Needlestick Injuries: What Is The Estimated Risk Of Disease Transmission And What You Should Do Next

What is the risk of infection after an occupational exposure?



Hepatitis B Virus (HBV)

Health care workers who have received hepatitis B vaccine and have developed immunity to the virus are at virtually no risk for infection. For an unvaccinated person, the risk from a single needlestick or a cut exposure to HBV-infected blood ranges from 6%–30% and depends on the hepatitis B e antigen (HBeAg) status of the source individual. Individuals who are both hepatitis B surface antigen (HBsAg) positive and HBeAg positive have more virus in their blood and are more likely to transmit HBV.

Hepatitis C Virus (HCV)

Based on limited studies, the estimated risk for infection after a needlestick or cut exposure to HCV-infected blood is approximately 1.8%. The risk following a blood splash is unknown but is believed to be very small; however, HCV infection from such an exposure has been reported.

Human Immunodeficiency Virus (HIV)

• The average risk for HIV infection after a needlestick or cut exposure to HlV-infected blood is 0.3% (about 1 in 300). Stated another way, 99.7% of needlestick/cut exposures to HIV-contaminated blood do not lead to infection.
• The risk after exposure of the eye, nose, or mouth to HIV-infected blood is estimated to be, on average, 0.1% (1 in 1,000).
• The risk after exposure of the skin to HlV-infected blood is estimated to be less than 0.1%. A small amount of blood on intact skin probably poses no risk at all. There have been no documented cases of HIV transmission due to an exposure involving a small amount of blood on intact skin (a few drops of blood on skin for a short period of time). The risk may be higher if the skin is damaged (for example, by a recent cut), if the contact involves a large area of skin, or if the contact is prolonged.

What should be done following an occupational exposure?

Wounds and skin sites that have been in contact with blood or body fluids should be washed with soap and water; mucous membranes should be flushed with water. Immediate evaluation must be performed by a qualified health care professional.1 Health care providers who evaluate exposed dental health care professionals should be

• Selected before dental health care professionals are placed at risk of exposure.
• Experienced in providing antiretroviral therapy.
• Familiar with the unique nature of dental injuries so they can provide appropriate guidance on the need for antiretroviral prophylaxis.

Employers should follow all federal (including the Occupational Safety and Health Administration (OSHA)) and state requirements for recording and reporting occupational injuries and exposures. The following information should be included in the exposure report, recorded in the exposed person's confidential medical record, and made available to qualified health care professionals:1

• Date and time of exposure.
• Details of the procedure being performed, including where and how the exposure occurred, whether the exposure involved a sharp device, the type of device, whether there was visible blood on the device, and how and when during its handling the exposure occurred.
• Details of the exposure, including the type and amount of fluid or material and the severity of the exposure. For a percutaneous injury, details would include the depth of the wound, the gauge of the needle, and whether fluid was injected; for a skin or mucous membrane exposure they would include the estimated volume of material, the duration of contact, and the condition of the skin (e.g., chapped, abraded, or intact).
• Details about the exposure source—whether the patient was infected with hepatitis B virus (HBV) and his or her hepatitis B e antigen (HBeAg) status; hepatitis C virus (HCV); or human immunodeficiency virus (HIV); and, if the source was infected with HIV, the stage of disease, history of antiretroviral therapy, and viral load, if known. If this information is not known from the medical record, then the source patient should be asked to obtain serologic testing for HBV, HCV, and HIV.
• Details about the exposed person (e.g., hepatitis B vaccination and vaccine-response status).
• Details about counseling, post-exposure management, and follow-up.

What factors must qualified health care professionals consider when assessing the need for follow-up of occupational exposures?

The evaluation must include the following factors to determine the need for further follow-up:

Type of exposure

• Percutaneous injury (e.g., depth, extent)
• Mucous membrane exposure
• Nonintact skin exposure
• Bites resulting in blood exposure to either person involved

Type and amount of fluid/tissue

• Blood
• Fluids containing blood

Infectious status of source

• Presence of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg)
• Presence of hepatitis C virus (HCV) antibody
• Presence of human immunodeficiency virus (HIV) antibody

Susceptibility of exposed person

• Hepatitis B vaccine and vaccine response status
• HBV, HCV, or HIV immune status

After conducting this initial evaluation of the occupational exposure, a qualified health care professional must decide whether to conduct further follow-up on an individual basis using all of the information obtained.

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