Needlestick accidents at work: What to do next

BOSTON – Following several procedures in the event of a sharp-related injury at work can minimize the risk for contracting infectious diseases, according to a speaker at the American Academy of Physician Assistants IMPACT 2014 meeting.

Approximately three in 1,000 sharp injuries that occur in healthcare settings result in infection, Sudave Mendiratta, MD, director of the emergency medicine program at the University of Tennessee College of Medicine in Chattanooga, reported here.


Following appropriate procedures and post-exposure prophylaxis (PEP) guidelines can ensure the majority of clinicians with a sharp-related injury stay infection free.

Sharp-related injuries occur most commonly with disposable syringes and intravenous tubing needles, followed by, cartridge syringes, butterflies, phlebotomy needles and IV stylets, according to Mendiratta.

No matter what the infectious agent, healthcare workers should follow four “Ds” to minimize the risk for transmission: decontaminate by washing and irrigating the wound immediately, document, determine the source and determine the risk.

Remember that PEP is most efficacious in the first two hours after exposure, so it's important that staff stop what they are doing and seek immediate treatment.  The benefits of PEP greatly diminish after 24 hours.

Once PEP is initiated and the accident has been documented, clinicians should undergo blood testing at regular intervals (0, 6 weeks, 3 months and 6 months) to determine infection status, and also PEP toxicity to make sure the chosen PEP regimen is well tolerated.

HIV PEP

The treatment of choice for PEP in the majority of HIV-related needlestick exposures is tenofovir-emtricitabine plus raltegravir once daily, due to the regimens high potency, few side-effects and general well tolerability, Mendiratta stated.

Other regimens for HIV PEP include:

  • Raltegravir (Isentress)and tenofovir plus emtricitabine (Truvada)
  • Darunavir (Prestiza) plus ritonavir  (Norvir) and tenofovir plus lamivudine (Epivir)
  • Etravirine (Intelence) and zidovudine plus lamivudine (Combivir)
  • Rilpivirine (Edurant) and zidovine plus emtricitabine
  • Altazanavir (Reyataz) and ritonavir (Norvir)
  • Lopinavir/ritonavir (Kaletra)

Several factors influence transmission risk in HIV exposure, including the patient's viral load, the route of exposure (percutaneous, mucous membrane, cutaneous), the depth of exposure and the volume of bodily fluid involved.

Hepatitis B & C PEP

Between 600,000 to 800,000 HBV and HBC exposures occur annually in hospitals, with the greatest risk occurring in ED, OR and patient room settings.

The CDC's Advisor Committee on Immunization Practices currently recommends that all healthcare workers be vaccinated against hepatitis B. Unvaccinated clinicians exposed to a needlestick should be vaccinated immediately. Hepatitis B immunoglobulin therapy should also be considered.

There is no currently recommended PEP for HCV, but early treatment with new HCV combination treatments can be curative, according to Mediratta, albeit expensive.

References

  1. Mendiratta S. #B4081. “Don't Bring Work Home: Needlesticks, Body Fluids and High-Risk Exposures.” Presented at: AAPA 2014. Boston; May 23-28, 2014.
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