Bloodbourne Infections and Needlestick Injury

Needlestick injuries and other exposures are a risk that all healthcare workers are exposed to. Out of hours they may easily present to the ED and are therefore on the syllabus for CT3 - they have also appeared in part B. Questions around rates of seroconversion, vaccinations and risks could easily appear in part A.

The Syllabus includes the following:

The health protection agency have a useful tutorial/ elearning http://www.health-protection-update.org.uk:8100/tutorials/needlestick/

Points to consider:

Risks:

Donor - Known blood HIV, Hepatitis B/C or High risk group - IVDU/ High prevalence Country

Fluid- Blood/ CSF/ Peritoneal or Pleural Fluid/ Breast Milk

Mechanism- hollow needles/ visible blood/ needle that has been in vein or artery/ deep wound/ not --------------------- through gloves/ injection of contaminated material

Disease Specifics:

The risks of transmission differ for the 3 main infections:

Hep B (30%) > Hep C (3%) > HIV (0.3.%)

Management:

It is necessary to take a relevant history including the risk factors and the vaccination status of the patient. The main point of management is to make a risk assessment and decide of post-exposure prophylaxis (PEP) is needed - you will have a local policy for this and it may well involve your oncall microbiologist. Follow up will be necessary however this is likely to be by occupational health rather than the ED.

• HIV - PEP available to high or unknown risk - many side effects and interatctions to consider
• Hep B - need to know immunisation status - immunoglobulin available
• Hep C - no PEP available