You are supervising a registrar during the insertion of a central line. He suffers a needle stick injury.
Outline your approach to this problem.
Stop the procedure, ensure patient is safe and you take over care if required.
Advise the registrar of the following:
• Wash the wound immediately with soap and water. Express any blood from the wound
• Alert your supervisor and initiate the injury reporting system used in your workplace.
• IdentifY the source patient,. who may need to be tested for HIV, hepatitis B, or
hepatitis C infections.
Report to employee health services, or other designated treatment facility.
• Get tested immediately and confidentially for HIV, hepatitisB, and hepatitis C infections.
• Document the exposure in detail, for your own records as well as for the employer. When the source patient is unknown or tests positive for HIV, hepatitis B, or hepatitis C infection, get postexposure prophylaxis (PEP) in accordance with CDC guidelines.If the patient has HIV,start prophylaxis within two hours of exposure. For possible hepatitis C exposure, no treatment is currently recommended, but you may want to talk to a specialist about experimental postexposure prophylaxis. .
• Make sure to follow up with postexposure testing at six weeks, three months, and six months, and depending on the risat one year. If PEP is prescribed, you should be monitored regularly for signs and symptoms of toxicity. Take precautions (especially by practicing safe sex) to prevent exposing others until follow-up testing is complete.
• Don't be afraid to seek additional information or a referral to an infectious disease specialist if you have any questions.
LITFL have an approach to staff needlestick injuries.
David Tripp's notes for the fellowship exam are also a source of a nice point-form algorithm.
A list of definitive sources for this information would include the NSW Health Policy Directive: HIV, Hepatitis B and Hepatitis C - Management of Health CareWorkers Potentially Exposed, as well as the Westmead Children's Hospital procedure "Needlestick and Blood Exposure Injuries: Health Care Worker".
An answer to this question, as a summary of the abovementioned references:
The following are associated with an increased risk of transmission:
Wicker, Sabine, et al. "Determination of risk of infection with blood-borne pathogens following a needlestick injury in hospital workers." Annals of occupational hygiene 52.7 (2008): 615-622.
McGovern, Patricia. "Needlestick injuries among health care workers: a literature review." AAOHN Journal 47 (1999): 237-244.
NSW Health Policy Directive: HIV, Hepatitis B and Hepatitis C - Management of Health CareWorkers Potentially Exposed
Westmead Children's Hospital procedure: "NEEDLESTICK AND BLOOD EXPOSURE INJURIES: HEALTH CARE WORKER"