Training Guide

Guide to Developing and Managing Syringe Access Programs

Appendix H: Needlestick Protocols

The following has been borrowed from Ontario Needle Exchange Programs: Best Practice Recommendations.

Examples of needlestick injury post-exposure guidelines
First Aid

  • Allow the wound to bleed freely.
  • Cleanse the wound thoroughly with soap and water.
  • If injury or blood contact is with mucous membranes (i.e., eyes, nose, mouth) flush well with water.

Medical Attention and Post-Exposure Prophylaxis

Seek immediate medical attention (within hours) from an emergency department, clinic or doctor’s office. The needlestick injury will be assessed there. Confidential HIV, HBV and HCV testing may be recommended. Post-exposure prophylaxis (e.g., immunoglobulin or antiviral therapy for HBV and HIV) may be recommended. Many hospitals have policies and procedures in place for NSI exposures, however there are regional variations. Local public health units have protocols in place and can provide guidance and information on what to do and, in some cases, how to assess risk of exposure. Delay or failure to seek medical attention may compromise the effectiveness of post-exposure treatment

Follow-up Counselling and Evaluation

Periodic testing for HCV antibodies, liver enzyme levels and HIV antibodies is recommended. Counselling for emotional stress related to the injury and possibility of infection may be appropriate. Counselling for prevention of transmission, such as through sexual contact, blood or organ donation is also recommended

Documentation & Surveillance

Report any needlestick injury to the NEP manager. Document all injuries in a sharps injury log. A sharps injury log includes information such as the date of the injury; the equipment involved; a description of the injury; and an explanation of how the incident occurred. This information can be used to help NEPs develop further strategies to prevent needlestick injuries

Sources: CDC (2005);The Works (2005); ONA (2004); Wilburn and Eijkemans (2004); Manitoba Public Health, Communicable Disease Control Unit (2003); Public Health Agency of Canada (1997).