Needlestick Injuries

Question 1

4 ways to prevent needlestick injuries

Answer 1

• educate families, etc about dangers of handling needles
• community support for addiction tx for IVDU
• community infection prevent programs for IVDUs
• adequate cleanup of parks, etc

Question 2

risk of infection depends on?

Answer 2

-Size of needle
o Depth of penetration
o Whether blood was injected
o Concentration of virus in the user’s blood

Question 3

needle stick injury and and not yet received hep b vaccine..do what?

Answer 3

give HBV vaccine and HBV Ig

Question 4

If not yet fully vaccinated for hep b, do waht?

Answer 4

test for surface antigen and ab…if both neg, treat with vaccine and ig; if Ab positive, continue vaccine series…if Antigen posiitve, stop vaccine series and arrange proper follow up…..if can’t get results within 48 hours, just give vaccine and Ig

Question 5

if fully vaccinated for hep B do waht?

Answer 5

test for surface Ab: if not ready in 48 hours, give one dose of vaccine….if Ab positive, nothing else….If Ab negative test for antigen….if anigen neg, give Ig adn vaccine…ig antigen positive, arrange proper follow-up

Question 6

HIV ppx for needlestick?

Answer 6

zidovudine: reduces risk of transmission by 80%

…but 3-drug regimen would be best

Question 7

5 things to do for needlestick injury

Answer 7

Clean the wound thoroughly with soap and water ASAP; DO NOT squeeze the area to induce bleeding
o Assess extent of wound/likelihood of exposure to blood through open skin lesions to mucous membranes
o Determine child’s HBV and tetanus vaccine status
o Document circumstances of injury- time/date/where needle found/how injury happened, etc.
o Obtain child’s blood work for: HBV, HIV, HCV status
o If starting HIV ppx: also do CBC, diff, AST, ALT, alk phos, BUN, creat
o No need to test needle/syringes for viruses
o If know the needle user, assess for risk factors of HIV/HBV/HCV or status if possible

Question 8

3 reasons for high risk of HIV trasnmission?

Answer 8

§ Source known to have HIV
§ Presumed or known high prevalence of HIV in local IVDU population (>15%)
§ Large lumen device with visible blood
§ Deep cut/injection of blood/bleeding at site
§ Exposure to mucous membranes or nonintact skin

Question 9

If high risk of HIV trasnmission, consider PEP, which is for how long?

Answer 9

28 days

Question 10

antiretrovirls should not be started if more than __ hours since injury

Answer 10

72

Question 11

HIV PEP for kids >12

Answer 11

EMTRICITABINE plus TENOFOVIR plus RALTEGRAVIR or DOLUTEGRAVIR

Question 12

HIV PEP for kids <12

Answer 12

§ Children < 12: ZIDOVUDINE plus LAMIVUDINE plus LOPINAVIR/RITONAVIR (give this last drug with fatty meal)

Question 13

very important to do what if starting PEP?

Answer 13

follow up in 2-3 days (adherence) and 2-4 weeks (adherence, AE bloodwork)

Question 14

describe follow-up at 4 weeks and beyond

Answer 14

4 weeks: another hep b vaccine
4-6 weeks: HIV serology
3 mos: HIV serology (if before was neg) and and hep c serology
6 mos: give another hep b vaccine and check all serologies hep b, c, hiv (unless already positive)..an omit HIV testing if it was negative at 3 months using a 4th gen combination HIV p24 antigen HIV antibody AND the child does not have HCV infection

7-8 mos: test again for hep serology…if still neg, test for antigen…if both neg, give another hep b vaccine and test again in 1-2 mos