Reviewed on : 4 Jul 2019

Reviewed by : Lisa Berry & Judith Timms

Expires : 4 Jul 2021

Injury from used needles and syringes found in community settings arouses much concern, especially when children find discarded needles and injure themselves while playing with them.

Although the actual risk of infection from such an injury is very low, the perception of risk by parents results in much anxiety.

There has been single case reports of HBV and HCV transmission and no reported transmission of HIV following injuries by needles discarded in the community.

Please see links to right for further information and guidance.

All Cases of Needlestick Injury

• After the injury, clean the wound thoroughly with soap and water as soon as possible. It should not be squeezed to induce bleeding.
• Assess the extent of the wound, if any, or the probability of exposure of open skin lesions or mucous membranes to blood.
• Determine immunization status for tetanus and HBV.
• Tetanus vaccine, with or without tetanus immunoglobulin, should be given if indicated.
• Document the circumstances of the injury (the date and time of injury or exposure, where the needle was found, circumstances of the injury, type of needle, whether there was a syringe attached, whether visible blood was present in or on the needle or syringe, whether the injury caused bleeding and whether the previous user of the needle is known).
• Testing needles and syringes for viruses is not indicated. Results are likely to be negative, but a negative result does not rule out possibility of infection.
• Take a baseline serum sample for storage (it does not need testing) and give 1^stdose of HBV vaccine. This should be done even when the source is identified i.e. while awaiting results on the donor.

Follow up of Cases – Source is Known

• Check donor results
• If negative for BBV’s but source is not thought to be high risk then reassure patient; no follow up required.
• If donor is HCV RNA positive, test recipient as follows:
• 6 weeks serum sample for HCV Ab
• 12 weeks serum sample for HCV Ab and RNA
• 6 months serum for HCV Ab
• If donor is HIV positive – do they know and are they on treatment?  Treated and suppressed patients are lower risk for transmission.
• Risk assess for HIV PEP – call GUM; must be started within 72 hours and ideally within the hour
• Follow up recipient as follows:
• Screen for HIV at 12 weeks post exposure
• If donor is HBsAg positive then perform risk assessment to decide if HBIg is required in addition to vaccine.
• Follow up recipient at 6 months screen serum for HBsAg and sAb

Follow up of Cases – Source Unknown

• The testing/vaccination schedule suggested below is based on the follow up of a recipient exposed to an unknown or untested source and where the recipient has not received HIV PEP and has not previously received HBV vaccine.