eMedicine Specialties > Emergency Medicine > Infectious Diseases

Needle-stick Guideline: Differential Diagnoses & Workup

Author: Brenda Cosens, RN, Director, Developmental Disabilities Provider Services, Metrocare Services, Incorporated
Coauthor(s): Robert E Suter, DO, MHA, Professor, Division of Emergency Medicine, University of Texas at Southwestern Medical School
Contributor Information and Disclosures

Updated: Aug 18, 2009

Workup

Laboratory Studies

  • Source patient (if available)
    • HIV
    • Hepatitis B antigen
    • Hepatitis C antibody
    • Aspartate aminotransferase/alanine aminotransferase (AST/ALT) and alkaline phosphatase levels
  • Victim/health care worker
    • Hepatitis B surface antibody
    • HIV
    • Hepatitis C antibody testing at 2 weeks, 4 weeks, and 8 weeks
  • Prior to initiating retrovirals
    • Pregnancy test (stat)
    • CBC count with differential and platelets
    • Serum creatinine/BUN levels
    • Urinalysis with microscopic analysis
    • AST/ALT levels
    • Alkaline phosphatase level
    • Total bilirubin level

More on Needle-stick Guideline

Overview: Needle-stick Guideline
Differential Diagnoses & Workup: Needle-stick Guideline
Treatment & Medication: Needle-stick Guideline
Follow-up: Needle-stick Guideline
References

References

  1. Bassett IV, Freedberg KA, Walensky RP. Two drugs or three? Balancing efficacy, toxicity, and resistance in postexposure prophylaxis for occupational exposure to HIV. Clin Infect Dis. Aug 1 2004;39(3):395-401. [Medline].

  2. CDC. Recommendations for follow-up of health-care workers after occupational exposure to hepatitis C virus. MMWR Morb Mortal Wkly Rep. Jul 4 1997;46(26):603-6. [Medline].

  3. Merchant RC, Keshavarz R. HIV postexposure prophylaxis practices by US ED practitioners. Am J Emerg Med. Jul 2003;21(4):309-12. [Medline].

  4. Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med. Nov 20 1997;337(21):1485-90. [Medline].

  5. CDC. Public Health Service guidelines for the management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis. Centers for Disease Control and Prevention. MMWR Recomm Rep. May 15 1998;47(RR-7):1-33. [Medline].

  6. Sidwell RU, Green JS, Novelli V. Management of occupational exposure to HIV--what actually happens. Commun Dis Public Health. Dec 1999;2(4):287-90. [Medline][Full Text].

  7. Houston SH, Sinnott JT, Palumbo SJ. Employee health and safety. In: Reese, ed. Practical Approach to Infectious Diseases. 1996:706-724, 1406-1409.

  8. CDC. Recommendations for Postexposure Interventions to Prevent Infections with Hepatitis B Virus, Hepatitis C Virus, or Human Immunodeficiency Virus, and Tetanus in Persons Wounded During Bombings or Similar Mass-Casualty Events - United States, 2008. MMWR [serial online]. August 2008;57(RR-6):1-19. Available at www.cdc.gov/mmwr/pdf/rr/rr5706.pdf.

  9. Hsieh WB, Chiu NC, Lee CM, Huang FY. Occupational blood and infectious body fluid exposures in a teaching hospital: a three-year review. J Microbiol Immunol Infect. Aug 2006;(4):321-7. [Medline].

  10. Merchant RC, Becker BM, Mayer KH, Fuerch J, Schreck B. Emergency department blood or body fluid exposure evaluations and HIV postexposure prophylaxis usage. Acad Emerg Med. Dec 2003;10(12):1345-53. [Medline].

  11. Moran GJ. Emergency department management of blood and body fluid exposures. Ann Emerg Med. Jan 2000;35(1):47-62. [Medline].

  12. Peate I. Occupational exposure of staff to HIV and prophylaxis therapy. Br J Nurs. Oct 28-Nov 10 2004;13(19):1146-50. [Medline].

  13. Rinnert KJ. A review of infection control practices, risk reduction, and legislative regulations for blood-borne disease: applications for emergency medical services. Prehosp Emerg Care. Jan-Mar 1998;2(1):70-5. [Medline].

  14. Schriger DL, Mikulich VJ, Centers for Disease Control and Prevention. The management of occupational exposures to blood and body fluids: revised guidelines and new methods of implementation. Ann Emerg Med. Mar 2002;39(3):319-21. [Medline].

  15. U.S. Public Health Service. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR Recomm Rep. Jun 29 2001;50(RR-11):1-52. [Medline][Full Text].

Further Reading

Keywords

blood, body fluids, other potentially infectious materials, OPIM, needle stick, sharps injury, hepatitis, HBV, HCV, HDV, human immunodeficiency virus, HIV, acquired immunodeficiency syndrome, AIDS, tetanus, hepatitis A, hepatitis B, hepatitis C, hepatitis D, occupational transmission of disease, occupational exposure to body fluids 

Contributor Information and Disclosures

Author

Brenda Cosens, RN, Director, Developmental Disabilities Provider Services, Metrocare Services, Incorporated
Brenda Cosens, RN is a member of the following medical societies: Emergency Nurses Association
Disclosure: Nothing to disclose.

Coauthor(s)

Robert E Suter, DO, MHA, Professor, Division of Emergency Medicine, University of Texas at Southwestern Medical School
Robert E Suter, DO, MHA is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

William G Gossman, MD, Associate Clinical Professor of Emergency Medicine, Creighton University School of Medicine; Consulting Staff, Department of Emergency Medicine, Creighton University Medical Center
William G Gossman, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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