How do I assess the risk of blood-borne virus transmission following a needlestick injury?

To assess the risk of blood-borne virus (BBV) transmission following a needlestick injury, first evaluate the source patient's infection status for key BBVs: hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). This includes checking known diagnoses and vaccination status, particularly for hepatitis B, and if possible, testing the source for hepatitis B surface antigen (HBsAg), hepatitis C antibodies, and HIV antigen/antibody combined tests. If the source is unknown or unavailable, store a blood sample for potential future testing.

Next, assess the nature of the injury: whether the skin was penetrated, the depth of the injury, the type and size of the needle, and the amount of blood involved. The risk is higher with deep injuries, visible blood on the device, and hollow-bore needles used for venous or arterial access.

Offer baseline testing to the exposed person for HBV, HCV, and HIV immediately after the injury, and repeat testing at 6 weeks, 3 months, and 6 months as per established protocols. For hepatitis B, consider the exposed person's vaccination and antibody status to guide the need for post-exposure prophylaxis (PEP). For HIV, assess the need for antiretroviral PEP urgently based on the source's status and exposure risk.

Standard precautions, including appropriate use of personal protective equipment and safe sharps disposal, are essential to prevent such injuries. Prompt wound care and reporting are critical. Consultation with occupational health or infectious disease specialists is advised for complex cases or when the source is known to be infected.

Overall, the risk assessment integrates clinical evaluation of the injury, source patient status, and exposed person’s immunity, supported by timely testing and prophylaxis to minimise transmission risk ¹,⁴,⁶ (Tansley et al., 2004)(Culver, 1997)(Robinson, 1998).