Discarded needles, managing injuries from needles discarded in the community

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Objectives

Management of injuries from needles discarded in the community, e.g in the park or street.

The risk of bloodborne virus transmission from a needle found discarded in the community is very low. To date, there have been no published reports in the UK of HIV or Hepatitis C infection being acquired following injury with such needles. Estimates of the risk of BBV transmission following needlestick with a used needle from an injecting drug user are given in appendix 1.

Following such an injury, basic first aid should be carried out (see appendix 2) and, after an initial assessment to confirm that a significant injury has ocurred, the patient should be referred to the Emergency Department for further management as follows:

  • Offer to take blood for storage. It is not necessary to take storage bloods from children (as the risk of their being already infected are so small), unless there are other concerns that would warrant taking blood.
  • Hepatitis B vaccination should be given as per the table in appendix 3.
  • Hepatitis B immunoglobulin is not indicated
  • HIV PEP is not indicated
Follow-up
  • Adults should be offered counselling through the specialist counselling services at the Brownlee Centre or Sandyford Initiative. These services can also be offered for parental counselling where the injured person is a child.
  • Children can be offered follow-up testing at 3 months. This should be done by a dictated referral to paediatric ID consultant.
    For specialist advice, contact on-call ID consultant via switchboard.
    Referrals to consultant paediatrician for follow-up testing:
    Glasgow: Refer to Dr Rosie Hague, Consultant ID Physician, RHC.
Appendix 1: Following needlestick injury from an injecting drug user (IDU), risk of BBV transmission

The risk of BBV transmission following a percutaneous injury involving a used needle from an IDU is dependent on the risk that the source is HIV, HCV or HBV positive, and the time that has elapsed since the needle was used. Estimates of the risks associated with such injuries in Scotland are given in the table below.

Infections Probability of infection in the IDU population in Scotland Risk of transmission if exposedi Estimated risk following exposure to needle

Very short interval after useii (seconds/minutes) Intermediate interval after useiii (minutes/hours) Long interval after useiii (hours/days)
HIV 1/100 1/33 1/30,000 1/3,000,000 1/30,000,000
HBV 1/33 1/3 (eAg+ve) - 1/17 (eAg-ve) 1/100-1/560 1/1,000-1/5,600 1/10,000-1/56,000
HCV 1/3 1/50 1/150 1/15,000 1/150,000

i The risk of transmission following percutaneous injury from an infected source

ii Probability of infection in the IDU population in Scotland x Risk of transmission if exposed

iii Adjusted by an estimated factor of 1/10 (HIV and HCV) for an intermediate interval scenario and of 1/100 (HBV) and 1,1000 (HIV and HCV) for a long interval scenario to account for the reduced viability of the particular virus outside the body and how recently the needle has been used.

Appendix 2: Basic first aid

Make sure proper First Aid has been carried out:

  • Encourage local bleeding of accidental puncture wounds by gentle squeezing. DO NOT SUCK THE AREA.

  • Wash the affected area with soap and warm water. DO NOT SCRUB THE AREA.

  • Treat mucosal surfaces such as mouth or conjunctivia by rinsing with warm water or saline.
    Water used for rinsing the mouth must not be swallowed.
    Do not use bleach on the injury
Appendix 3: HBV prophylaxis for reported significant injury
HBV Status of person exposed HBsAg positive source Unknown source HBsAg negative source
Known responder to HB vaccine (anti-HBs≥10 mIU/ml) Give booster dose of HB vaccine No treatment required No treatment required

≥ 2 Doses of HB vaccine given, or course completed but response unknown.

Give one dose of HB vaccine followed by second dose one month later. Give one dose of HB vaccine. Finish course of HB vaccine.
Unvaccinated or only 1 dose of HB vaccine given. Accelerated course of HB vaccine.
HBIG X 1 in other arm.
Accelerated course of HB vaccine. Initiate or complete course of HB vaccine.
Non responder to vaccine (anti-HBs <10mIU/ml) Give booster dose of HB vaccine.
Give HBIG X 1 in other arm.
Repeat HBIG in 30 days.
Give booster dose of HB vaccine.
Give HBIG X 1 in other arm.
Repeat HBIG in 30 days.
No treatment required.

Table is based on guidance from the Joint Committee on Vaccination and Immunisation1 and the Center for Disease Control and Prevention2

An accelerated course of vaccine consists of doses spaced at zero, one and two months. A fourth dose should be given at 12 months. A very rapid course consisting of the first three doses given at 0, 7 and 21 days, with a fourth dose at 12 months. 

Dose of Energix B in children under 16 = 10 micrograms (IM)

PLEASE REMEMBER TO SEND LETTER TO GP TO GIVE REST OF COURSE