See also 

Tetanus-prone wounds  

Key Points

1. Community acquired needlestick injuries (CA-NSI) in children are a cause of significant parental anxiety
2. There are no published reports of an incidental CA-NSI in a child leading to transmission of a blood borne virus such as hepatitis B, hepatitis C, or HIV
3. It is important to determine whether a CA-NSI is high risk, and ascertain the immunisation status of the child

Background

Community acquired needlestick injuries in children are uncommon but cause a great deal of worry for families. They mostly occur in public places such as the park or street and often after the child intentionally picks up the syringe or needle.  

Assessment 

History 

• Details of incident: time, date, place
• Details of injury: location on body, superficial or deep
• Source (the person who used the needle): known or unknown
• What kind of needle/syringe
• What first-aid has been provided
• Was there visible blood on/in the needle/syringe
• Immunisation history (specifically tetanus and hepatitis B)

High risk CA-NSI

• Source known to be infected with a blood borne virus
• Needlestick injury from a deliberate assault
• Deep, large volume injection with hollow bore needle
• Personal history of injecting drug use (adolescents)
• Needle directly placed into vein or artery
• Device visibly contaminated with blood

Management

• Assess and manage associated injuries prior to specific management of CA-NSI
• First Aid: wash site with soap and water
• Dispose of needle safely
• If high risk CA-NSI, discuss with a senior clinician and consider referral to the Infectious Diseases team

Investigations  

• If child is immunised, test for:
  • Hepatitis B surface antibody (HBsAb) marked urgent, follow up result within 72 hours (in ED or via GP)
  • Anti-HBs antibody level should be >10 mIU/mL
  • Take serum to store, do not routinely investigate for hepatitis C or HIV
• Source - if known, test for:
  • Hepatitis B surface antigen
  • Hepatitis C serology
  • HIV serology
• Do not send the needle or syringe for testing, as results on discarded injecting equipment are unreliable (and not generally performed by diagnostic laboratories)

Treatment:

Post-exposure prophylaxis

Tetanus

• Needlestick injuries are considered tetanus-prone wounds, see Management of tetanus-prone wounds

Hepatitis B

• See flowchart, Australian Red Cross Lifeblood for immunoglobulin and Australian Immunisation Handbook for immunisation information

Hepatitis C

• No post-exposure prophylaxis is available for hepatitis C

HIV

• Only children with high risk CA-NSI are offered HIV post-exposure prophylaxis - discuss with Infectious Diseases

Immunisations provided as post-exposure prophylaxis mark the beginning of a catch-up schedule. Children who require further or catch-up vaccinations should be referred to their GP or local immunisation service to complete this schedule.

Consider consultation with local paediatric team when

Consider consultation with paediatric infectious disease team when

High risk CA-NSI

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services.

Consider discharge when

Necessary treatment, immunisations and plan to follow up results is arranged

Follow up

• Reassure parents that the risk of viral transmission from CA-NSI in children is exceedingly low
• For unimmunised children, provide written information about further catch-up doses of hepatitis B and tetanus immunisations (at minimum)
• Consider referral to Infectious Diseases outpatient clinic to provide an opportunity for questions and to plan follow-up investigations and immunisations, if required

Parent information sheet

Needle Stick Injury

Additional notes

• Queensland Health guideline community needlestick injury
• Queensland Health guideline post-exposure prophylaxis for HIV
• Queensland Health guideline tetanus prophylaxis in wound management
• Children's Hospital Westmead guideline child exposed to blood or potentially blood contaminated secretions management

Last Updated January 2021