Needle Stick Injury

A needle stick injury occurs when you are stuck by a needle that may have the blood from another person on it. Most of the time these injuries heal without any problem, but several diseases can be transmitted this way. You should be aware of the risks. A needle stick injury can cause risk for getting:

  • Hepatitis B.

  • Hepatitis C.

  • HIV infection (the virus that causes AIDS).

The chance of getting one of these infections from a needle stick injury is small. However, it is important to take proper precautions to prevent such an injury. It is also important to understand and follow some health care recommendations when such an injury occurs.

RISK FACTORS

In general, the risk of infection after a needle stick injury appears to be higher with:

  • Exposure to a needle that is visibly contaminated with blood.

  • Exposure to the blood of a patient with an advanced disease or with a high viral load.

  • A deep injury.

  • Needle placement in a vein or artery.

PREVENTION

All healthcare workers should:

  • Wash their hands often, including before and after caring for each patient.

  • Receive the hepatitis B vaccine before any possible exposure to blood or bloody body fluids.

  • Use personal protective equipment (PPE) when appropriate. This includes:

  • Gloves.

  • Gowns.

  • Boots.

  • Shoe covers.

  • Eyewear.

  • Masks.

  • Wear gloves when any kind of venous or arterial access is being done.

  • Use safety devices when available.

  • Use sharp edges and needles with caution.

  • Dispose of used needles and other sharps in puncture proof receptacles.

  • Never recap needles.

TREATMENT

  • After a needle stick injury, immediate cleansing with soap and water or an alcohol-based hand hygiene agent is needed.

  • If you did not have a tetanus booster within the past 10 years, a booster shot should be given.

  • If the puncture site becomes red, swollen, more painful, or drains yellowish-white fluid (pus), medicine for a bacterial infection may be needed.

  • If the blood on the needle is known or thought to be high risk for hepatitis B or HIV, additional treatment is needed.

  • For needle stick exposures to the HIV virus, drug treatment is advised. This treatment is called post-exposure prophylaxis (PEP), and should be started as soon as possible following the injury. The recommended period of treatment with medicines is usually 4 weeks with 2 or more different drugs. You should have follow-up counseling and a medical evaluation, including HIV blood tests, right away. The tests should be repeated at 6 weeks, 3 months, and 6 months. Blood tests to monitor for drug toxicity effects of the PEP medicines are usually recommended immediately before treatment starts and again at 2 weeks and 4 weeks after the start of PEP. Additional recommendations during the first 6 to 12 weeks after exposure include:

  • Practicing sexual abstinence or using condoms to prevent sexual transmission and to avoid pregnancy.

  • Refraining from donating blood, plasma, semen, organs, or other tissue.

  • For breastfeeding women, considering temporary discontinuation of breastfeeding while on PEP.

  • For needle stick exposures to hepatitis B, blood testing and PEP is also needed. If you have not been vaccinated against hepatitis B, this vaccine series should be started and hepatitis B immune globulin should also be given. If you have been previously vaccinated, your status of immunity to infection with hepatitis B can be tested by a blood antibody test. Before or after those test results are available, repeat vaccination with or without hepatitis B immune globulin will be considered.

  • Unfortunately, no helpful treatment following hepatitis C exposure has been identified or is recommended. Follow-up blood testing is advised over a period of 4 weeks to 6 months to determine if the needle stick led to an infection. Ask your caregiver for advice about this follow-up testing.

HOME CARE INSTRUCTIONS

  • Take medicine exactly as told by your caregiver.

  • Keep all follow-up appointments.

  • Do not share personal hygiene items.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have concerns about your injury, treatment, or follow-up.

  • The injury site becomes red, swollen, or painful.

  • The injury site drains pus.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.