Needle‑Stick Injury Prophylaxis – CDC Recommendations

Immediate Wound Care

• Wash the wound and surrounding skin with soap and water immediately; flush eyes or mouth with water if exposed. 1

Source Patient Evaluation

• Test the source patient promptly for HBsAg, anti‑HCV, and HIV antibody (rapid HIV test preferred) to guide prophylaxis decisions. 1
• Do not attempt virologic testing of discarded needles or syringes; results are unreliable. 1

Hepatitis B Prophylaxis

• Vaccinated worker with documented anti‑HBs ≥ 10 IU/L – no post‑exposure treatment required. 1
• Vaccinated worker with anti‑HBs < 10 IU/L or unknown status – give a single hepatitis B vaccine booster dose. 1
• Vaccinated non‑responder exposed to an HBsAg‑positive source – administer HBIG 0.06 mL/kg plus a vaccine booster. 1
• Unvaccinated worker exposed to an HBsAg‑positive source – give HBIG 0.06 mL/kg immediately and start the hepatitis B vaccine series. 1
• Unvaccinated worker exposed to an HBsAg‑negative source – start the hepatitis B vaccine series only. 1
• HBIG is most effective when given within 24 hours but may be administered up to 7 days after exposure. 1

Hepatitis C Management

• No antiviral prophylaxis is recommended after exposure; management consists of surveillance testing. 1
• Perform anti‑HCV antibody and ALT testing at baseline and again at 4–6 months post‑exposure. 1
• Optional HCV RNA testing at 4–6 weeks can provide earlier diagnosis if desired. 1
• Do not give hepatitis C immune globulin, interferon, or ribavirin as prophylaxis. 2

HIV Post‑Exposure Prophylaxis (PEP)

• Initiate PEP within 72 hours (ideally within 2 hours) after percutaneous injury from an HIV‑positive source or a high‑risk unknown source. 1
• Indications for PEP:
• Do not give PEP for exposures to urine, saliva, or other non‑bloody fluids; for intact‑skin contact with blood; or when the source is confirmed HIV‑negative. 2
• Basic regimen (2001 CDC guideline): Zidovudine 600 mg/day in 2–3 divided doses + Lamivudine 150 mg twice daily (available as COMBIVIR). 1
• Duration of therapy: 4 weeks (28 days). 1
• Monitoring: evaluate the worker within 72 hours of starting PEP, obtain baseline CBC, renal and liver function tests, and repeat toxicity labs at least every 2 weeks. 1

Follow‑Up Testing Schedule

• HIV exposure: baseline test, then at 6 weeks, 3 months, and 6 months; test immediately if acute retroviral syndrome symptoms appear. 1
• HBV exposure: test anti‑HBs 1–2 months after the final vaccine dose; interpretation is unreliable if HBIG was given within the prior 3–4 months. 1
• HCV exposure: baseline and 4–6 month anti‑HCV and ALT testing; optional HCV RNA at 4–6 weeks for earlier detection. 1

Counseling and Precautions

• Advise exposed workers to seek immediate medical evaluation for any acute illness during the follow‑up period. 1
• No special infection‑control precautions are needed to prevent secondary transmission after HBV or HCV exposure. 2
• For HIV exposures where PEP is used: employ barrier protection during sexual activity and refrain from blood or tissue donation for 6 months. 1
• Patient‑care duties do not need modification after any blood‑borne pathogen exposure. 2

Common Pitfalls to Avoid

• Do not delay HIV PEP while awaiting source‑patient test results; start empirically when exposure is high‑risk. 1
• Do not administer hepatitis C immune globulin or antiviral agents prophylactically. 2
• Do not test discarded needles; base management on clinical risk assessment instead. 1

CDC Recommendations for Bloodborne Pathogen Exposure Management

HIV Post‑Exposure Prophylaxis (PEP) – Indications

• The CDC (MMWR 2005) recommends initiating HIV PEP after percutaneous injury or mucous‑membrane/non‑intact skin exposure to HIV‑positive blood or high‑viral‑load body fluids (e.g., cerebrospinal, synovial, pleural, peritoneal, pericardial, amniotic fluid). 3

HIV PEP – Situations Where PEP Is Not Indicated

• The CDC (MMWR 2005) states that PEP is not required for exposures to urine, saliva, tears, sweat, feces, nasal secretions, or vomitus unless the material is visibly bloody. 3

HIV PEP – Regimen Guidance

• The CDC (MMWR 2005) expanded antiretroviral options for HIV PEP, emphasizing the selection of tolerable regimens and advising consultation with an HIV specialist for complex exposures or regimen selection. 3

Post‑Exposure Precautions for Hepatitis B and C

• The CDC (MMWR 2001) indicates that no special infection‑control precautions are needed to prevent secondary transmission after HBV or HCV exposure. 4

Post‑Exposure Work‑Practice Recommendations

• The CDC (MMWR 2001) advises that patient‑care duties do not need modification after any bloodborne pathogen exposure. 4