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Sharps Injuries: What to Do Following a Sharps Injury

Step 1: Provide immediate care to the exposure site

  • Wash wounds and skin with soap and water.
  • Flush mucous membranes with water.

Step 2: Evaluate the exposure

  • Determine risk associated with exposure.
Exposures Substances
Exposures posing risk of infection
  • Percutaneous injury
  • Mucous membrane exposure
  • Non-intact skin exposure
  • Bites resulting in blood exposure to either person involved
Substances posing risk of infection transmission
  • Blood
  • Fluids containing visible blood
  • Potentially infectious fluids (semen; vaginal secretions; and cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids) or tissure
  • Concentrated virus

Step 3: Give post-exposure prophylaxis (PEP) for exposures posing risk of infection transmission

  • HBV – view treatment tableExternal
    • Give PEP as soon as possible, preferably within 24 hours.
    • PEP can be given to pregnant women.
  • HCV – PEP not recommended
  • HIV – view treatment tableExternal
    • Initate PEP within hours of exposure.
    • Offer pregnancy testing to all women of childbearing age even if they are not known to be pregnant.
    • Seek expert consultation if viral resistance is suspected.
    • Administer PEP for 4 weeks if tolerated.

Step 4: Perform follow-up testing and provide counseling

  • HBV exposures
    • Test for anti-HB 1 to 2 months after the last dose of the vaccine if only a vaccine is given.
    • Follow-up is not indicated if the exposed person is immune to HBV or has received HBIG PEP.
  • HCV exposures
    • Perform testing for anti-HCV and ALT 4 to 6 months after exposure.
    • Perform HCV RNA testing at 4 to 6 weeks if an earlier diagnosis of HCV infection is desired.
    • Confirm repeatedly reactive anti-HCV EIAs with supplemental tests.
  • HIV exposures
    • Evaluate exposed persons taking PEP within 72 hours after exposure and monitor them for drug toxicity for at least 2 weeks.
    • Perform HIV antibody testing for at least 6 months post-exposure (e.g., at baselines of 6 weeks, 3 months, and 6 months).
    • Perform HIV antibody testing for illness compatible with an acute retroviral syndrome.
    • Advise exposed persons to use precautions to prevent secondary transmission during the follow-up period.
Page last reviewed: September 28, 2010