eMedicine Specialties > Emergency Medicine > Infectious Diseases
Needle-stick Guideline: Follow-up
Updated: Aug 18, 2009
Follow-up
Further Outpatient Care
- Follow up with occupational health or infectious disease in 24-72 hours.
- Discuss need for safe sex practices until follow-up laboratory testing is negative for HIV. Most now recommend a follow-up screen at 3 or 6 months.
Inpatient & Outpatient Medications
- Antiretrovirals, as indicated, by the 3-step assessment process (see Treatment section)
Deterrence/Prevention
- Universal precautions7
Complications
- Infection
Prognosis
- Most health care workers with occupational exposure to body fluids do not develop disease. For those who do, prognosis is the same as for other routes of transmission.
- For more specific information, see the relevant eMedicine topic.
Patient Education
- Refer to occupational health for extensive patient education. Having a brochure available to be given out in the ED is helpful to alleviate fear.
- For excellent patient education resources, visit eMedicine's Infections Center. Also, see eMedicine's patient education article Tetanus.
Miscellaneous
Related guidelines
HIV prophylaxis following occupational exposure
Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis
HIV post-exposure prophylaxis for children beyond the perinatal period
Diagnosis, management, and treatment of hepatitis C
Medicolegal Pitfalls
- With the advent of CDC recommendations for HIV postexposure prophylaxis, failure to counsel patients on the existence of retroviral treatment (eg, explain its risk/benefits) could be the source of a significant judgment if the patient subsequently develops HIV.
- Involvement of an informed patient in the decision-making process is essential.
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 |
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References
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].
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].
Merchant RC, Keshavarz R. HIV postexposure prophylaxis practices by US ED practitioners. Am J Emerg Med. Jul 2003;21(4):309-12. [Medline].
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].
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].
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].
Houston SH, Sinnott JT, Palumbo SJ. Employee health and safety. In: Reese, ed. Practical Approach to Infectious Diseases. 1996:706-724, 1406-1409.
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.
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].
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].
Moran GJ. Emergency department management of blood and body fluid exposures. Ann Emerg Med. Jan 2000;35(1):47-62. [Medline].
Peate I. Occupational exposure of staff to HIV and prophylaxis therapy. Br J Nurs. Oct 28-Nov 10 2004;13(19):1146-50. [Medline].
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].
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].
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
Follow-up: Needle-stick Guideline