should be initiated as soon as possible after exposure, preferably w/in 24 hrs, but can be considered up to 72 hours.
3. Immunisation status - give booster dose of HBV vaccine or HBIG.
4. For exposures to Hep C, there is no PEP- Follow-up is key to making sure any transmission is detected.
   - blood test, regular follow-up by Occupational Health,
   referral to Viral Hepatitis Clinic.

Question 6

Other pathogens that can be transmitted in blood?

Answer 6

• Cutaneous gonorrhea
• Herpes
• Malaria
• Mycobacteriosis
• Staphylococcus aureus
• Streptococcus pyogenes
• Syphilis
• TB