Needle-stick Guideline

Updated: Oct 13, 2017
  • Author: Megan A Stobart-Gallagher, DO; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Overview

Background

Concern regarding the management of occupational exposure to human immunodeficiency virus (HIV) was heightened when it was realized that HIV is transmitted through bodily fluids. Despite this concern, the risk of hepatitis is actually a greater occupational threat.

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Pathophysiology

The major pathogens of concern in occupational body fluid exposure are HIV, hepatitis A, hepatitis B, and hepatitis C. [1, 2, 3, 4] 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 central nervous system.

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Epidemiology

The rate of occupational transmission from the blood of an HIV-positive source is believed to be 0.3% for a percutaneous exposure and 0.1% for a mucous membrane (nose, eye, mouth) exposure. [5, 6] For an exposure to intact skin, there is no risk of transmission if removed in timely fashion via washing. The rate of transmission from a hepatitis B–positive source to a nonimmunized host is 6%-24% and 1%-.8% (range, 0%-7%) for exposure to hepatitis C. [2] Hepatitis B infectivity depends on the hepatitis B e antigen (HBeAg) status of the source. If HBeAg-positive, the rate of transmission can be up to 30% but, when negative, is 1%-6%.

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