Sex, Bites, and Needle Sticks

First Aid (ALL)

  • Encourage bleeding
  • Wash with copious amounts of water or saline
  • Don’t Suck
  • Don’t use Caustic agents

 

Risk of contamination

Exposure to body fluids (esp. bloody) carries some risk however the following confer:

Increased Risk

  • Deep or penetrating injuries/ wounds
  • Wide/hollow bore needles
  • Significant amount of blood contamination
  • Contamination of large areas of broken skin
  • The quality of the blood e.g. freshness and dilution factor
  • Lack of barriers to the transfer of body fluid
  • High viral load
  • Non-immune recipient
  • Needle previously in donor’s vein or artery
  • Some types of sexual activity

High Risk

  • Sharps injury/bite with: Skin penetration/ Contamination of broken skin or mucous membranes
    • Needles discovered in the street or the park should be considered as high risk of transmitting Hepatitis B and Hepatitis C but not HIV. 
  • Transfer of blood stained body fluid to the injured site
  • Blood or body fluid from a person known or suspected of having a blood borne virus

Typical Transmission Rates (from known infective sources)

  • Needle-stick; (Hep C) 1:3, (Hep B) 1:33, (HIV) 1:333
  • Sharing injecting equipment/ChemSex (HIV); 1:149
  • Receptive anal intercourse (HIV); general 1:90, ejaculation 1:65, no ejaculation 1:170
  • Insertive anal intercourse (HIV); general 1:666, non-circumcised 1:161, circumcised 1:909
  • Receptive vaginal intercourse (HIV); 1:1000
  • Insertive vaginal intercourse(HIV); 1:1219
  • Oral intercourse (HIV); <10,000
  • Human bite (HIV); <1:10,000

 

Treatment

  • Take 10ml Gel (brown) sample – saved sample(EPR in ED contamination injury order set)
  • Establish status of donor (Ward staff to do if patient)
  • Complete: Risk assessment form (& Sharpes injury form if staff member)

HIV

  • HIV +ve and within 72hr (preferably 1hr) of incident prescribe PEPSE pack (7 days)
    • Discuss with On-Call GUM/Microbiology with viral load if possible
    • One Truvada tablet (245mg tenofovir disoproxil & 200mg emtricitabine) OD
    • One Raltegravir tablet (400mg) BD
    • Occupational health/GUM Clinic within 7day
    • Provide;  PEP advice sheet
    • Children: Must be referred to Paediatrics Consultant On-Call
  • Not known but considered high risk with 72hr, discuss with GUM or Microbiology on-call (see source risk questions, at end of post)
  • Unknown or negative, or beyond 72hrs – treatment not recommended but needs Occupational Health/GP follow-up in 6 weeks

Hep B

  • Hep B +ve  or Unknown(see risk questions below)
    • Recipient immunised & currently >10mIU/ml (check anti-HBS)
      • Booster of Hep B vaccine
    • Recipient immunised & currently <10mIU/ml (check anti-HBS)
    • Unimmunised
      • Accelerated course immunisation (0, 1, & 2 months)
      • Consider Immunoglobulin (discuss with Microbiology On-Call)
  • All will need Occupational Health/GP follow-up in 6 weeks (1 month if having accelerated course)

Hep C

No treatment available, will need follow up with Occupational health/GP at 6 weeks, and if known positive counselling

 

A list of questions to determine the risk category of the source patient’s blood 

  • Have you ever given blood? If yes, when last donated? Continue to ask the following:
  • Have you ever been told that you are positive for HIV/AIDS, HBV or HCV?
  • (For men only) have you ever had sex, even safe sex with another man?
  • Have you ever injected yourself with drugs? (This includes body-building drugs, but excludes prescription drugs, such as insulin).
  • Have you ever lived in, or visited, any country outside the UK and had sex with men or women living there or received hospital treatment?
  • Have you ever received a blood transfusion outside the United Kingdom? If yes, where and when?
  • Have you ever undergone a medical or dental procedure outside of the UK. If so, where and when?
  • Have you paid or been paid for sex at any time?
  • Have you ever had sex with a person in the above groups?
Searchs: needlestick, needlesticks

2 comments

  1. Diccon says:

    Would you consider follow up via the sexual health service for low risk patients that don’t have access to occupational health? For eg “simple” occupational needle stick that may or may not be vaccinated for hep b.

    It is my usual practice to advise self referral to this service (as the BBV specialists), or to GP if they are reluctant to access due to stigma or location.

    I think they are better placed to provide counselling regarding the risk, or otherwise, and should anything be detected.

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