Common needlestick questions for medical students, finals, OSCEs and MRCP PACES
What are the risks following needlestick injury?
- Other than pain and anxiety, potentially any infection can be transmitted from a bacteraemia or viraemia, but the main infections of concern are blood-borne viruses:
- Hepatitis B virus (HBV) – 30% risk of transmission
- Hepatitis C virus (HCV) – 3% risk of transmission
- Human immunodeficiency virus (HIV) – 0.3% risk of transmission
What factors increase the risk of blood-borne virus transmission from needlestick injuries?
- The injury and factors that increase risk of transmission
- Gloves not worn
- Hollow, wide-bore needle
- Needle had contacted donor’s artery or vein
- Blood visible on device
- Brief time between needle’s contact with donor and recipient
- Deep puncture wound
- Contaminated material injected
- The donor and factors that increase risk of transmission
- Identity (name, date of birth, hospital/NHS number) for tracing and consenting for blood tests
- Known blood-borne virus infection
- Acquired immunodeficiency syndrome (AIDS)-defining illness eg cytomegalovirus (CMV) retinitis
- Previous or current intravenous drug user (IVDU)
- From a region with a high prevalence of blood-borne viral disease
- Men who have sex with men
- The recipient and factors that decrease risk of transmission
- Gloves worn
- Wound bled and irrigated immediately
- Confirmed immunity against HBV
Outline how you would assess and manage a patient who presented with a needlestick injury from a donor who they are concerned may be HIV positive?
- Ensure the patient had done the immediate management steps of encouraging bleeding and irrigated the wound.
- Assess the wound and ensure it is covered.
- Take full history assessing for risk of infection (as per notes on needlestick injury).
- Assess ideas, concerns and expectations. Reassure where appropriate. Explain that the risks are very low no matter what the route of transmission.
- Consent recipient patient for relevant investigations.
- The same will need to be done with the donor.
- Treat with vaccinations or PEP as appropriate (as per notes on needlestick injury).
- Refer to occupational health or onward service.