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.