A needlestick injury is one of the most frightening moments in a nurse’s career. The good news is that the risk of infection from a single exposure is low, and fast action reduces it further. Here’s exactly what to do.
Always follow your hospital’s occupational exposure policy and national guidelines. This guide is general information.
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Immediately: first aid
- Encourage the wound to bleed gently. Don’t squeeze hard or suck it.
- Wash with soap and running water. Don’t scrub or use bleach or strong antiseptics on the skin.
- For splashes to the eyes, nose or mouth: rinse thoroughly with plenty of water or saline. Remove contact lenses.
- Cover the wound with a waterproof dressing.
Within the first hour: report
- Tell the nurse in charge immediately.
- Go to occupational health, the emergency department or the designated PEP provider, depending on your hospital’s policy. Out of hours, emergency departments usually manage exposures.
- Complete an incident report.
- Don’t wait until the end of your shift. Time matters.
Risk assessment
A clinician will assess:
- Type of injury: deep injury, hollow-bore needle, visible blood or a needle that was in a vein or artery carry higher risk.
- Type of fluid: blood is higher risk than, for example, urine without visible blood.
- The source patient: known HIV, hepatitis B or hepatitis C status, viral load and treatment. With consent, the source patient may be tested.
- Your status: hepatitis B vaccination and immunity, and baseline blood tests.
Approximate infection risk
Commonly quoted estimates after a needlestick from an infected source are:
- HIV: about 0.3% (around 1 in 300)
- Hepatitis C: about 1.8% on average
- Hepatitis B: up to 30% in non-immune people, depending on the source
The HIV risk is much lower if the source patient is on effective treatment with an undetectable viral load.
HIV post-exposure prophylaxis (PEP)
- PEP is a short course of antiretroviral medicines, usually taken for 28 days.
- It should be started as soon as possible, ideally within hours, and generally no later than 72 hours after exposure.
- The decision to start depends on the risk assessment. If in doubt, PEP is often started and then stopped if the source tests negative.
- Common side effects include nausea, tiredness and headache. Modern regimens are generally well tolerated.
- Take every dose on time and complete the course.
Hepatitis B
- If you’re vaccinated with known immunity, you may need no further treatment.
- If you’re not immune, you may be offered a hepatitis B vaccine booster or course and, in some cases, hepatitis B immunoglobulin.
- All healthcare workers should complete hepatitis B vaccination and know their antibody response.
Hepatitis C
There’s no PEP for hepatitis C, but you’ll be tested at intervals. Early infection can be treated very effectively with modern antiviral medicines.
Follow-up
- Baseline blood tests, then follow-up tests at intervals set by your local policy (often at around 6 weeks and 3–4 months).
- Practise safer sex and avoid blood or organ donation until follow-up is complete, as advised.
- If you’re pregnant or breastfeeding, tell the clinician so medicines can be chosen safely.
- Seek support. It’s normal to feel anxious; talk to occupational health or a counsellor.
Preventing needlestick injuries
- Never recap needles.
- Dispose of sharps immediately into a sharps bin at the point of use.
- Don’t overfill sharps bins (close at the fill line).
- Use safety-engineered devices when available.
- Don’t pass sharps hand to hand.
- Wear gloves; they can reduce the volume of blood transferred.