Immediate care and risk assessment

Click on the image below to access a pdf of the flowchart for needlestick injury immediate care and BBV risk assessment.

Initial assessment of needlestick injuries should be conducted according to the above flowchart, which is also available as a separate PDF (Needlestick injury immediate care and risk assessment flowchart). Priorities are:

Appropriate wound care.
Assessing if a Significant Exposure has occurred (requires both a high-risk fluid and high-risk exposure).
If a Significant Exposure has occurred, determining the risk of the injured party contracting BBVs (depends on source patient BBV status, or likelihood the source is BBV+) and offering follow-up testing.

Please note:

HIV: PEP is rarely recommended unless source is known to be HIV+ with a detectable viral load, or from a high-risk group.
HBV: In non-significant exposure to HBV, consider initiating a course of HBV vaccine if there is ongoing risk (e.g. patient is a healthcare worker, police officer etc.).
HCV: There is no PEP for HCV. Patients at risk of HCV infection are managed by follow up testing only.

Risk assessment of bites

Transmission of HIV by human bite is extremely rare and occurs when there is severe trauma with extensive tissue damage.

Possible biting scenarios include:

HIV positive person bites injured party: a significant exposure would require:
- Mucosal trauma to the mouth of the biter
- Severe trauma with extensive tissue damage to the victim

HIV negative person bites known HIV positive person: significant exposure would require:
- Mucosal trauma to the mouth of the biter
- Significant bleeding from the victim into the mouth of the biter

If neither party is known to be HIV positive then a bite would not be considered a high-risk exposure.

Bite injuries are common in pre-school and school-age children and are low-risk.

Occasionally children can sustain community needlestick injuries; these are also low-risk; children should attend RHCYP for assessment & follow up.