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Common needlestick questions for medical students, finals, OSCEs and MRCP PACES

Question 1.

What are the risks following needlestick injury?

  • Other than pain and anxiety, potentially any infection can be transmitted from a bacteraemia or viraemia, but the main infections of concern are blood-borne viruses:
    • Hepatitis B virus (HBV) – 30% risk of transmission
    • Hepatitis C virus (HCV) – 3% risk of transmission
    • Human immunodeficiency virus (HIV) – 0.3% risk of transmission

Question 2.

What factors increase the risk of blood-borne virus transmission from needlestick injuries?

  • The injury and factors that increase risk of transmission
    • Time
    • Mechanism
    • Gloves not worn
    • Hollow, wide-bore needle
    • Needle had contacted donor’s artery or vein
    • Blood visible on device
    • Brief time between needle’s contact with donor and recipient
    • Deep puncture wound
    • Contaminated material injected
  • The donor and factors that increase risk of transmission
    • Identity (name, date of birth, hospital/NHS number) for tracing and consenting for blood tests
    • Known blood-borne virus infection
    • Acquired immunodeficiency syndrome (AIDS)-defining illness eg cytomegalovirus (CMV) retinitis
    • Previous or current intravenous drug user (IVDU)
    • From a region with a high prevalence of blood-borne viral disease
    • Men who have sex with men
  • The recipient and factors that decrease risk of transmission
    • Gloves worn
    • Wound bled and irrigated immediately
    • Confirmed immunity against HBV

Question 3.

Outline how you would assess and manage a patient who presented with a needlestick injury from a donor who they are concerned may be HIV positive?

  • Ensure the patient had done the immediate management steps of encouraging bleeding and irrigated the wound.
  • Assess the wound and ensure it is covered.
  • Take full history assessing for risk of infection (as per notes on needlestick injury).
  • Assess ideas, concerns and expectations. Reassure where appropriate. Explain that the risks are very low no matter what the route of transmission.
  • Consent recipient patient for relevant investigations.
    • The same will need to be done with the donor.
  • Treat with vaccinations or PEP as appropriate  (as per notes on needlestick injury).
  • Refer to occupational health or onward service.