Management of Needle Stick Injuries

Immediate Actions

The American Academy of Pediatrics recommends washing the puncture site thoroughly with soap and water without squeezing or applying pressure to increase bleeding 1, 2
The Centers for Disease Control and Prevention (CDC) suggests flushing the involved area immediately with clean water or saline if blood splashed into eyes, nose, or mouth 1, 2
Documenting the exact time of injury immediately is critical for determining post-exposure prophylaxis (PEP) eligibility 2
Reporting to a supervisor immediately and documenting the date, time, type of device involved, depth of injury, and other relevant details is essential 1, 2, 3

The CDC recommends seeking emergency evaluation within 1 hour to initiate PEP if needed, as the sooner PEP starts, the more effective it is, with a dramatic drop in effectiveness after 72 hours 2, 4
The World Health Organization (WHO) suggests obtaining rapid HIV testing of the source patient to expedite PEP decisions 2, 3
Testing the source for Hepatitis B surface antigen (HBsAg) and Hepatitis C antibody (anti-HCV) is also recommended 1, 3

The CDC recommends starting PEP immediately if presentation is within 72 hours, even before confirming the source's HIV status for substantial exposures 2, 4
PEP reduces the risk of HIV transmission by approximately 81% when started promptly 2
The risk of HIV transmission from a percutaneous needlestick with HIV-infected blood is approximately 0.36% (3-4 per 1,000 exposures) 5, 2, 3

The preferred regimen is Bictegravir/emtricitabine/tenofovir alafenamide (single tablet once daily) for 28 days 2, 4
An alternative regimen is Dolutegravir plus (tenofovir alafenamide or tenofovir disoproxil fumarate) plus (emtricitabine or lamivudine) 2, 4
Completing the full 28-day course is essential for protection, and stopping early eliminates protection 2, 4

The CDC recommends administering Hepatitis B Immune Globulin (HBIG) and beginning the hepatitis B vaccine series for unvaccinated or incompletely vaccinated exposed workers if the source is HBsAg-positive 1, 3
For previously vaccinated workers with known adequate response, no treatment is necessary 1, 3

The CDC states that no post-exposure prophylaxis exists for hepatitis C, and early identification through testing is the primary approach 2, 3
The risk of HCV transmission is approximately 1.8% (range 0-7%) per percutaneous exposure 3

The CDC recommends baseline HIV testing before starting PEP, and follow-up testing at 6 weeks, 3 months, and 6 months post-exposure 2, 3
For hepatitis C, baseline anti-HCV and ALT testing is recommended, followed by testing at 4-6 weeks and 4-6 months post-exposure 2, 3
For hepatitis B, anti-HBs testing is recommended 1-2 months after the last vaccine dose 3

The CDC recommends using barrier protection during sexual activity for 6 months post-exposure 2
Donating blood, plasma, organs, tissue, or semen should be avoided during the 6-month follow-up period 2
Seeking immediate medical evaluation for any acute illness during follow-up is essential, as it may indicate acute retroviral syndrome 2, 3