Infectious Disease and Foreign Travel Emergencies 151
Needlestick and Sharps Incidents
Inoculation Incident with HIV Risk
DIAGNOSIS
1 The risk of seroconversion is 0.1–0.5% following accidental inoculation of
blood or infectious material from a suspected HIV-positive person.
2 This risk depends on the nature and extent of the inoculation, and the viral
disease activity of the HIV-positive source.
3 Take 10 mL clotted blood from the injured person, and if possible 10 mL with
consent from the source. Send for HIV, hepatitis B and C testing, clearly
marking the specimen as ‘needlestick/sharps injury’.
MANAGEMENT
1 Wash wounds, and clean and f lush mucous membranes immediately after
exposure. Use a skin antiseptic such as 0.5% chlorhexidine in 70% alcohol
and encourage bleeding by local venous occlusion.
2 When the source is known to be HIV-positive with a high viral load or late-
stage disease, and higher-risk exposure has occurred, e.g. a deep needlestick
or laceration with blood inoculated, proceed as follows:
(i) Discuss the situation immediately with an infectious diseases
specialist.
(ii) On their advice, commence (within hours) antiretroviral therapy
such as lamivudine 150 mg with zidovudine 300 mg orally b.d.,
and lopinavir 400 mg with ritonavir 100 mg orally b.d. usually for
4 weeks. Check your local policy for regional variations.
(iii) The side effects of these drugs are complex and significant,
including rash, malaise, fatigue, headache, nausea, vomiting,
diarrhoea, hepatitis, pancreatitis and blood dyscrasias.
3 When the source is HIV-positive with a low viral load and lower-risk
exposure has occurred, e.g. superficial scratch or mucous membrane
contamination, commence zidovudine and lamivudine alone, or according
to local policy.
4 Refer the injured person to Occupational Health for follow-up with repeat
serology and monitoring blood tests, advice and ongoing counselling with
psychological support.
(i) Report the incident to the senior ED doctor and infection control
officer.
(ii) The exposed person requires follow-up for up to 6 months,
should practise safe sex, should not donate blood, and should
avoid pregnancy.
(iii) Assure confidentiality and sensitivity for all concerned.
