Needle-Stick Exposure
A contaminated sharp injury triggers three parallel prophylaxis decisions at once.
- 3.5M: Global needlesticks/yr (healthcare workers, estimated)
- 6–30%: HBV transmission risk (unvaccinated, HBeAg+ source)
- ~1.8%: HCV transmission risk (average per-exposure risk)
- ~0.3%: HIV transmission risk (percutaneous, blood source)
What counts as an exposure
Percutaneous injury, mucous membrane, or non-intact skin contact with blood.
Why three pathways at once
HBV, HCV, and HIV each need a separate, simultaneous risk decision.
First response steps
Wash the wound, report the injury, and start the clock immediately.
Source Patient Status Assessed
Testing the source patient, when possible, drives every downstream decision.
- 20–30 min: Rapid HIV test result (source patient testing)
- Same day: HBsAg result needed (guides HBIG decision)
- ~20%: Source untraceable (of reported exposures)
- 3 pathogens: Baseline panel scope (HBV, HCV, HIV screened)
Known source
Rapid HBsAg, anti-HCV, and HIV antigen/antibody testing is drawn at once.
Unknown source
Treat as moderate-to-high risk until source status can be ruled out.
Consent and confidentiality
Source testing requires consent; results stay confidential from the exposed worker.
Hepatitis B Immunoglobulin & Vaccination
HBV is the only exposure of the three with both a vaccine and an antibody shot.
- ≤24h: HBIG window (ideally, up to 7 days)
- 3 doses: Vaccine series (0, 1, 6 month schedule)
- ≥10 mIU/mL: Protective titer (anti-HBs defines immunity)
- ~75%: HBIG efficacy (risk reduction if given)
Immune responders
A documented protective titer means no further action is needed.
Non-immune, high-risk source
HBIG plus vaccine series gives the fastest, most reliable protection.
Non-immune, unknown source
Vaccine series starts now; HBIG added if source tests positive.
Hepatitis C — Testing, Not Prophylaxis
No approved PEP exists for HCV, so surveillance testing is the entire pathway.
- 0: Approved PEP drugs (none exist for HCV)
- 6 weeks: Early RNA check (earliest reliable detection)
- ~25%: Spontaneous clearance (of acute infections)
- >95%: Cure rate if treated (with direct-acting antivirals)
No prophylactic drug
Unlike HBV and HIV, HCV has no post-exposure medication to offer.
Testing schedule
Baseline, 6-week, and 4–6 month HCV antibody and RNA testing.
Early treatment if positive
Direct-acting antivirals cure most acute infections caught by follow-up.
HIV Post-Exposure Prophylaxis
HIV PEP is the most time-critical branch — every hour of delay matters.
- ≤72h: Must start by (sooner is always better)
- <2h: Ideal start time (for maximal efficacy)
- 28 days: Regimen duration (combination ARV course)
- ~81%: Risk reduction (with timely PEP)
The 72-hour window
ARV PEP loses effectiveness rapidly the longer it is delayed.
High-risk source
Start the 28-day regimen immediately, without waiting for confirmation.
Unknown source
Start PEP now and stop early if source testing comes back negative.