eMedicine Specialties > Emergency Medicine > Infectious Diseases

Needle-stick Guideline

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

Introduction

Background

Concern regarding the management of occupational exposure to human immunodeficiency virus (HIV) was heightened when it was realized that HIV is transmitted by body fluids. In spite of this concern, the risk of hepatitis continues to be the greater occupational threat.

Pathophysiology

The major pathogens of concern in occupational body fluid exposure are HIV, hepatitis A, hepatitis B, hepatitis C, and hepatitis D.1,2,3 These pathogens are viruses that require percutaneous or mucosal introduction for infectivity. The major target organs are the immune system (HIV) and the liver (hepatitis). A lesser theoretical concern is tetanus, which attacks the CNS.

Frequency

United States

The rate of occupational transmission from an HIV-positive source is believed to be 0.3% for a percutaneous exposure and 0.09% for a mucous membrane exposure.4,5 The rate of transmission from a hepatitis B-positive source to a nonimmunized host is 6-24% and 1-10% for exposure to hepatitis C.2

Clinical

History

  • No symptoms of disease should be expected from the needle-stick exposure, upon a timely presentation.
  • The history should focus on the patient's medical history, including immunizations and risk factors for both HIV and hepatitis.
  • Specific questions include the following:
    • Complete immunization record, including tetanus and hepatitis B
    • Previous occupational exposure to body fluids
    • Intravenous drug abuse
    • Sexual history
    • Body piercing or tattooing
    • Receiving blood and/or blood products
    • Any history of dialysis
    • Travel outside the United States in the last year

Physical

  • No abnormal physical findings, other than evidence of the reported trauma, should be expected upon a timely presentation.
  • At a minimum, a baseline screening examination of the lungs, liver, and lymph nodes should be documented for future reference.

Causes

  • Risk factors for occupational exposure to body fluids include the following:
    • Failure to adhere to universal precautions
    • Using equipment designed without appropriate safety features
    • Performance of exposure-prone procedures

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

  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].

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Further Reading

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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 

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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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