Needle Stick Injury : General

• Take blood and request hepatitis B surface antibody (serum gel tube) and to store serum.
• Do not routinely request investigations for hepatitis C or HIV.
• Source known: it is important that efforts are made to test the person who used the needle for blood borne viruses as for an occupational injury (i.e hepatitis B and C, and HIV serology). We do not test the syringe.
• Investigate specific injuries as clinically indicated. 

Acute Management

 http://www.rch.org.au/clinicalguide/guideline_index/Needle_Stick_Injury/#acute-management

First Aid

• Initial thorough washing of site with soap and water. 

Post-exposure prophylaxis - immunised patient
Tetanus:

• Needlestick injuries are considered tetanus-prone wounds.
• See Tetanus-prone wounds CPG 

Hepatitis B:

• In immunised patients, unless there has been a previous documented anti-HBs antibody level > 10 mIU/mL, check anti-HBs antibody level. 
• Administer hepatitis B booster vaccination to all patients with anti-HBs < 10 mIU/mL. Monovalent Engerix-B paediatric formulation or H-B-Vax II 0.5 mL IM.
• If hepatitis B serology is not available at the time of discharge from the emergency department, ensure results are followed up within 72 hours. Hepatitis B booster vaccines can be given by the LMO.

Hepatitis C:

• No post-exposure prophylaxis is available for hepatitis C. 

HIV:

• Only the highest risk needlestick injuries are offered HIV post-exposure prophylaxis which consists of 2-3 anti-retroviral medications administered for 28 days. For these scenarios, consult with the Infectious Diseases team

Post-exposure prophylaxis - unimmunised patients

• Ideally, post-exposure prophylaxis should be provided as the first part of a comprehensive plan for catch-up vaccinations. 

At minimum:

• Offer hepatitis B immunoglobulin within 72 hours.
• <30 kg: 100 IU IM injection.
• >30 kg: 400 IU IM injection.
• Offer Hepatitis B vaccination (3 dose-schedule).
• 0.5 mL IM (hepatitis B containing vaccine eg: Infanrix hexa, monovalent Engerix-B paediatric formulation or H-B-Vax II).
• Within 7 days, and at 1 and 6 months after first dose.
• Can be given at same time but different limb from immunoglobulin. 

Follow up

• Reassure patients and carers that the risk of viral transmission from community-acquired needlestick injuries in children is exceedingly low.
• Provide unimmunised patients with written information in relation to further catch-up doses of hepatitis B and tetanus vaccines (at minimum).
• Refer to the Infectious Diseases outpatient clinic to provide an opportunity for questions and to plan follow-up investigations and vaccinations, if required.

Reference:

1. http://www.rch.org.au/clinicalguide/guideline_index/Needle_Stick_Injury/#acute-management
2. Guidelines On Occupational Exposures To Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) And Hepatitis C Virus, And Recommendations For Post Exposure Prophylaxis (PEP)
3. Recommendations on the Postexposure Management and Prophylaxis of Needlestick Injury or Mucosal Contact to HBV, HCV and HIV 
4. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendation for Postexposure Prophylaxis
5. Needlestick Injury
6. MANAGEMENT OF NEEDLESTICK INJURIES AND INCIDENTS
   INVOLVING EXPOSURE TO BLOOD AND BODY FLUIDS