Emergency Medicine

152 Infectious Disease and Foreign Travel Emergencies

NEEDLESTICK AND SHARPS INCIDENTS

5 Consider the additional possibility of transmission of hepatitis B and the

need for tetanus prophylaxis (see p. 321).

Inoculation Incident with Hepatitis Risk

DIAGNOSIS

1 The risk of seroconversion in a non-immunized person following a needle-

stick injury with HBV-positive blood is 5–40%, and following injury with

hepatitis C virus-positive blood is 3–10%.

2 Take 10 mL clotted blood from the injured person, and if possible 10 mL with

consent from the source. Send for hepatitis B and C and HIV testing, clearly

marking the specimen as ‘needlestick/sharps injury’.

MANAGEMENT

1 Wash the area with soap and water, dress the wound, and give tetanus

prophylaxis.

2 Use Table 4.1 to determine the need for hepatitis B prophylaxis following

significant percutaneous, ocular or mucous membrane exposure in persons

without adequate immunity, i.e. anti-HBs levels unrecordable or <10 IU/mL.

Check your local policy for regional variations.

3 Refer the injured person to Occupational Health for follow-up, with repeat

serology and monitoring blood tests for up to 6 months.

(i) Inform the senior ED doctor and infection control officer.

Table 4.1 Hepatitis B prophylaxis following significant percutaneous, ocular or
mucous membrane exposure for persons without adequate immunity

Exposure source Exposed person

Test for HBsAg Test for anti-HBs (unless recent

satisfactory level of ≥10 IU/mL is

known)

HBsAg +ve, or cannot be identified

and tested rapidly

anti-HBs –ve or <10 IU/mL, give:

HBIGa

HB vaccineb

HBsAg –ve anti-HBs –ve offer HB vaccinec

anti-HBs, antibody to HBsAg; HB vaccine, hepatitis B vaccine; HBIG, hepatitis B

immunoglobulin; HBsAg, hepatitis B surface antigen.

aHBIG: 400 IU i.m. for adults, or 100 IU i.m. for children <30 kg, within 72 hours.

bHB vaccine: 1 mL i.m. within 7 days, then at 1–2 months, and a third dose at

6 months.

cInjury indicates evidence that the work area represents a significant exposure risk, so

full vaccination is encouraged for the injured (exposed) person.