Needlestick injuries are a common occupational hazard among healthcare workers. These injuries occur when needles or other sharp instruments accidentally puncture the skin. Such injuries can expose healthcare workers to bloodborne pathogens like HIV, hepatitis B and hepatitis C. Therefore, it is critical to respond quickly and appropriately when a needlestick injury occurs.
Immediate First Aid
The very first thing to do after sustaining a needlestick injury is to perform basic first aid on the wound. This involves:
- Washing the wound with soap and water. Use an antiseptic if available.
- Do not suck on the wound or promote bleeding in any way.
- Dry the wound and cover it with a bandage.
Proper cleansing and protection of the wound helps minimize the risk of infection. Avoiding behaviors like sucking on the wound prevents introduction of pathogens deeper into the puncture. Bandaging the wound also keeps it from becoming contaminated again.
After performing immediate first aid, the next crucial step is to identify the source patient. The source patient is the individual whose blood or bodily fluid is on the needle or sharp causing the injury. When the source is known, their blood can be tested to determine infection status. This allows the injured healthcare worker to receive appropriate post-exposure treatment based on potential exposure risks.
Report the Incident
The needlestick injury should be formally reported to the designated department or person as required by the employer. Timely reporting within 1-2 hours is ideal, as post-exposure treatment is most effective when started right away. Essential details to report include:
- Date, time and location of the incident
- How the injury occurred and the circumstances involved
- Type and brand of needle or device involved
- Depth of the wound
- Whether fluid was injected into the healthcare worker
- Identification of the source patient if known
Clear documentation helps ensure the injured staff receives proper follow-up care. It also contributes insight to improve training or procedures and prevent recurrences. Many facilities have an incident report form that should be completed.
Seek Immediate Medical Attention
The injured healthcare worker should promptly seek medical evaluation, even if the source patient is unknown. The evaluation aims to assess the exposure risk, provide counseling, and start post-exposure prophylaxis (PEP) if warranted. PEP involves taking antiretroviral medications as soon as possible after an exposure to HIV, ideally within 1-2 hours. Starting PEP quickly can significantly reduce the risk of contracting HIV after a needlestick injury.
During the medical evaluation, a blood sample is taken to test for HIV, hepatitis B, and hepatitis C. The results serve as a baseline for comparison. The healthcare worker receives counseling on risks associated with needlestick injuries and importance of post-exposure treatment. Tetanus immunization may be administered if the worker’s tetanus vaccination status is not up to date.
The source patient is identified whenever possible, and tested after consent is obtained. Their test results determine whether the healthcare worker requires PEP for possible exposure to HIV, hepatitis B, or hepatitis C based on specific guidelines. The exposed worker should follow up with the occupational health clinic or emergency department at designated intervals for repeat testing and monitoring.
Consider Source Patient Testing
When the source patient can be identified, it is vital to obtain their consent for testing as soon as possible after the injury. Testing the source for HIV, hepatitis B, and hepatitis C helps determine the injury risk and need for PEP or other prophylaxis. Source testing involves drawing a blood sample and having it quickly examined.
If the source patient is already known to have one of these infections, new testing may not be needed. Their existing status would warrant appropriate post-exposure prophylaxis for the injured healthcare worker. However, if the source patient’s status is unknown, rapid testing should be performed after consent is obtained. The exposed worker can then be offered PEP according to guidelines based on the source test results.
HIV Testing
For source HIV testing, the blood sample first undergoes an immunoassay test to detect HIV antibodies. If this immunoassay is positive, the sample is reflexed to an RNA test to detect the virus itself. The RNA test confirms whether the source patient is actually HIV positive or not. Results are typically available within 24 hours, and the injured healthcare worker can begin PEP if indicated.
Hepatitis B Testing
The source patient’s blood is tested for hepatitis B surface antigen (HBsAg) to determine if they are currently infected. hepatitis B can also be transmitted when the source has a resolved infection. So an antibody test for total hepatitis B core antibody (anti-HBc) is also done. Results are usually available within 24 hours to guide need for hepatitis B immunoglobulin (HBIG) in the exposed healthcare worker.
Hepatitis C Testing
Like HIV, hepatitis C testing of the source patient’s blood sample starts with an immunoassay for antibodies. If positive, an RNA test follows to confirm whether the source is actively infected. This helps determine if the exposed healthcare worker requires hepatitis C virus PEP. Results are often available within 48 hours.
Obtain Post-Exposure Prophylaxis
Post-exposure prophylaxis (or PEP) refers to medications given after exposure to an infectious disease, before symptoms occur, to prevent infection. Whether PEP is warranted, and choice of regimen, depends on the pathogen involved and factors such as source patient test results. PEP should begin as soon as possible after a potential exposure for greatest efficacy. Options may include:
- HIV PEP – Combination antiretrovirals, taken for 28 days. Recommended if source patient is HIV positive or status unknown.
- HBIG -Hepatitis B immune globulin provides temporary protection. Given if source is hepatitis B positive or not fully vaccinated.
- Hepatitis B vaccine – For exposed workers who are unvaccinated. Also used if source status unknown.
- Hepatitis C virus PEP – There are currently no medications recommended for pre-exposure prophylaxis for hepatitis C.
Adherence to the full 28-day course of HIV PEP maximizes prophylactic benefit. The prescribing provider should monitor for potential side effects and conduct follow up testing at baseline, 6 weeks, 3 months, and 6 months post-exposure.
Consider Work Restrictions
Facilities may require temporary work restrictions for staff after needlestick injuries depending on several factors:
- Require restrictions if source patient has HIV, hepatitis B or hepatitis C.
- Restrict phlebotomy, dialysis, surgery duties until worker’s infection status is clear.
- Modify duties if needed for those taking HIV PEP due to side effects.
- Allow return to normal duties after defined period if all follow up tests are negative.
Restricting certain procedures helps protect patients from potential transmission if the worker has seroconverted. Modifying PEP-related side effects also improves adherence. Restrictions are lifted when follow up testing indicates the worker did not contract HIV, hepatitis B or hepatitis C infection.
Provide Counseling and Education
Counseling and education are important components of the response after a healthcare worker experiences a needlestick injury. Topics to cover include:
- Risks related to needlestick injuries and transmission of bloodborne pathogens
- Emotional impact and normal reactions to the incident
- Steps taken at the facility to assess risks and provide prophylaxis
- Importance of adherence with medications, follow up, and work restrictions
- Strategies to prevent recurrences and safely handle sharps
A difficult needlestick injury can be distressing. Education aims to alleviate anxiety related to bloodborne infection risks. It also empowers staff to reduce future hazardous sharps exposure. Counseling provides support coping with emotional and psychological effects in the aftermath of the event.
Review Sharps Safety Procedures
Evaluation of the circumstances surrounding a needlestick injury allows identification of shortcomings in sharps safety practices. It facilitates procedure changes to enhance healthcare worker safety. Areas to review include:
- Use of safety needles and sharps devices
- Accessibility of sharps disposal containers
- Techniques used for injecting, phlebotomy, suturing
- Handling and disposal of used sharps
- Practices to avoid needle recapping, disassembly and reuse
For example, the injury may reveal a need for more staff training on available safety devices or techniques to avoid exposure during multistep procedures. Or it may demonstrate a need to replace standard sharps with safety needles. Comprehensive sharp device and technique review promotes continual improvement in reducing needlestick hazards.
Take Measures to Prevent Bloodborne Conditions
Beyond immediate management, it is essential for healthcare workers to take measures after a needlestick injury to prevent contracting a bloodborne illness. Recommended practices include:
- Strictly adhere to full course of PEP if prescribed.
- Abstain from blood or tissue donation during follow up period.
- Use appropriate protection with sex partners during follow up.
- Avoid pregnancy or breastfeeding until confirmed infection free.
- Get regular follow up testing as scheduled.
- Report any symptoms associated with HIV, hepatitis B or hepatitis C.
PEP non-compliance increases infection risk if exposed. Proper protection and avoidance of transmission routes protects partners. Abstaining from pregnancy and breastfeeding prevents infections to babies. Finally, diligent follow up is key to detect and treat potential seroconversion as early as possible.
Understand Risks of Contracting Bloodborne Pathogens
Needlestick injuries can transmit infections like HIV, hepatitis B and hepatitis C. Understanding the nature and transmission risk of each helps healthcare workers manage anxiety and take appropriate precautions after an exposure.
HIV Risk
- Transmission risk from single needlestick is low, around 0.3%.
- Higher volume blood exposure increases risk greater than a surface scratch.
- PEP reduces transmission risk up to 80% if started in 1-2 hours.
Hepatitis B Risk
- Transmission risk from needlestick is 6-30% if patient is hepatitis B positive.
- HBIG and hepatitis B vaccine together are >90% effective when given promptly.
Hepatitis C Risk
- Transmission risk from needlestick is 1-2% on average.
- No PEP exists, only treat if seroconversion occurs.
Understanding transmission risks allows healthcare workers to assess their individual level of concern based on the source patient test results. They can also take proper prophylactic steps to minimize the likelihood of contracting these viruses.
Follow Up Schedule for Bloodborne Pathogen Testing
Healthcare workers exposed to a bloodborne pathogen via needlestick require follow up testing to monitor for infection. The clinician should provide a clear schedule for follow up testing for HIV, hepatitis B and hepatitis C. Recommended testing intervals are:
| Time after Exposure | Testing Recommended |
|---|---|
| Baseline | HIV, hepatitis B, hepatitis C |
| 6 weeks | HIV, hepatitis C |
| 3 months | HIV, hepatitis B, hepatitis C |
| 6 months | HIV, hepatitis C |
| 1 year | Hepatitis B, hepatitis C (if continued concern) |
Baseline testing establishes comparison values. Follow up tests at intervals monitor for delayed seroconversion. If baseline and 6 week HIV tests are negative, chance of conversion is low. Hepatitis B and C testing extends for a year due to their longer seroconversion window. Compliance with the full follow up schedule is essential.
Create a Personal Sharps Safety Plan
After being injured in a needlestick incident, it is a good idea for the healthcare worker to develop a personal sharps safety plan. This helps prevent recurrences by identifying individual prevention strategies. Elements of a sharps safety plan may include:
- Commit to using safety engineered devices and personal protective equipment.
- Identify high hazard procedures to have extra focus.
- Enhance skills practicing safe handling techniques.
- Increase awareness of surroundings when using or disposing sharps.
- Speak up to colleagues who demonstrate unsafe behaviors.
- Report concerns with safety devices or procedures immediately.
Having a purposeful plan empowers healthcare workers to take an active role in protecting themselves from sharps injuries. It also promotes staff participation in ongoing safety initiatives. Management can incorporate components of individual safety plans into overall exposure prevention programs.
Consider Emotional Support Options
Healthcare workers often experience emotional distress following a needlestick injury. Anxiety, stress and depression may occur related to fear of contracting an illness. Trauma counseling helps staff cope with feelings of vulnerability, anger or guilt after the incident. Support options to consider include:
- Employee assistance programs (EAPs) – Counseling and other services offered by some employers.
- Peer support groups – Those with similar experiences can relate best.
- Talking to trusted co-workers – Sharing feelings may provide relief.
- Family and friends – Seek support from personal relationships.
- Spiritual leaders/guidance – May help address emotional needs.
Seeking counseling does not imply weakness. Therapeutic discussions help staff achieve emotional wellbeing following a needlestick traumatic event. This facilitates healthy coping and full recovery.
Consider Legal Counsel
In rare cases, a healthcare worker may want to consider legal counsel following a needlestick injury. Reasons could include:
- Sustaining the injury due to an unsafe work environment
- Insufficient provision of protective equipment
- Failure to provide adequate PEP treatment
- Lack of follow up testing and cover of costs
- Discrimination based on HIV or hepatitis infection
- Termination instead of providing work restrictions
Facilities should make every effort to follow guidelines and protect healthcare workers before and after an injury. But if mistreatment or other problems occur, employees do have legal rights. Consulting an attorney helps determine appropriate options based on individual circumstances.
Conclusion
In conclusion, prompt and proper response is imperative when the unfortunate occurs and a healthcare worker sustains a needlestick injury. The very first priorities are to perform immediate wound first aid, report the incident, and seek urgent medical evaluation. Treatment focuses on preventing transmission of bloodborne viruses like HIV and hepatitis according to specific recommendations. Ongoing follow up and testing monitors for infection in subsequent months. Emotional support addresses feelings of fear and anxiety. Finally, evaluation aims to improve training and procedures to enhance prevention of such injuries.
