Question What is the risk of developing Hepatitis B, C, or HIV following a needlestick injury? Answer Needlestick injuries are quite common in the health care environment. In fact, it has been estimated that there are 385,000 needlestick injuries per year. However, the number of needlestick injuries is likely underreported because individuals often do not take the time to report the injury or downplay the risk. Physicians and nurses have the most injuries, and amongst physicians, surgeons and anesthesiologists have the highest rates of injury while radiologists and pediatricians have relatively low rates. Needlesticks have the potential to transmit bacteria, viruses, and prions. The risk of infection, assuming a large bore hollow tip needle with deep penetration and with infected debris (such as blood) on it is as follows. Note that the risk of transmission for • Hepatitis B - 30% • Hepatitis C - 3% and HIV - 0.3% HEPATITIS B Carries the greatest risk of transmission in patients who have not been immunized. The risk is approximately 30%. • 85% of individuals who develop hepatitis B, the disease resolves spontaneously. • 12% of individuals will develop chronic disease, • 1% will develop cirrhosis, • 1% will develop hepatocellular carcinoma. HEPATITIS C The risk of transmission is between 0.5% and 3%. • 85% of infected individuals will develop chronic disease, • 20% of these individuals will develop cirrhosis. • 5% will develop hepatocellular carcinoma. HIV The risk of transmission is approximately 0.3% 2 factors Increase the RISK 1 - If the patient was terminally ill secondary to HIV (likely because of a high viral load), 2 - or if there was visible blood on the needle. Following a needlestick injury, standard hospital protocols should be followed. • The wound should be cleaned thoroughly with soap and water, • Baseline lab tests should be ordered on the injured individual (HIV, hepatitis panel) and the infectious status of the source. Unless the status of the source is already known, post exposure prophylaxis should be offered, ideally within one hour of the injury. Post exposure prophylaxis has been shown to have proven benefits in reducing HIV transmission. There is no HCV post exposure prophylaxis, and there is limited data on HBV post exposure prophylaxis. Ref 1. Barash: Clinical Anesthesia, ed 6, p 370-1 2. Morgan: Clinical Anesthesiology, ed 4, p 702
Posted on: Sun, 23 Mar 2014 22:06:25 +0000
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