I would recommend the following approach for the OSCE Exams and in your day to day practice. Remember, approach these cases as an urgency and do not make the patient wait in the waiting areas. In case you need to start Post Exposure Prophylaxis (PEP), you should ideally do it within 1 hour of exposure.
- Introduction
Hi, my name is Dr. XYZ, one of the ED registrars on duty and would be helping you out today. May I know your name please? your age? and What is your designation in the hospital?
As I understand you have sustained a needlestick injury, Is it correct?
When was it? and What have you done immediately after it?
Before going into further details, I want to ensure that you have encouraged bleeding and washed the injury site with copious amount of water and soap.
- History
Okay, Could you tell me what exactly happened in more detail?
When was it?
What were you doing?
Was the needle hollow or solid? did it puncture the skin? Was there bleeding? Was the needle contaminated?
What is your Hep B Vaccination status?
What do you know about the patient? Enquire about the age, gender, occupation, and reason for his current hospitalization? His current Hepatitis and HIV status? Classify as high risk or low risk
- Management
If high risk, the HCW will need to be started on PEP immediately, and if low risk, reassurance is required. Explain about the undetermined efficacy of PEP, and the side effects of medications like GI upset, and hepatic injury.
Ask the HCW to fill an incident form.
Give samples for estimation of Hep B titres, and storage for further testing if required.
Obtain samples of the patient for testing for Hep B, C and HIV after consent.
Ensure TT is given to exposed.
- Counseling
Referral to ID specialist and occupational health department.
Further testing will be required in 6 weeks, 3 months, and 6 months.
Advice of safe sex practice and avoid donating blood until 6 months.
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