Summary: This page focusses on the actions which must be taken in the event of a needlestick injury.
Who’s it for: All staff
Inoculation Incidents
An inoculation incident is where blood or body fluid of one person could gain entry into another person's body, such as:
- a sharps / needlestick injury with a used instrument or needle.
- spillage of blood or body fluid onto damaged skin (e.g. a graze, cut or burn).
- splash of blood or blood-stained body fluid into the eye, nose or mouth.
- a human bite causing skin to be broken.
Risk of infection
Risk of infection following exposure will vary depending on: the nature of pathogens in the patient’s blood, the type of inoculation, and the amount of virus in the patient’s blood/body fluid at the time of exposure.
If you become inoculated with blood of a patient with HIV, Hepatitis B or Hepatitis C, your risk of acquiring the virus is as follows:
Virus | Risk of infection |
HIV | 1 in 300 (for needlestick injury)
1 in 1,000 (for mucous membrane exposure) |
Hepatitis B | 1 in 3 (if unvaccinated)
No risk (if vaccinated) |
Hepatitis C | 1 in 30 |
Reducing risk of injury & transmission
- Dispose of single-use items after one use.
- Be sure to follow our Safe Use & Disposal of Sharps, Hand Hygiene and Personal Protective Equipment (PPE) policies at all times.
- For invasive procedures where there is risk of exposure to contaminated sharps, wear disposable gloves.
- For extra protection, you can wear disposable gloves whenever you handle a sharp, as long as this does not affect your dexterity.
- Hepatitis B → all staff are offered an HBV vaccination after joining (see Onboarding & Pre-Start Checks for more information). If you’re exposed to the virus, you may be offered an additional vaccine dose/booster or HBIG.
- Hepatitis C → only basic first aid is advised after exposure. If exposed to a known hepatitis C source, contact Occupational Health for further advice on testing, management and preventing onward transmission.
- HIV → if you have been significantly exposed to a confirmed / suspected HIV-infected source, or if there is evidence of an AIDS-related illness, PEP is recommended.
PEP can only be provided at an Emergency Department (ED) — go ASAP after exposure (PEP as it is most effective if started within one hour of exposure, and not recommended beyond 72 hours post-exposure).
What to Do in the Event of an Injury
Immediately follow these steps:
- If there has been a puncture wound, make it bleed under running water.
- Clean the injured area / wound well with copious amounts of soap and warm running water and dry thoroughly. If blood/body fluid has splashed into the eyes, nose or mouth, irrigate with water.
- Apply a waterproof dressing to the wound.
- Report the injury to Lead Nurse and your line manager.
- Seek urgent clinical advice immediately (e.g. from your GP, Occupational Health provider or the nearest ED if out of normal working hours. If you seek ED advice, notify your GP or Occupational Health afterwards.)
- Complete a Significant Event form, ensuring to include the following information:
- What was the source of the sharp.
- A description of the accident (including date, time, name of any witnesses).
- EMIS number of patient.
- Any action taken following the accident.
- Any advice given to the patient and staff member involved.
- Any action taken to prevent another accident happening.
See note above about exposure to HIV/AIDS.
If the patient involved consents, a blood sample for hepatitis B, hepatitis C and HIV should be taken.
3 months after the needlestick injury, the member of staff involved should be offered a blood test for hepatitis B, hepatitis C and HIV.
You may be advised to liaise with:
- Guy’s and St Thomas’ (GSTT) → 020 7188 4152
- University Hospital Lewisham (UHL) → 020 8333 3000
Handling Exposure Incidents in the Community
If a patient presents to the practice following community exposure (e.g. injury with a discarded needle and syringe), take the following actions:
- Explain risk of infection to the patient → risk of infection is low for discarded needles. Risk for needlestick injuries from a known positive source are described above.
- If the source of injury is unknown or if the individual has any human bites, give accelerated course of hepatitis B vaccine:
- Three doses of hepatitis B vaccine at 0, 1 and 2 months following injury. Booster at 12 months.
- Offer Hepatitis B booster to patients that have been previously vaccinated.
- If an unimmunised patient has been exposed to a known hepatitis B positive source, consider referring for Hepatitis B immunoglobulin (HBIG) (only available via CCDC or Consultant Microbiologist).
- Medically assess human bites, and injuries from fights → due to risk of bacterial infection, consider need for antibiotic prophylaxis.
- Consider testing for Hepatitis C 3-months after exposure, if there has been significant exposure to a used needle.
- Consider referring the patient to ED for PEP, if they have been exposed to a known HIV positive transmission risk.