NEEDLE STICK

 

Etiology:

  1. Risk of getting HIV from percutaneous and from mucous membrane exposure is 0.3% and less than 0.1% respectively.
     
  2. Risk of being infected with Hep B is 5-40% and with Hep C is 5-10% after needle stick.

DX:

  1. Obtain Hep B & C profiles, i.e. HBsAg, HBsAb, HCV Ab.
     
  2. Obtain LFTs, Amylase, CBC, SMA, UPT. These tests are for baseline, since pt has to get f/u tests to monitor drug toxicity.
     
  3. Advise pt about HIV testing as OPD (not in the ER). Contact  CSW for counseling and testing information

Treatment / Management:

  1. Clean wound with soap, saline, iodine, hydrogen peroxide and "Let it bleed."
     
  2. Td is given if needed.
     
    1. Hep B - pt not vaccinated and not immune:
       
      • give HB Ig 0.06 ml/kg IM within 24 hrs.
         
      • give first Hep B Vaccine (1.0 mL IM) series (total of three) within 7 days
         
  3.        HepB - pt vaccinated
     
      • draw blood to check for titers and LFTs and, if needed, give vaccine booster dose.
         
  4. Hep C
      • draw HCV Ab titers and LFTs.  Check latest literature for efficacy and recommendation of Ig. Advise pt to f/u the results.
  5. HIV
      • If pt is not at risk, i.e. urine, bloodless sputum, short contact with intact skin, treatment is not recommended.
      • If pt is at risk  of contracting HIV, i.e. blood products, fluids contaminated with blood, semen, CSF, pericardial, pleural, amniotic, synovial and vaginal fluids whether by needle, by membrane or by prolonged contact with extensive area of skin, treatment is offered. Treatment is started as soon as possible and preferably  within 1-2 hrs. but can be used up to 36 hrs postexposure. For latest, contact local CDC.  At present triple therapy is recommended.
         
    1. Following is the regimen and dosage:
       
        • Zidovudine (AZT, ZDV, Retrovir) 200 mg TID x 4 weeks
                               +
        • Lamivudine (3TC, Epivir) 150 mg BID x 4 weeks
                               +
        • Indinavir (IDV, Crixivan) 800 mg TID  (or Nelfinavir 750 mg PO BID) x 4 weeks.
           
        • Combivir 1 tab PO BID can be given instead of  Zidovudine + Lamivudine but Indinavir still needs to be prescribed.
           
    2. *Note! The medications may change in the future due to continued developments in the field.  Check with ID department, Occupational Health  or local CDC for the latest recommendations.
       
    3. If pt is started on medications, baseline CBC, SMA, LFT, Amylase, UPT are done in ED.
       
    4. Pt must be advised to f/u for HIV testing for 1.5-3-6 months and repeat lab tests.  Prophylactics must be used for  the first 6 months.

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