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Needlestick injury and occupational blood exposure
After a needlestick or blood splash, wash at once, report, assess the source and the worker's immunity, and start HIV post-exposure prophylaxis as early as possible – preferably within 2 hours and no later than 72 hours – alongside hepatitis B protection and follow-up for hepatitis C.
Why it matters in the exam
This is a fixed scenario in the exam: a resident is stuck by a needle after drawing blood from a patient, and you are asked for the first step, the risk of infection, whether to give prophylaxis and what follow-up is needed. The risk after a needlestick from a positive source differs greatly between viruses: hepatitis B – up to about 30% when the source is HBeAg positive and the worker is unprotected; hepatitis C – about 1.8% by the classic data; HIV – about 0.3%, and less for a mucosal exposure. The first step is washing with soap and water without irritant agents, followed by immediate reporting, so that no time for prophylaxis is lost. The source is tested (HBsAg, hepatitis C antibodies and HIV, with consent) and so is the worker (baseline tests and anti-HBs level). For HIV, a three-drug combination is given for 28 days when the source is positive or at high risk, and stopped if the source proves negative. A worker not vaccinated against hepatitis B, when the source is positive, receives immunoglobulin and starts vaccination – preferably within 24 hours; a worker who previously responded to the vaccine (anti-HBs of at least 10) needs no treatment. There is no prophylaxis for hepatitis C, so RNA and antibodies are followed and early treatment is given if infection develops. In prevention, most of the effect comes from safety-engineered devices, a ban on recapping needles and sharps containers within reach.
Key points
- Washing with soap and water and immediate reporting are the first steps.
- The risk after a needlestick: hepatitis B up to about 30%, hepatitis C about 1.8%, HIV about 0.3%.
- HIV prophylaxis starts as early as possible, up to 72 hours, for 28 days.
- A worker unprotected against hepatitis B receives immunoglobulin and vaccine when the source is positive.
- There is no prophylaxis for hepatitis C – there is follow-up and early treatment.
Summary table
| Virus | Risk after a needlestick from a positive source | Prophylaxis | Follow-up |
|---|---|---|---|
| Hepatitis B | Up to about 30% (HBeAg-positive source, unprotected worker) | Immunoglobulin and vaccine for an unprotected worker, preferably within 24 hours | Not needed for a worker with anti-HBs of at least 10 |
| Hepatitis C | About 1.8% | No prophylaxis | RNA after a few weeks and antibodies later; early treatment if infected |
| HIV | About 0.3% for a needlestick, less for mucosa | Three drugs for 28 days, as early as possible and up to 72 hours | Repeat tests according to the protocol |
| First aid | Washing with soap and water | No irritant agents | Immediate reporting |
| Prevention | Safety-engineered devices, no recapping of needles | Sharps container within reach | Hepatitis B vaccination for all staff |
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Sources
- CDC, Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis, 2013 — Infection Control and Hospital Epidemiology
- CDC, Guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management, 2013 — MMWR Recommendations and Reports
- Israel Ministry of Health, Director-General circular on prevention of bloodborne infection after occupational exposure, current — Management of exposed workers
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.
See also: HIV