Intended for healthcare professionals

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.

Sharps injuries in the community – same same but different

Riddell et al correctly highlight the critical place of risk assessment in the management of healthcare-related sharps injuries.[1] The relatively high risks in the healthcare setting are often misapplied to community-acquired sharps injuries, most common in young children. This provokes unnecessary anxiety in families and doctors, compounded by further investigations, and sometimes inappropriate prescription of HIV post-exposure prophylaxis (PEP).

In reviewing the risk to a child from an incidental community-acquired needlestick injury from over 1500 individual adult and paediatric exposures in published reports, we found no HIV cases, three hepatitis B cases (one child), and three cases of hepatitis C virus transmission.[2] None of the hepatitis B cases were fully immunised or received adequate PEP, and an alternative route of infection could not be ruled out for any case. We concluded that the risk of blood-borne virus transmission in such a scenario to an immunised child (or after adequate hepatitis B PEP) is “so low as to possibly be negligible.”

Only the most exceptional community exposures could conceivably meet the requirements for virus transmission. In the typical case of a child pricking their finger with a discarded needle found in a public place, it is therefore only necessary to ensure the child has been appropriately immunised against tetanus and consider hepatitis B PEP. Risk assessment is the basis for reassuring patients and parents in this situation, to avoid the inevitable sleeplessness associated with arranging unnecessary follow-up testing for blood borne virus transmission where the risk is practically negligible.

References

1. Riddell A, Kennedy I, Tong CY. Management of sharps injuries in the healthcare setting. BMJ 2015;351:h3733.
2. Osowicki J, Curtis N. A pointed question: is a child at risk following a community-acquired needlestick injury? Archives of disease in childhood 2014;99(12):1172-5.

Competing interests: No competing interests

27 August 2015
Dr Joshua Osowicki
Infectious Diseases Fellow
Professor Nigel Curtis
The Royal Children's Hospital Melbourne,
Flemington Rd, Parkville, VIC, Australia, 3052