Needlestick Injury: What Every Nurse Should Do in the First Hour (HIV PEP, Hepatitis B and C)

Sharps injuries are one of the most common occupational hazards in nursing. The World Health Organization has long recognised that health workers face a risk of hepatitis B, hepatitis C and HIV through needlestick and sharps injuries, and that most of these infections are preventable. If it happens to you, what you do in the first hour matters. Do not ignore it, and do not wait until the end of your shift.

Immediately: first aid

1. Encourage the wound to bleed gently. Do not suck it or squeeze hard.
2. Wash with soap and running water. Do not scrub, and do not use bleach or strong disinfectants on the skin.
3. Splash to the eyes, nose or mouth: rinse thoroughly with plenty of water (or saline for eyes). Remove contact lenses.
4. Cover the wound with a waterproof dressing.
5. Make the area safe: dispose of the sharp, hand over your patient, and tell the person in charge.

Within the hour: report and get assessed

Go straight to occupational health, the emergency department, or your facility’s designated PEP provider, according to policy. Out of hours, go to the emergency department. Report the incident in writing. Reporting protects you, including for any later compensation claim, and helps the hospital prevent the next injury.

How the risk is assessed

• Type of exposure: a deep injury with a hollow-bore needle that was in a vein or artery carries the highest risk. A splash on intact skin carries virtually none.
• Type of fluid: blood and visibly bloody fluids carry the most risk.
• The source patient: their HIV, hepatitis B and C status if known. If not known, the source patient may be asked for consent to testing. A colleague other than the injured worker should ask.
• Your own status: especially your hepatitis B vaccination and antibody level.

Commonly cited estimates of transmission risk from a single needlestick with infected blood are about 0.3% for HIV, about 1.8% for hepatitis C, and, for hepatitis B, up to 30% if the worker is unvaccinated and the source is highly infectious. That is why hepatitis B vaccination is so important.

HIV post-exposure prophylaxis (PEP)

• PEP is a course of HIV medicines that greatly reduces the chance of infection after a significant exposure.
• Start as soon as possible, ideally within hours, and no later than 72 hours after exposure, according to WHO.
• It is taken for 28 days. WHO’s preferred regimen for adults is tenofovir disoproxil fumarate + lamivudine (or emtricitabine) + dolutegravir. Your clinician will prescribe according to national guidelines.
• A baseline HIV test is done at the start; it is free and confidential in most public facilities.
• Complete the full course. Side effects are usually mild (nausea, headache, tiredness). Speak to your clinician rather than stopping.
• Use condoms and avoid donating blood until follow-up testing is complete.

Hepatitis B

If you have been vaccinated and have a documented protective antibody response, you need no further action for hepatitis B. If you are unvaccinated or not known to be protected, you may need a dose of hepatitis B vaccine (and start the full course), and, if the source is known to be positive, hepatitis B immunoglobulin, ideally within 24–48 hours.

Hepatitis C

There is no PEP or vaccine for hepatitis C. Instead, you will have follow-up testing so that any infection can be found early. Modern direct-acting antiviral medicines cure the vast majority of people with hepatitis C.

Follow-up

Follow-up testing schedules vary by country, but typically include repeat HIV and hepatitis C testing over the following months. Keep your appointments. It is normal to feel anxious after an exposure; ask about support, and talk to someone you trust.

Prevention: stop the next one

• Never recap needles. If you must, use a one-handed scoop technique.
• Dispose of sharps at the point of use in a puncture-proof sharps container. Take the container to the bedside.
• Do not overfill containers: close them at the fill line (usually three-quarters).
• Use safety-engineered devices (retractable or shielded needles) where available.
• Get fully vaccinated against hepatitis B and check your antibody response.
• Wear gloves, and eye protection where splashes are likely.
• Never pass sharps hand-to-hand; use a tray.

If your workplace lacks sharps containers, safety devices or PEP access, raise it formally with management and your union. Protecting health workers is part of protecting patients.

Related: WHO 5 Moments of hand hygiene · PPE donning and doffing

Based on WHO guidelines on HIV post-exposure prophylaxis, WHO occupational health guidance and US CDC occupational exposure guidance. Educational content: follow your national guidelines and occupational health advice.