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Starship Children’s Health Clinical Guideline Note: The electronic version of this guideline is the version currently in use. Any printed version can not be assumed to be current. Please remember to read our disclaimer. NEEDLESTICK INJURIES • • • Wound Care Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) • • • Human Immunodeficiency Virus Summary of Procedure References Guidelines for management of needlestick injuries in healthcare workers are available via the Auckland District Health Board intranet, occupational health. This document pertains to needlestick injuries from discarded needles in the community, from an unknown source: the risks of blood-borne pathogen transmission are very much lower. Consider potential for infection with: HIV, Hepatitis B, Hepatitis C, Tetanus Wound Care Thoroughly clean with soap and water. Administer tetanus toxoid or tetanus immune globulin (TIG) according to usual guidelines 2. Hepatitis B virus (HBV) HBV is the hardiest pathogen, surviving several days on surfaces, maybe over a week. Follow table below. Administration of hepatitis immune globulin (HBIG) is not indicated if the child has completed a standard three-dose regimen of hepatitis B vaccination. TABLE 1 : Hepatitis B Prophylaxis after Percutaneous Exposure to Blood (modified from3) Exposed person Unvaccinated or only one dose of vaccine Treatment when source is : HbsAg-Positive HbsAg-negative Unknown Administer HBIG, 1 dose, and commence/continue vaccine schedule Commence/continue vaccine schedule Commence/continue vaccine schedule No treatment No treatment No treatment HBIG 1 dose and initiate revaccination; or HBIG 2 doses one month apart No treatment If known high-risk source, treat as if source were HbsAg-positive Test exposed person for anti-HBs • If <10mIU/ml, give 1 dose HBIG and initiate revaccination • If >10mIU/ml, no treatment No treatment As for source HbsAgpositive Previously fully vaccinated: Known responder Known nonresponder Response unknown Author: Editor: Needlestick Injuries Dr Elizabeth Wilson / Infection Control Dr Raewyn Gavin Service: Infectious Diseases / Infection Control Date Reviewed: August 2008 Page: 1 of 2 Starship Children’s Health Clinical Guideline Note: The electronic version of this guideline is the version currently in use. Any printed version can not be assumed to be current. Please remember to read our disclaimer. NEEDLESTICK INJURIES Hepatitis C virus (HCV) HCV viability on fomites is poor, so risk of transmission from discarded needles is low. No postexposure prophylaxis known to be effective 4. Human Immunodeficiency Virus The risk of HIV transmission from a needlestick injury from a person with known HIV infection to a healthcare worker is 0.3%: the risk from a discarded needle in the community is many fold lower than this because 1)HIV does not survive well outside the body: drying HIV reduces concentrations by 90-99% within several hours. 2) the prevalence of HIV in intravenous drug users in NZ is very low Therefore the use of post-exposure HIV prophylaxis is not routinely recommended in this situation5. NB If features of the incident suggest substantially increased risk (e.g. deep injury, large bore needle, fresh blood) please discuss with on-call paediatric infectious diseases consultant regarding need for post-exposure prophylaxis. If required, this should be started within hours of the injury. HIV testing of the syringe blood (if available) is not practical or reliable and is not recommended. Summary of Procedure 1) Local wound care 2) Take blood for HIV, HBV and HCV at baseline and arrange follow-up bloods at 6 weeks, 3 months and 6 months. N.B. Seroconversion would be grounds for ACC claim 3) Assess need for tetanus and HBV prophylaxis, and initiate 4) Assess risk level for HIV: this will be extremely low but if in doubt discuss with paediatric ID consultant . 5) Counsel family regarding need for these measures. References References 1 CDC.MMWR Recommendations and Reports.2001;50 (RR-11):1-52 2 Immunisation Handbook 2006. NZ ministry of Health.p94 3 . American Academy of Pediatrics .Hepatitis B. In Pickering. LK, et al.eds. Red Book 27th edition 2006. pg 354 4 Chadwick E. Pediatric Infectious Diseases Journal 1998 18(1):69 -70 5 Havens PL and Committee on pediatric AIDS: Pediatrics 2003;111;1475-1489 Author: Editor: Needlestick Injuries Dr Elizabeth Wilson / Infection Control Dr Raewyn Gavin Service: Infectious Diseases / Infection Control Date Reviewed: August 2008 Page: 2 of 2