Needle Stick Injury (NSI) and Post-Exposure Prophylaxis – PLAB 2 Guide

Ann Augustin
Jun 30
3 min read

Updated: Jul 2

🔹 Introduction

Needle stick injuries (NSI) are common occupational hazards for healthcare professionals and also occur accidentally in community settings. Understanding risk assessment, appropriate post-exposure management, and vaccine protocols is crucial for PLAB 2 and safe NHS practice.

🔹 What is a Needle Stick Injury?

✅ An injury caused by a sharp medical instrument (e.g. needle, cannula, lancet) that penetrates the skin, potentially exposing the person to blood-borne viruses (BBVs) such as:

Hepatitis B (HBV)
Hepatitis C (HCV)
Human Immunodeficiency Virus (HIV)

🔹 Immediate First Aid (Same for Hospital and Community)

Encourage bleeding at the site (do NOT suck the wound).
Wash thoroughly under running water with soap.
Do not scrub or use harsh antiseptics.
Cover with a waterproof dressing.

🔹 Management Protocol

A. Hospital/Occupational Exposure

✅ 1. Report immediately

Inform supervisor and occupational health.
If out of hours ➔ contact A&E or infection control team.

✅ 2. Risk assessment

Type of injury: Hollow bore needles have highest risk due to blood within the lumen.
Source status: HIV, Hep B, Hep C status (if known).
Your vaccination status: Especially Hepatitis B.

✅ 3. Investigations

Source patient (with consent): HIV, Hep B surface antigen, Hep C antibody
Your baseline tests: HIV, Hep B surface antibody, Hep C

✅ 4. Post-Exposure Prophylaxis (PEP)

Pathogen	PEP
HIV	Oral antiretroviral therapy started ideally within 1-2 hours, up to 72 hours
Hepatitis B	HBIG + vaccine if unvaccinated or non-responder; nothing if fully vaccinated with adequate titres
Hepatitis C	No PEP available; baseline testing + follow up at 3 and 6 months

✅ 5. Documentation

Time/mechanism, site, first aid given, risk assessment, counselling, and PEP started.

✅ 6. Follow-up

Occupational Health arranges blood test follow-up and support.

B. Community Exposure (e.g. Child pricked by needle in park)

✅ 1. First Aid

Wash thoroughly under running water.

✅ 2. Risk Assessment

Usually extremely low risk of HIV or Hep C from discarded needles.
Hepatitis B: If child is fully vaccinated with routine 6-in-1 vaccines, no further action is needed.

✅ 3. Management

HIV: PEP not required due to negligible risk.
Hepatitis B: If unvaccinated and source is known positive ➔ HBIG + vaccine. Otherwise, check immunisation status.
Hepatitis C: No PEP; observe for symptoms and routine follow-up.

✅ 4. Tetanus Consideration

If child is fully vaccinated (6-in-1 covers tetanus), no booster is needed for clean puncture wounds.
Booster is due at 3 years 4 months (4-in-1 vaccine) and again at 14 years (teenage booster).

🔹 💉 Vaccine Courses and Boosters

🛡️ Tetanus

Primary series (3 doses): 8, 12, 16 weeks (6-in-1 vaccine)
Booster 1: 3 years 4 months (4-in-1 pre-school booster)
Booster 2: 14 years (teenage booster)✅ Duration: ~10 years after last booster; lifelong immunity with proper wound management.

🛡️ Hepatitis B

Primary course: 3 doses (0, 1, 6 months)
Accelerated schedule: 0, 1, 2 months + booster at 12 months (for occupational/travel)✅ Duration: ≥20-30 years, often lifelong if adequate response (anti-HBs ≥10 mIU/ml).✅ Non-responders: Repeat full course once; if still inadequate, label as non-responder and use HBIG for future exposures.

🔹 Key Differences – Hospital vs Community Needle Stick Injury

	Hospital Exposure	Community Exposure
Risk assessment	Based on source patient status and injury type	Usually unknown source, risk extremely low
PEP for HIV	May be needed (high-risk exposure)	Not needed (negligible risk)
Hep B management	Depends on vaccination and source status	Depends on vaccination; source often unknown
Follow-up	Occupational Health	GP or paediatric follow-up if needed

🔹 Examiner Top Tips

✔ Always wash the wound immediately and report occupational injuries without delay.

✔ Hollow bore needles carry higher risk than solid needles.

✔ No oral medications for Hep B or Tetanus PEP; only HIV PEP is oral.

✔ For PLAB 2, structure your answer: First aid ➔ risk assessment ➔ PEP ➔ documentation ➔ follow-up.

✔ Always check vaccination records (Red Book) in children to determine tetanus and hepatitis B protection.

🔹 Final Takeaway

Needle stick injuries require prompt action, risk-based assessment, and clear counselling. Knowing which vaccines protect, when boosters are due, and when PEP is indicated ensures safe practice and success in PLAB 2.

📚 References: