How Should Healthcare Workers Handle Needlestick Injuries?

by Nichole G. Zehnder, MD •

Further, they suggested that HCV seroconversion only occurred from hollow-bore needles, because no seroconversions were noted in healthcare workers who sustained injuries with solid sharp objects.

Post-Exposure Management

The CDC does not recommend prophylaxis when source fluids make contact with intact skin; however, if a percutaneous occupational exposure has occurred, PEPs exist for HIV and HBV but not for HCV.3,6 If a source patient’s HIV, HBV, and HCV statuses are unknown, occupational health personnel can interview the patient to evaluate his or her risks and initiate testing. Specific information about the time and nature of exposure should be documented.

When testing is indicated, it should be done following institutional and state-specific exposure control policies and informed consent guidelines. In all situations, the decision to begin antiviral PEP should be carefully considered, weighing the benefits of PEP versus the risks and toxicity of treatment.

Human immunodeficiency virus. If a source patient is known to be HIV-positive, has a positive rapid HIV test, or if HIV status cannot be quickly determined, PEP is indicated and should be started as quickly as possible.3,8,10

The 2013 U.S. Public Health Service recommendations for PEP call for initiating three (or more) antiretroviral drugs for all occupational exposures. Current recommendations indicate that PEP should be continued for four weeks, with concurrent clinical and laboratory evaluation for drug toxicity.10

Although the combination of HBIG and the hepatitis vaccine B series has not been evaluated as PEP in the occupational setting, evidence in the perinatal setting suggests this regimen is more effective than HBIG alone.3,6,8

Table 4. Risk of Infection and Required Post-Exposure Prophylaxis for the Three Most Commonly Transmitted Pathogens

(Click for larger image)
Table 4. Risk of Infection and Required Post-Exposure Prophylaxis for the Three Most Commonly Transmitted Pathogens

Hepatitis C virus. No PEP exists for HCV, and current recommendations for post-exposure management focus on early identification and treatment of chronic disease. There are insufficient data for a treatment recommendation for patients with acute HCV infection with no evidence of disease; the appropriate dosing of such a regimen is unknown. Further, evidence suggests that treatment started early in the course of chronic infection could be just as effective and might eliminate the need to treat persons whose infection will spontaneously resolve.7

Back to the Case

Your needlestick occurred while using a hollow-bore needle to cannulate a source patient’s vein, placing you at higher risk for seroconversion. You immediately reported the exposure to the department of occupational health at your hospital. The source patient’s HIV, HBV, and HCV serological statuses were tested, and the patient was found to be HBV-positive. After appropriate counseling, you decide to receive HBIG prophylaxis to reduce your chances of becoming infected with HBV infection.

Bottom Line

Healthcare workers who suffer occupational needlestick injuries require immediate identification and attention to avoid transmission of such infectious diseases as HIV, HBV, and HCV. Source patients should undergo rapid serological testing to determine appropriate PEP.