1) Needle stick injuries can result in exposure to bloodborne viruses like hepatitis B, hepatitis C, and HIV. The risk of infection depends on factors like the type of needle and whether the needle was visibly contaminated with blood. 2) Immediate first aid for exposures includes washing wounds with soap and water and flushing splashes to the eyes or mouth with water. Exposed individuals should also take the first dose of post-exposure prophylaxis (PEP) for HIV as soon as possible. 3) Management of exposures involves testing the source for bloodborne viruses, evaluating the exposure risk, deciding on PEP treatment, obtaining consent, counselling, and follow-up testing of exposed individuals to monitor for potential

1. Needle Stick Injury
Prevention and Management
Dr. Rakesh Prasad Sah
Assistant Professor, Microbiology

2. • A penetrating stab wound from a needle (or other sharp
object) that may result in exposure to blood or other
body fluids.

3. • Splash injury:
– Contact with mucous membrane (eye or mouth)
– Contact with non-intact skin (abraded skin or afflicted with
dermatitis)
– Contact with the intact skin when the duration is prolonged (e.g.
several minutes or more)

4. Agents transmitted
• Hep-B  30%
• Hep-C  3%
• HIV  0.3%
• Blood borne viruses

5. • Infectious specimens for NSI
– Potentially infectious Body fluid  blood, genital secretions
(semen, vaginal), CSF, synovial fluid, pleural fluid, peritoneal fluid,
pericardial, aminiotic.
– Not considered potentially infectious  until visibly
contaminated with blood: Faeces, nasal secretions, saliva, sputum,
sweat, tears, urine and vomits.

6. Factors that influence risk
of contracting infection
following NSI
• Type of needle (hollow bore needle has a higher risk than
solid needle)
• Device visibly contaminated with blood
• Depth of injury
• Volume of blood involved in the exposure
• Timely performing first aid
• Timely start of appropriate PEP for HBV and HIV.

7. Prevention of Needle Stick
Injury
Precautions during
handling Needles
• Standard infection control
precautions must be
followed such as hand
hygiene and appropriate use
of personal protective
equipment (PPE) (e.g. gloves,
gowns, masks, and goggles)
while handling blood or body
fluids.
• Work surface  1% sodium
hypochlorite
• Health care worker (HCW) 
immunized with HBV
vaccine.

8. • Spillage of blood & other body fluids  cleaned & disinfected with 10%
sodium hypochlorite
• Disposable needles should be used. Needles should never be reused.
Disposable syringes

9. • Never recap needles: if unavoidable, single hand scoop
technique must be followed
• Disposal after use: needles into sharp box
immediately after use. Should not be left on
trolleys and bed side tables.

10. • Video

11. Precaution during
surgical procedure
• Passing of sharp instruments during surgery
• Suturing
• Preoperative testing of patient for BBVs is not mandatory;
should be performed when clinical indication present

12. • Patient known to have BBV infections may require the following
additional precautions for surgical operation
– Lead surgeon  should ensure that all members or the team
know about infection hazards and appropriate measures should
be followed, such as use of double gloves
– Surgical team  must be limited to essential staff only

13. Post exposure Management
• First aid
• Report to designated nodal centre
• Take first dose of PEP for HIV
• Testing for BBVs
• Decision on PEP for HIV and HBV
• Documentation and recording of exposure
• Informed consent and counselling
• Follow-up testing of HCWs
• Precautions during the follow-up period

14. First Aid: Management of
exposed site
 Earlier the first aid, lesser the chances of
transmission of BBVs
 Do not panic
 For splash injury: Irrigate thoroughly the site (e.g.
eyes or mouth or other exposed area) vigorously with
water at least for 5 min
 Do not place the pricked
finger into mouth reflexively
 Spit fluid out immediately if gone into mouth and
rinse the mouth several times
 Do not squeeze blood from
wound
 If wearing contact lenses, leave them in place while
irrigating. Once the eye is cleaned, remove the contact
lens and clean them in a normal manner
 Do not use antiseptics and
detergents

15. Take first dose of PEP for HIV
• As early as possible, max effect within
2 hours, nil after 72 hours
• NACO  TLE (Tenofovir 300mg +
Lamivudine 300mg + Efavirenz
600mg)
• HIV status  negative  PEP not
required
• Test report not available  do not
immediately perform as it delays the
PEP

16. Testing of BBVs
• Test are done for both source
& HCW.
• Rapid method and results
should be available within 1-
2hrs.
– Anti-HIV Ab
– HBsAg detection
– Anti-HCV Ab
– Anti-HBs Ab ( for HCW 
previously vaccinated but
titer not tested)

17. Decision on PEP for HIV
(NACO)
Revised NACO Guidelines for post-exposure prophylaxis (PEP), 2015
Exposure code (EC) HIV source code (SC) PEP Recommendation
1,2 or 3 Negative Nor warranted
1 1 Not warranted
1 2 PEP is recommended
Duration of PEP : 28 days
Regimen (TLE): Single daily
dose of
•Tenofovir 300mg
•Lamivudine 300mg
•Efairenz 600mg
2 1
2 2
3 1 or 2
2 or 3 Unknown (in area with
high prevalence)

18. • Source material : Blood, body fluids or other potentially
infectious material (CSF, synovial, pleural, pericardial and
amniotic fluid and pus) or an instrument contaminated with
any of these substances.

19. • Exposure code:
– EC-1 (Mild exposure): Mucous mem/non stick skin exposure
with small vol or less duration
– EC-2 (Moderate exposure):
• Mucous membrane/non-stick skin with large vol/splashes for
several minutes or more duration OR
• Percutaneous superficial exposure with solid needle or
superficial scratch
– EC-3
• Large volume transfer
• By hollow needle, wide bore needle or deep puncture
• Visible needle in patient’s artery or vein

20. • Source HIV Status code (SC)
– SC-1: HIV positive, asymptomatic or low viral load (<400
copies/ml)
– SC-2: HIV positive, symptomatic (advanced AIDS or primary HIV
infection), high viral load
– SC Unknown: Status of the patient is unknown and neither the
patient nor his/her blood is available for testing
– HIV negative: Tested negative according to NACO strategy
• The first dose of PEP
– Should be started within 2 hrs (for greater impact) and
definitely within 72 hrs. No need to provide PEP if exposure
occurred >72 hrs.

21. PEP not required in the
following situations
• > 72hrs
• Exposed person is HIV positive
• Skin is intact
• Source is HIV negative
• Exposure with low risk specimens like tear, saliva, urine, stool,
vomits, nasal secretion, sweat etc.
• For exposures with EC-1 and SC-1
• Source unknown if HIV prevalence is low.

22. Side effects and
compliance to PEP
• At the beginning: Nausea, diarrhoea, muscular pain,
headache or fatigue
• Later during the course: Anemia, leukopenia or
thrombocytopenia
• Compliance of > 95% to the PEP schedule is required to
maximize the efficacy of PEP. Hence, the person should be
counselled to continue the PEP and to take medication to
minimize the side effects of PEP

23. Post-exposure prophylaxis
(PEP) for Hep-B
HCW Status If source is positive or
unknown for HBsAg
If source is negative for
HBsAg
If the exposed person is
vaccinated and the Ab titer
is protective (≥10mIU/mL)
No further treatment is required:
• Regardless of the HBV status of the source
•Regardless if the titer falls down later
If the exposed person is
vaccinated and the Ab titer
is not protective
(≤10mIU/mL)
HBIG-1 dose should be started
immidiately, given maximum
within 7 days
Vaccine: Statr the the 2nd series (3
dose)
Vaccine: Start the
second series (3
doses)
If the exposed person is
not vaccinated or
partially vaccinated
HBIG-1 dose should be started
immediately max upto 7 days
Vaccine: Complete the vaccine
series from the last dose given
(do not restart)
Vaccine: Complete
the series of 3
doses from the last
dose given (do not
restart)
Nonresponders HBIG-2 doses at 1 month apart
(0.06mL/kg or 10-12 IU/kg)
Nothing is required

24. • Informed consent and counseling
– Almost every person feels anxious after exposure.
– They should be counselled and provided with psychological
support
– Informed about the risks and benefits of PEP medications
– PEP is not mandatory. Exposed person should however be made
to understand the risk of acquiring transmission if PEP is not
taken.

25. • Documentation and recording of exposure
– Structured Performa
• Date, time, place of exposure
• Type of procedure done
• Duration of exposure
• Source status and volume and type of specimen
– Consent form
• For prophylactic treatment

26. • Follow-up testing
– HCW for BBVs should be done if the source status is
positive/unknown
• HIV testing  6 weeks, 3 months and 6 months after
exposure
• HBV and HCV  6 months after exposure

27. Spill management for Blood
and Body Fluids
• Bring the spill kit to the site of
spillage – wear PPE (gloves,
gown)  put ‘no entry’ sign
board near the spill area.
• Small volume (<10ml)
– Wipe up spill immediately with
absorbent material and discard into
appropriate bin
– Wipe the area with 10% sodium
hypochlorite and allow it to dry
– Remove PPE and perform hand
hygiene

28. • Large volume (>10ml)
– Place disposable paper towels
over spills to absorb the spillage
and then pour 10% sodium
hypochlorite on the top of
absorbent paper towels and
leave for 15mins
– Remove the absorbent papers;
put fresh disposable paper
towels to clean the area and
then discard these into
appropriate waste bin
Spill management for Blood
and Body Fluids