Clinical Review

Management of sharps injuries in the healthcare setting

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3733 (Published 29 July 2015) Cite this as: BMJ 2015;351:h3733
Managing sharps injuries infographic
Click here to see a printable infographic, showing first aid, risk assessment, and follow-up.

  1. Anna Riddell, specialist registrar in infectious diseases and virology1,
  2. Ioana Kennedy, consultant occupational health physician2,
  3. C Y William Tong, consultant virologist and honorary reader13
  1. 1Department of Infection, Barts Health NHS Trust, London E1 2ES, UK
  2. 2Occupational Health Service, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  3. 3Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  1. Correspondence to: C Y William Tong william.tong{at}nhs.net

The bottom line

  • First aid should be undertaken as soon as possible and a risk assessment needs to be carried out urgently by an appropriately trained individual

  • If post-exposure prophylaxis is deemed necessary this should begin as soon as possible without waiting for the test results of the source patient

  • Post-exposure prophylaxis using antiretroviral drugs within the hour after injury can considerably reduce the risk of HIV transmission

  • Hepatitis B vaccine is highly effective in the prevention of hepatitis B; all healthcare workers should be immunised against the virus

  • Despite the lack of post-exposure prophylaxis to hepatitis C, such exposure should be followed up vigorously as treatment has a high success rate

Sharps injuries are common in the healthcare setting. Between 2004 and 2013 a total of 4830 healthcare associated occupational exposures to body fluid were reported in the UK, 71% of these for percutaneous injuries.1 As the reporting system is likely to have recorded only cases with an important exposure, the actual burden of sharps injuries is likely to be much higher. Healthcare workers need to be familiar with immediate management both for themselves if they become injured and for assisting injured colleagues. Many healthcare workers do not know how to manage a sharps injury,2 particularly if this occurs out of hours. This review presents a summary of the immediate management of sharps injuries and outlines the risk assessment and management strategies to prevent the transmission of HIV, hepatitis B virus, and hepatitis C virus.

Sources and selection criteria

We searched PubMed and the Cochrane Library for articles published over the past 20 years using the terms “sharps injury”, “needle stick injury”, and “body fluid exposure” and hand selected the most relevant and appropriate articles. To search for relevant UK national guidelines we also accessed the UK Department of Health and Public Health England …

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