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Question #1: needlestick injuries Question #2: Accidental exposure with needle stick
Sep 24, 1997

Question #1:

I was wondering about the statistics concerning needlestick injuries with Hiv positive blood. The rate of infection for this type of situation is said to be 1 in 370. Now, is this number with or without a person having latex gloves on and if the person who became injured with the needlestick had latex gloves on would not the blood on the needlestick but wiped off by the latex? Can these statistics be used with any accuracy to predict Hiv positive blood coming into contact with open wounds on the skin or hands without latex gloves on them? Thank You.

Question #2:

I'm a doctor and I live in Palermo (ITALY),can I Know how great is the risk for accidental injection with a needle stick from a heroine addict?

Response from Mr. Sowadsky

Hi. Thank you for your questions. Needlesticks and other occupational exposures can lead to infection with various bloodborne diseases including HIV, Hepatitis B, and Hepatitis C. When we are talking about needlestick injuries, whether a person is wearing latex gloves or not, will usually not make any significant difference in terms of risk. This is because a needle will readily pass right through latex gloves. The deeper the stick, and the more blood that one is exposed to, the greater the chance of infection.

If blood were to get into an open wound on the skin, there would be a risk of infection, but less of a risk than a needlestick injury. A needlestick is a much more efficient transmitter of infected blood (and therefore a higher risk of infection) than exposure through an open wound (although infection through either route is possible). The more blood one is exposed to, and the deeper and fresher the open wound is, the greater the chance of infection. It is extremely important that all healthcare workers wear latex gloves when performing any activities where blood can get onto their hands. Using latex gloves prevents an open wound exposure, but would not protect against needlestick injuries. In addition, if risky body fluids (like blood) get onto mucous membranes (eyes, nose, or mouth), there would also be a risk of infection, but less of a risk than a needlestick. In other words, compared to various types of occupational exposures, needlesticks are the most efficient ways these infections are transmitted, and lead to the highest risks of occupational infection.

Most healthcare workers who became infected with these viruses on the job, became infected through needlestick injuries. For example, of the 52 proven cases of occupationally acquired HIV infection in the USA (as of 31 December, 1996), 45 became infected through needlestick injuries, 5 had mucocutaneous exposures (mucous membrane/skin exposures), 1 had both a needlestick injury and a mucocutaneous exposure, and 1 had an unknown route of exposure. 47 of these 52 cases involved exposure to blood, 1 to a visibly bloody body fluid, 3 to concentrated virus in a laboratory, and 1 from an unspecified fluid.

The overall risk from a needlestick from a known HIV positive patient is 0.3%. This compares to the risks for Hepatitis C (1.8% to 10% depending on the study), and Hepatitis B (up to 30%). In other words, through a needlestick injury, the risk of infection is greater for both Hepatitis B and C, as compared to HIV. Remember, these statistics are an overall risk, and cannot be used to determine individual risk! This is because individual risk is determined by many different factors including:

what body fluid a person was exposed to (body fluids like blood have higher concentrations of these viruses than body fluids like saliva or urine),

how much body fluids (especially blood) a healthcare worker was exposed to,

how deep the needlestick was, or how large/fresh an open wound was,

how long the body fluid (especially blood) was outside the patients body.

These statistics can therefore only give an overall estimate of risk, not the risk for a specific individual. Besides strictly following Universal Precautions, there are ways we can further reduce the risks of occupational infection from HIV and Hepatitis B. Post-exposure prophylaxis against HIV, started immediately after an occupational exposure, can reduce the risk of HIV infection by approximately 79%. Vaccination against Hepatitis B can virtually eliminate the risks of occupational infection with this virus. However, there are no post-exposure treatments, nor vaccinations, for Hepatitis C at this time.

For more information on needlestick injuries, see the posts:

Significant Exposure - Health Care Workers

(1)CDC standards for needlesticks? (2)regarding needlesticks, how can you get the needle apparatus fluid residue tested for HIV, hepatitis and any other suspected ID's?

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).



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