Needlestick

Basics

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 HBsAg-positive and HBeAg-positive source, 23–37% from HBsAg-positive and HBeAg-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)

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