• Reference Number: HEY1212/2021
• Departments: Emergency Department, Paediatrics
• Last Updated: 12 March 2021

Introduction

This leaflet has been produced to explain what happens after your child has sustained a needle stick injury. A child is any young person under 18 years of age. It is understandable to feel worried if your child has had a needle stick injury. There are certain procedures that need to be followed to ensure that your child is at as little risk from this as possible.

What is a needle stick injury?

The term ‘needle stick’ can be used to describe an injury caused by a sharp object that carries a risk of transmitting an infection that is in the blood or bodily fluid on the sharp implement. Some examples include surgical stitch needles (suture needles), hollow needles such as those used to inject drugs, scalpels (surgical knives), razors, sharp edged or pointed surgical instruments, broken glass or any sharp object or material that breaks the natural skin barrier. Sharp tissues such as bone or teeth may also pose a risk of injury similar to that of a needle stick injury.

A common example is from a needle found in the park, on the beach, or elsewhere in the community, that is thought to have been used to inject drugs. 

What infections can happen after a needle stick injury?

If the user of the needle or object causing the needle stick injury is known to carry a blood borne virus, then there is a risk of transmission to the person suffering from the needle stick injury. The risk posed can change depending on where you live due to differences in how common certain viruses are in the population.

Infections such as Hepatitis B, Hepatitis C and Human Immunodeficiency Virus (HIV) are known to spread through bodily fluids such as blood and saliva. These are known as ‘blood borne viruses’.

One way this can occur is through sharing needles for injecting intravenous drugs and medicines, or through accidental needle stick injuries. Whilst it is normal to feel anxious when a child sustains a needle stick injury, the actual risks of a child developing a virus after an accidental needle stick injury are extremely low.

With penetrating injuries such as those from a needle stick there is a very small risk of developing tetanus. These are known as ‘tetanus-prone injuries’.

There is also a risk of developing infection in the wound caused by bacteria on the skin.

Can anything be done to reduce the risk of infection?

Hepatitis B

The most likely infection to be transmitted from a contaminated needle stick injury is Hepatitis B. This is still very rare. We can reduce the risk of developing Hepatitis B even further by giving booster immunisations to those already immunised (if required), or by giving an accelerated immunisation course to those not previously immunised. In the rare event that the child is not immunised and has had a needle stick injury from a known Hepatitis B-infected user, then they will receive the accelerated immunisation course in addition to treatment with Hepatitis B immunoglobulin. This provides immediate immunity whilst waiting for the vaccine to work.

Hepatitis C

There is no vaccine or post exposure prophylaxis (PEP) for preventing Hepatitis C infection, however, in the extremely rare event that a child develops Hepatitis C infection after a needle stick injury, there are several available treatments that work well in treating Hepatitis C.

Human Immunodeficiency Virus (HIV)

There have been no reported cases of a child contracting HIV from a needle stick injury. Once blood has dried, HIV does not survive longer than 2 hours. Whilst there are post-exposure prophylactic (PEP) treatments for HIV, they are not without risks and side effects. In most cases, the child will not need HIV PEP.

Tetanus

Children who have received their childhood immunisations should be protected against developing Tetanus. Your child’s doctor will asses whether a booster immunisation is required. If your child has not been immunised then they will require a full course if they are thought to be at risk of developing Tetanus.

Bacterial Skin Infection

As with any injury that breaks the skin, there is a risk of developing a bacterial infection in the wound. For this reason, your child may be given a course of antibiotics if it is felt they are needed. If any redness and swelling develops at the site of injury after your visit then your child will need to see their doctor for a review and to consider a course of antibiotics.

If you are not clear about the risks or are still worried please ask us and we will be happy to discuss further. 

What happens next?

During your child’s visit to the Children’s Emergency Department, your child will need to have blood tests and any necessary immunisations. They may be given a course of antibiotics. If you are unsure what is happening, please ask and we will be happy to explain.

If further immunisations are needed after the date of your attendance at the Children’s Emergency Department, you will be advised to book these with your child’s doctor.

If your child requires an accelerated course of Hepatitis B immunisation, they will have the first dose in the Emergency Department. The second dose will need to be 4 weeks later and the third dose a further 8 weeks later (8 weeks after the incident). You will need to phone your child’s doctor to arrange this.

Your child will need further blood tests and 3 and 6 months after the injury. These will need to be arranged through your child’s doctor.

How will my child’s doctor know what has happened?

The doctor reviewing your child in the Emergency Department will write an electronic letter to your child’s doctor. In addition, we advise you to phone your child’s doctor after a few days to book any further immunisations if needed, to ensure these happen on time and do not get missed. You can also arrange the follow-up blood tests this way, through your child’s doctor.

How will I know if my child develops an infection?

It is extremely rare to develop a blood-borne viral infection after an accidental needle stick injury. If your child develops a fever after sustaining a needle stick injury then please contact your child’s doctor to discuss any concerns. If they develop local signs of bacterial infection around the wound such as redness, pain and swelling then also see your child’s doctor for a review and to consider whether a course of antibiotics is needed.

Will my child receive any follow up?

Follow-up will be as stated above, with repeat blood tests at 3 and 6 months through your child’s doctor. If any issues arise your child’s doctor can refer to the paediatric department at the hospital as needed.

What if I am not happy?

 Please let us know if you have any concerns and we will aim to resolve them as soon as possible.