What Should I Do If I Get a Needlestick?

Case

While placing a central line, you sustain a needlestick. You’ve washed the area thoroughly with soap and water, but you are concerned about contracting a bloodborne pathogen. What is the risk of contracting such a pathogen, and what can be done to reduce this risk?

Overview

Needlestick injuries are a common occupational hazard in the hospital setting. According to the International Health Care Worker Safety Center (IHCWSC), approximately 295,000 hospital-based healthcare workers experience occupational percutaneous injuries annually. In 1991, Mangione et al surveyed internal-medicine house staff and found an annual incidence of 674 needlestick injuries per 1,000 participants.1 Other retrospective data estimate this risk to be as high as 839 per 1,000 healthcare workers annually.2 Evidence from the Centers for Disease Control and Prevention (CDC) in 2004 suggests that because these are only self-reported injuries, the annual incidence of such injuries is in fact much higher than the current estimates suggest.2,3,4

Nearly 300,000 U.S. healthcare workers experience occupational percutaneous injuries annually.

Nearly 300,000 U.S. healthcare workers experience occupational percutaneous injuries annually.

More than 20 bloodborne pathogens (see Table 1, right) might be transmitted from contaminated needles or sharps, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). A quick and appropriate response to a needlestick injury can greatly decrease the risk of disease transmission following an occupational exposure to potentially infectious materials.

Review of the Data

After any needlestick injury, an affected healthcare worker should wash the area with soap and water immediately. There is no contraindication to using antiseptic solutions, but there is also no evidence to suggest that this reduces the rates of disease transmission.

As decisions for post-exposure prophylaxis often need to be made within hours, a healthcare worker should seek care in the facility areas responsible for managing occupational exposures. Healthcare providers should always be encouraged and supported to report all sharps-related injuries to such departments.

The source patient should be identified and evaluated for potentially transmissible diseases, including HIV, HBV, and HCV. If indicated, the source patient should then undergo appropriate serological testing, and any indicated antiviral prophylaxis should be initiated (see Table 2, p. 19).

KEY Points

  • Occupational needlestick injuries are under-reported.
  • Although rare, transmission of disease from a percutaneous injury might lead to life-threatening illness.
  • Post-exposure antiviral prophylaxis exists for HIV and HBV, while post-exposure management for HCV centers around identification and treatment of chronic disease.
  • Rates of disease transmission are significantly reduced with timely and appropriate post-exposure antiviral prophylaxis.

Additional Reading

  • Overview: Risks and Prevention of Sharps Injuries in Healthcare Personnel. Centers for Disease Control and Prevention; Atlanta: 2004.
  • Davenport A, Myers F. How to protect yourself after body fluid exposure. Nursing. 2009;39(5):22-28.
  • Gabriel J. Reducing needlestick and sharps injuries among healthcare workers. Nurs Stand. 2009;23(22):41-44.

Nearly 300,000 U.S. healthcare workers experience occupational percutaneous injuries annually.

Risk of Seroconversion

For all bloodborne pathogens, a needlestick injury carries a greater risk for transmission than other occupational exposures (e.g. mucous membrane exposure). If a needlestick injury occurs in the setting of an infected patient source, the risk of disease transmission varies for HIV, HBV, and HCV (see Table 3, p. 19). In general, risk for seroconversion is increased with a deep injury, an injury with a device visibly contaminated with the source patient’s blood, or an injury involving a needle placed in the source patient’s artery or vein.3,5,6

Comments

  1. Linda Nelson says

    The brief reference on page 1 reflects that the FDA has approved a needle to prevent needlsticks. Aftere going throuhg 20 + pages – I was not able to find any additional information.

  2. Ade says

    Somebody help me cut my nails with general scissors that is use for different people mistakely cut me with a little blood outside.

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