Community acquired needle stick injury

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  • 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


    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.  



    • 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


    • 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


    • 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)


    Needle stick injury

    Post-exposure prophylaxis


    Hepatitis B

    Hepatitis C

    • No post-exposure prophylaxis is available for hepatitis C


    • 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

    Last Updated January 2021

  • Reference List

    1. Centre for Population Health 2015, Human Immunodeficiency Virus (HIV) – Management of Non-Occupational Exposure, NSW Health, viewed June 2020 <>
    2. Clinical Nurse Consultant 2014, Child Exposed to Blood or Potentially Blood Contaminated Secretions: Management Guideline, The Children’s Hospital Westmead, viewed June 2020 <>
    3. Director of Emergency Department 2017, Needlestick Injury Guideline, The Government of Western Australia Child and Adolescent Health Service, viewed June 2020 <
    4. Feigin ER et al 2004, Textbook of Pediatric Infectious Diseases (5th Edition)
    5. Moore DL 2018, Needlestick Injuries in the community, Paediatrics & Child Health vol 23: 8 pp532-538
    6. Palasanthiran P et al 2019, Community Needlestick Injury Guideline, Children’s Health Queensland Hospital and Health Service, viewed June 2020 <>
    7. Wilson E 2017, Community Needlestick Injuries Guideline, Starship Child Health, viewed June 2020 <>