Needlestick

Description

• Potential exposure to HIV, hepatitis B (HBV), or hepatitis C (HCV) defined as exposure to infectious body fluid AND portal of entry (percutaneous, mucous membrane, nonintact skin)
• Infectious body fluid:
  • Blood
  • Semen/vaginal fluid
  • amniotic fluid/breast milk
  • Pericardial/peritonea/pleural fluid
  • Synovial fluid, CSF
  • Note that saliva, urine, vomit, feces, sweat, tears, resp secretions NOT considered an exposure unless visibly blood tinged
• General prevention:
  • Universal precautions
  • Avoid recapping of needles
  • Wear gloves: Decreases amount of blood exposure by 50%
  • Double gloving
  • Follow body–substance isolation protocols
  • Hepatitis B virus vaccination
• Risk factors:
  • Risk of seroconversion from a single needlestick exposure without prior immunization:
    • Hepatitis B virus: 37–62% from HB_sAg-positive and HB_eAg-positive source, 23–37% from HB_sAg-positive and HB_eAg-negative source
    • Hepatitis C virus: 1.8%
    • HIV: Blood 0.3%, mucous membrane 0.09%
  • Infectiousness of various body fluids for HIV:
    • Plasma/serum: 10–5,000 ppm
    • CSF: 10–1,000 ppm
    • Semen: 10–50 ppm
    • Vaginal secretions, urine, saliva, tears, breast milk: <1 ppm
  • Factors affecting risk:
    • Viral load
    • Actual injection volume
    • Type and size of needle
    • Portal of entry (depth of inoculation)
    • Duration of contact
    • Level of disease in source patient
    • Host susceptibility
    • Barriers (e.g., through gloves)