Needle Stick Injuries: Prevention & Post-Exposure Management

Hepatitis B Virus (HBV)

Hepatitis C Virus (HCV)

Human Immunodeficiency Virus (HIV)

---

🛡️ Pre-Exposure Prophylaxis (PrEP) 🩺

🦠 HCV & HIV

🚫 No pre-exposure prophylaxis available for HCV or HIV.

💉 Hepatitis B (HBV) Vaccination

👨‍⚕️ All healthcare workers (HCWs) should be immune to HBV!
📅 Approved vaccination schedules:
✔ Engerix-B (Smith-Kline) → 1.0 mL (20 mcg) at 0, 1, 6 or 0, 1, 2, 12 months
✔ Recombivax-HB (Merck) → 1.0 mL (10 mcg) at 0, 1, 6 months

🩸 Follow-Up Testing After Immunization

📊 After the final dose, test anti-HBs in 1-2 months
🛑 If anti-HBs < 10 mIU/mL:
🔍 Check HBsAg
✔ If HBsAg positive → Evaluate for chronic HBV
✔ If HBsAg negative → Repeat vaccine series
❌ No boosters needed for immunocompetent HCWs!

---

🚑 Post-Exposure Prophylaxis (PEP) 💊

⚠️ Definition of Exposure

🔪 Percutaneous injury (e.g., needle stick, sharp object cut)
🧪 Mucous membrane or broken skin contact
🩸 Exposure to high-risk body fluids

---

🦠 HBV Exposure Management

🔎 Immediate evaluation and PEP depend on HBV immunity status.

---

🦠 HCV Exposure Management

📊 Baseline tests: Anti-HCV, HCV RNA, ALT
📅 Follow-up tests:
✔ 4-6 weeks → HCV RNA
✔ 4-6 months → Anti-HCV, HCV RNA, ALT
❌ No proven prophylactic treatment for HCV.

---

🦠 HIV Exposure Management

🚨 Start PEP within 1-2 hours!
📌 Risk assessment determines treatment:
✔ Low-risk exposure → Two NRTIs
✔ High-risk exposure → Two NRTIs + third drug

🩸 Injury Classification

✔ Low-risk: Superficial wound, solid needle, HIV viral load < 1500 copies/mL
❌ High-risk: Hollow-bore needle, visible blood, artery/vein exposure

---

💊 Recommended PEP Regimens

✔ Low-risk exposures:

• Zidovudine + Lamivudine (ZDV + 3TC) → (Combivir)
• Tenofovir + Emtricitabine (TDF + FTC) → (Truvada)
  ✔ High-risk exposures (Expanded regimen):
• Two nucleosides + Lopinavir/Ritonavir (LPV/r)

🚫 Drugs to Avoid in PEP

❌ Abacavir (ABC) → Severe hypersensitivity reactions ⚠
❌ Nevirapine (NVP) → Liver toxicity & Stevens-Johnson syndrome

---

🩺 Conclusion

🏥 Needle stick injuries pose serious risks to healthcare workers!
💉 Prevention through HBV vaccination is essential.
⚡ Post-exposure PEP should be started immediately, especially for HIV.
🚑 Early intervention = Reduced infection risk & better outcomes!

---

🔖 Hashtags

#NeedleStickInjury #Healthcare #MedicalSafety #InfectionControl #HIV #HCV #HBV #Hepatitis #PostExposureProphylaxis #MedicalEducation #DoctorLife #EmergencyMedicine #DrMuhammadIsmail #ڈاکٹر_محمد_اسماعیل #MBBS #Medicine