Occupational health and safety issue and each hospital should have established policy and protocols. Aim is prevention through personal protective equipment and safe handling and disposal of sharps.
Risk of blood borne infections • Hep B - 1 in 10, Depends on patient infectivity eg. HBeAg and staff immunization state • Hep C - 1 in 50, Depends on viral load • HIV - 1 in 300, Depends on viral load, highest in AIDS (HIV+ with CD4 count <200) • Other blood borne disease eg. Syphilis
Risk depends on needle type and degree of contamination. Highest risk with hollow bore and visible blood
Initial management • Remove needle/suture from operative field • Unscrub, take gloves off. • Initiate first aid, Express blood from wound. Copious irrigation with water. Dress. No evidence for topical antiseptics. • Inform infectious control and documentation o Test source (patient) for infections with consent (Hep B, C, HIV serology). Consent ideally obtained preoperatively, otherwise post operatively by another member of the team. o Test trainee for - Infection: HIV 1+2 antibody, HBsAg (exclude carrier), anti-HCV, HCV PCR. - Baseline LFTs - Immunity: anti-HbsAg antibody > 10 IU/mL
Hepatitis B • If donor negative and not in window period, and if immunised and seroconversion proven then no further action required • If un-immunised or seroconversion unknown administer dose of HBV vaccine immediately and dose of HB immunoglobulin immediately.
Hepatitis C • If donor is negative and not in window period, no further action required • No evidence for prophylactic treatment should source be Hep C + • Follow up with HCV RNA at 6 weeks and HCV antibodies and LFT and 3 and 6 months
HIV • Double gloving dramatically ↓ incidence of penetrating injury to skin: 7%, Single glove: 51% • If donor is negative and not in window period, no further action required • Follow up HIV antibody testing at 6 weeks 3 months and 6 months • If need post exposure prophylaxis start within 24 hours • 2 anti-retrovirals for 4 weeks • High risk give 3 anti-retrovirals • Supervised by ID/HIV physician • Counselling/confidentiality
Risk depends on • Size of inoculum eg. Solid needle vs hollow bore needle • Infectivity of inoculums eg. HBeAg + most infective • Method of inoculation eg. Splash on skin vs mucous membrane