Summary: This page focusses on the actions which must be taken in the event of a needlestick injury.
Who’s it for: All staff
All staff likely to be in contact with sharps or inoculation risks should be aware of their immunisation status regarding hepatitis B
Prevention of inoculation incidents
Inoculation incident: 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. graze, cut, burn
- Splash of blood or blood-stained body fluid into the eye, nose or mouth
- Human bite causing skin to be broken
Risk of infection from an inoculation incident
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 |
Precautions for reducing risk of an inoculation incident
- Dispose of single-use items after one use
- Be sure to follow our Safe use and 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
Immediate Actions
If the patient involved consents, a blood sample for hepatitis B, hepatitis C and HIV should be taken by the practice
In the event of a needlestick 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. 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, ANP, Occupational Health provider or the nearest Emergency Department (ED) if out of normal office hours. If you seek ED advice, notify a GP or Occupational Health.
- Complete a significant event form using the guide below
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You may be advised to liaise with:
- Lambeth and Southwark: Guy’s and St Thomas’ (GSTT), Third Floor The Education Centre, 75 York Road, Waterloo, SE1 7NJ. GSTT can be contacted on 020 7188 4152
- Lewisham: University Hospital Lewisham, Lewisham High Street, London, SE13 6LH. UHL can be contacted on 020 8333 3000
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3-months after the needlestick injury, the member of staff involved should be offered a blood test for hepatitis B, hepatitis C and HIV
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:
Action | Information |
Explain risk of infection to the patient | Risk of infection is low for discarded needles. Risk for needlestick injuries from a known positive source is described here |
If the source of injury is unknown or if the individual has any human bites, give accelerated course of hepatitis B vaccine | Give patient three doses of hepatitis B vaccine at 0, 1 and 2 months following injury. Give a 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) | HBIG is 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 |
Reducing risk of virus transmission in the practice
Seeking early advice from Occupational Health is key to preventing transmission
- Hepatitis B: all staff are offered an HBV vaccination after joining (see Onboarding & Pre-Start Checks for more information). If you are 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 ED. Go to ED as soon as possible after exposure, and notify Occupational Health.
It is very important to get PEP quickly after exposure, as it is most effective if started within one hour of exposure but not recommended beyond 72 hours post-exposure.
If you have any questions or concerns with any of these infection control policies, please let your Line Manager know or tell us here
Resources:
- For more information on significant event forms, see Significant Events