Needlestick

Seroconversion

 

HIV

 

Risk seroconversion

- 1 in 250

- 50% less with gloves & blunt needle

 

US Public Health Service Guidelines

- recommend 2 drug therapy for 4 weeks post exposure (AZT and 3TC)

- consider if patient's virus is resistant, and change medications accordingly

 

Hepatitis C

 

Seroconversion risk varied reports

 

Kubitschke et al Internist 2007

- systematic review

- average rate of seroconversion 0.75%

 

US Public Health Service Guidelines

- do not recommend prophylaxis post exposure

 

Management

- wait to see if seroconvert

- 2/3 will eliminate HCV RNA

- otherwise can use interferon

 

Hepatitis B

 

Most likely to seroconvert if not immunised

- 20%

 

Contamination

 

Sharp injury in 1.3 - 15.4% of operations

- half from suture needle

 

Mucous membrane contamination

- facial 100% in THR

- risk unknown

 

Management of Needlestick

 

1.  Wash wound +++ with betadine

 

2.  Take blood for serology from health care worker

- repeat at regular intervals

- important for management

- important for insurance

 

3.  Take blood for serology from patient

- history of risk / exposure

- consent obtained

- need to repeat at 6/12

 

Reduction of Exposure

 

Universal Precautions

 

Known infective status of patient

- warn OT staff of status / risks

- maintain confidentiality

- minimal equipment

- ergonomic setup

- most experienced staff & surgeon

- glasses / hood

- impervious disposable gowns & drapes

- boots

- universal precautions

- double gloves

- taperpoint needles & staples

- single suturing surgeon

- instrument only technique

- sharps tray

 

Screening HCV & HBV in high risk groups

- of dubious value

- windown periods for HIV