Needle Stick Injury

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edu/en/departments-and-centers/central-facilities/265-biomedical/7355-needle-
stick-injury.html
NEEDLE STICK INJURY

 Last Updated On : 30 Aug 2017
PROTOCOL
1. Immediate
1. For Injury: Wash with soap and running water.
2. For Non intact Skin Exposure: Wash with soap and water.
3. For Mucosal Exposure: Wash thoroughly.
2. Reporting
1. All sharps injury and mucosal exposure MUST be reported to the immediate supervisor,
and to the Casualty Medical Officer to evaluate the injury. Details of the needle-stick injury should
be filled by the supervisor and handed over to the HIC nurse for further follow-up.
3. Management
1. Management is on a case to case basis.
4. Follow-Up
1. Follow-up and statistics of needle-stick injury are done by
the HIC nurse on a weekly basis. This information is presented at
the HICC meeting and preventive actions to avoid needle-stick
injuries, if any, are recorded.
POST-HIV EXPOSURE MANAGEMENT / PROPHYLAXIS (PEP)
Occupational exposure:
Occupational exposure refers to exposure to potential blood-borne infections (HIV,

HBV and HCV) that occurs during performance of job duties.
“Exposure” which may place an HCP at risk of blood-borne infection is defined

as:
 a percutaneous injury (e.g. needle-stick or cut with a sharp instrument),

 contact with the mucous membranes of the eye or mouth,
 contact with non-intact skin (particularly when the exposed skin is chapped,
abraded, or afflicted with dermatitis), or
 contact with intact skin when the duration of contact is prolonged (e.g.
several minutes or more) with blood or other potentially infectious body fluids.
What is infectious and what is not?
Page 1 of 5
TABLE 12.3.4 POTENTIALLY INFECTIOUS BODY FLUIDS
Exposure to body fluids considered Exposure to body fluids considered

‘at risk’ ‘not at risk’
Blood Tears
Unless these
Semen Sweat secretions
contain visible
Vaginal secretions Urine and Faeces blood
Cerebrospinal fluid Saliva
Synovial, pleural, peritoneal,
pericardial fluid
Amniotic fluid
Other body fluids contaminated with

visible blood
Protocol:
It is necessary to determine the status of the exposure and the HIV status of the
exposure source
before starting post exposure prophylaxis (PEP).
Step 1: Immediate measures
For skin — if the skin is broken after a needle-stick or sharp instrument:
· Immediately wash the wound and surrounding skin with water and soap, and
rinse. Do not scrub.
· Do not use antiseptics or skin washes (bleach, chlorine, alcohol, betadine).
After a splash of blood or body fluids on unbroken skin:
· Wash the area immediately
· Do not use antiseptics
Page 2 of 5
For the eye:
· Irrigate exposed eye immediately with water or normal saline. Sit in a chair, tilt
head back and ask a colleague to gently pour water or normal saline over the eye.
· If wearing contact lens, leave them in place while irrigating, as they form a
barrier over the eye and will help protect it. Once the eye is cleaned, remove the
contact lens and clean them in the normal manner. This will make them safe to
wear again
· Do not use soap or disinfectant on the eye.
For mouth:
· Spit fluid out immediately
· Rinse the mouth thoroughly, using water or saline and spit again. Repeat this
process several times
· Do not use soap or disinfectant in the mouth
· Consult the designated physician of the institution for management of the

exposure immediately.
Don’ts

· Do not panic
· Do not put pricked finger in mouth
· Do not squeeze wound to bleed it
· Do not use bleach, chlorine, alcohol, betadine, iodine or any

antiseptic or detergent
Step II: Prompt reporting:
a) All needle-stick/sharp injuries should be reported to the immediate supervisor,

and then to the Casualty Medical Officer.
b) An entry is made in the Needle-Stick Injury Register in the Casualty.
Step III: Post exposure treatment:
Page 3 of 5
The decision to start PEP is made on the basis of degree of exposure to HIV and
the HIV statusof the source from where the exposure/infection has occurred. More
so, it should begin as soon as possible preferably within two hours, and is
notrecommended after 72 hours.
PEP is not needed for all types of exposures:The HIV seroconversion rate of
0.3% after an AEB (accidental exposure to blood) (for percutaneous exposure) is
an average rate. The risk of infection transmission is proportional to the amount of
HIV transmitted, which depends on the nature of exposure and the status of the
source patient. A baseline rapid HIV testing of exposed and source person must be
done for PEP. However, initiation of PEP should not be delayed while waiting for
the results of HIV testing of the source of exposure. Informed consent should be
obtained before testing of the source as per national HIV testing guidelines.
First PEP dose within 72 hours
A designated person/trained doctor must assess the risk of HIV and HBV
transmission following an AEB. This evaluation must be quick so as to start
treatment without any delay, ideally within two hours but certainly within 72
hours; PEP is not effective when given more than 72 hours after exposure. The first
dose of PEP should be administered within the first 72 hours of exposure. If the
risk is insignificant, PEP could be discontinued, if already commenced.
Step IV: Counselling for PEP
Exposed persons (clients) should receive appropriate information about what PEP
is about and the risk and benefits of PEP in order to provide informed consent for
taking PEP. It should be clear that PEP is not mandatory.
Step V: Psychological support
Many people feel anxious after exposure. Every exposed person needs to be
informed about the risks, and the measures that can be taken. This will help to
relieve part of the anxiety. Some clients may require further specialised
psychological support.
Step VI: Documentation of exposure

Documentation of exposureis essential. Special leave from workshould be
considered initially for a period of two weeks. Subsequently, it can be extended
based on the assessment of the exposed person’s mental state, side effects and
requirements.
IMPORTANT: Seek expert opinion in case of
· Delay in reporting exposure (> 72 hours).
· Unknown source
Page 4 of 5
· Known or suspected pregnancy, but initiate PEP
· Breastfeeding mothers, but initiate PEP
· Source patient is on ART
· Major toxicity of PEP regimen.
Step VII: Follow-up of an exposed person
Whether or not post-exposure prophylaxis is started, a follow up is needed to

monitor for possible infections and to provide psychological support.
Clinical follow-up
In the weeks following an AEB, the exposed person must be monitored for the
eventual appearance of signs indicating an HIV seroconversion: acute fever,
generalized lymphadenopathy, cutaneous eruption, pharyngitis, non-specific flu
symptoms and ulcers of the mouth or genital area. These symptoms appear in 50%-
70% of individuals with an HIV primary (acute) infection and almost always
within 3 to 6 weeks after exposure. When a primary (acute) infection is suspected,
referral to an ART centre or for expert opinion should be arranged rapidly.
An exposed person should be advised to use precautions (e.g., avoid blood or

tissue donations, breastfeeding, unprotected sexual relations or pregnancy) to
prevent secondary transmission, especially during the first 6–12 weeks following
exposure. Condom use is essential.Drug adherence and side effect counselling
should be provided and reinforced at every follow-up visit. Psychological support
and mental health counselling is often required.
Laboratory follow-up
Exposed persons should have post-PEP HIV tests. HIV-test at 3 months and again
at 6 months is recommended. If the test at 6 months is negative, no further testing
is recommended.
Page 5 of 5

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NEEDLE STICK INJURY

POST-HIV EXPOSURE MANAGEMENT / PROPHYLAXIS (PEP)

Occupational exposure refers to exposure to potential blood-borne infections (HIV,

“Exposure” which may place an HCP at risk of blood-borne infection is defined

 a percutaneous injury (e.g. needle-stick or cut with a sharp instrument),

What is infectious and what is not?

Exposure to body fluids considered Exposure to body fluids considered

Cerebrospinal fluid Saliva

Synovial, pleural, peritoneal,

Other body fluids contaminated with

before starting post exposure prophylaxis (PEP).

Step 1: Immediate measures

For skin — if the skin is broken after a needle-stick or sharp instrument:

· Do not use antiseptics or skin washes (bleach, chlorine, alcohol, betadine).

After a splash of blood or body fluids on unbroken skin:

· Wash the area immediately

· Do not use antiseptics

· Do not use soap or disinfectant on the eye.

· Spit fluid out immediately

· Do not use soap or disinfectant in the mouth

· Consult the designated physician of the institution for management of the

· Do not put pricked finger in mouth

· Do not squeeze wound to bleed it

· Do not use bleach, chlorine, alcohol, betadine, iodine or any

Step II: Prompt reporting:

a) All needle-stick/sharp injuries should be reported to the immediate supervisor,

b) An entry is made in the Needle-Stick Injury Register in the Casualty.

Step III: Post exposure treatment:

First PEP dose within 72 hours

Step IV: Counselling for PEP

Step V: Psychological support

Step VI: Documentation of exposure

IMPORTANT: Seek expert opinion in case of

· Delay in reporting exposure (> 72 hours).

· Breastfeeding mothers, but initiate PEP

· Source patient is on ART

· Major toxicity of PEP regimen.

Step VII: Follow-up of an exposed person

Whether or not post-exposure prophylaxis is started, a follow up is needed to

An exposed person should be advised to use precautions (e.g., avoid blood or

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