Most infectious diseases can be transmitted by needlestick injury.
Post Exposure Prophylaxis (PEP) for HIV: (0.3% risk of transmission)
The most urgent priority is to assess whether there is a significant risk of transmission of HIV infection. Post exposure prophylaxis with anti-retroviral drugs can significantly reduce the chance of transmission of HIV, but for maximum effectiveness it is recommended that it is administered within one hour. The decision to start PEP is made on the basis of degree of exposure to HIV and the HIV status of the source from whom the exposure/infection has occurred.
Zidovudine (AZT) – 600 mg in divided doses (300 mg/twice a day or 200 mg/thrice a day for 4 weeks + Lamivudine (3TC) – 150 mg twice a day for 4 weeks.
Basic regimen + Indinavir – 800 mg/thrice a day, or any other protease inhibitor, 4 weeks therapy.
The health care provider should be tested for HIV as per the following schedule :
On all three occasions, HCW (health care workers) must be provided with a pre-test and post- test counseling. HIV testing should be carried out on three ERS (Elisa/ Rapid/ Simple) test kits or antigen preparations.The HCW should be advised to refrain from donating blood, semen or organs/tissues and abstain from sexual intercourse.
PEP should be started, as early as possible, after an exposure. It has been seen that PEP started after 72 hours of exposure is of no use and hence is not recommended. The optimal course of PEP is not unknown, but 4 weeks of drug therapy appears to provide protection against HIV.
If the HIV test is found to be positive at anytime within 12 weeks, the HCW should be referred to a physician for treatment.
Based on limited information, anti-retroviral therapy taken during 2nd and 3rd trimester of pregnancy has not caused serious side effects in mothers or infants. There is very little information on the safety in the 1st trimester. If the HCW is pregnant at the time of exposure to HIV, the designated authority/physician must be consulted about the use of the drugs for PEP.
Most of the drugs used for PEP have usually been tolerated well except for nausea, vomiting, tiredness or headaches. Due to these debilating side effects, routine post exposure prophylaxis cannot be advocated.
Risk of trasmission is 30%. 0.1 ml of blood is sufficient to transmit infection.
Risk of transmission is 3%.
How to minimize chances of needle stick injury?
Needlestick-type injuries do not always result from needles. Burs, broken plastic or hand instruments and other contaminated sharps all constitute a risk. You should ensure that the entire dental team are trained in the disposal of sharps.