Contents

Search

prophylaxis after needle stick; prophylaxis for blood-borne infection

Epidemiology: - 1000 accidental needlesticks/day in U.S. hospitals - 1 in 300 chance of transmitting HIV if the source is positive Management: - hepatitis B vaccine with hepatitis B immune globulin - seropositive contact or serostatus unknown - not needed if hepatitis B immunity after hepatitis B vaccination [1] - HBsAb in serum in > 10 mIU/mL implies immunity [1] - consider post-exposure HIV prophylaxis - 1st antiviral dose should be within 3 hours - 3-drug regimen for most patients - use Truvada (emtricitabine/tenofovir) plus dolutegravir or raltegravir (Isentress) for 4 weeks in most cases [1,2] - HIV antibody to assess victim's prior exposure (why the epipheny now?) [3] - presumably prior to 1st post-exposure prophlactic antiviral dose within 3 hours - postexposure management of hepatitis C - hepatitis C serology & hepatitis C virus RNA at the time of exposure then every 2 months for indefinite period [3]

Related

hypodermic needle post-exposure HIV prophylaxis

General

chemoprophylaxis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 14, 18, 19 American College of Physicians, Philadelphia 2006, 2018, 2022.
  2. Prescriber's Letter 20(12): 2013 HIV Occupational Post-Exposure Prophylaxis Detail-Document#: 291209 (subscription needed) http://www.prescribersletter.com
  3. Henderson DK. Management of needlestick injuries: a house officer who has a needlestick. JAMA. 2012;307(1):75-84. Epub 2011 Dec 6. PMID: 22146902
  4. NEJM Knowledge+