# Needlestick Injury and Post-Exposure Prophylaxis

> Needlestick injury and post-exposure prophylaxis for NEET-PG Microbiology, with HBV, HCV and HIV transmission risks, first aid and PEP protocols for staff.

- Canonical URL: https://prepelephant.com/topics/neet-pg/microbiology/needlestick-injury-and-post-exposure-prophylaxis
- Exam / course: NEET-PG · Subject: Microbiology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-15
- Last updated: 2026-10-15
- Reference basis: NACO National Guidelines for HIV Care and Treatment; Harrison's Principles of Internal Medicine
- How to cite: "Needlestick Injury and Post-Exposure Prophylaxis", PrepElephant, https://prepelephant.com/topics/neet-pg/microbiology/needlestick-injury-and-post-exposure-prophylaxis

## Direct answer

Needlestick injury is a percutaneous exposure to blood that carries a risk of blood-borne virus transmission, and prophylaxis is available for hepatitis B and HIV. The risk per exposure is highest for hepatitis B, followed by hepatitis C and then HIV. Immediate washing, a documented risk assessment and prompt start of prophylaxis form the basis of management.

## What you must remember

- **Hepatitis B:** transmission risk of roughly 6 to 30 percent after a percutaneous exposure, depending on the source's HBeAg status, which makes vaccination the key protection.
- **Hepatitis C:** transmission risk of about 1.8 percent per exposure, and no effective post-exposure prophylaxis exists.
- **HIV:** transmission risk of about 0.3 percent per exposure, a low but serious risk that prophylaxis can reduce.
- **Immediate first aid:** wash the wound with soap and running water, let it bleed freely without squeezing, and flush mucosal splashes with water or saline.
- **Source testing:** the source patient's HBsAg, anti-HCV and HIV status is tested with consent, ideally without delay.
- **HIV PEP timing:** start as early as possible, ideally within two hours and always within 72 hours.
- **HIV PEP regimen:** current NACO guidance favours a 28-day, three-drug regimen, commonly tenofovir with lamivudine and dolutegravir.
- **HBV PEP:** an unvaccinated worker exposed to an HBsAg-positive source receives hepatitis B immunoglobulin with vaccine, whereas a vaccinated worker with adequate antibody needs none.

## The response pathway after a sharps injury

Management is time-critical, so the sequence is standardised in most hospitals. The steps below are the usual order in an occupational health setting.

1. **Wash immediately:** wash the wound with soap and running water, and let it bleed freely without squeezing or applying harsh antiseptics.
2. **Report and assess:** report to the occupational health unit at once, and document the device, the source and the depth of injury.
3. **Test the source:** with consent, test the source patient for HBsAg, anti-HCV and HIV, and counsel both parties on the result.
4. **Test the worker:** draw baseline blood for HIV, HBV and HCV serology, with consent and counselling, so that status is documented.
5. **Start prophylaxis:** give hepatitis B immunoglobulin and vaccine where indicated, and start HIV prophylaxis when the source is positive or high risk.
6. **Follow up:** repeat HIV testing at set intervals, extending to about six months, and monitor for hepatitis infection after the exposure.

The first hour matters most for HIV, because prophylaxis works best when started early. Hepatitis B immunoglobulin is also time-sensitive and is ideally given within 24 hours.

## Where the exam tries to catch you

Post-exposure questions test which virus has prophylaxis and how the timing works.

- **Trap:** starting post-exposure prophylaxis for hepatitis C — **Correct:** no effective prophylaxis exists for HCV, so the worker is tested at baseline and followed up for infection.
- **Trap:** giving the hepatitis B vaccine alone to an unvaccinated worker after an HBsAg-positive exposure — **Correct:** immunoglobulin is added in that setting, because vaccine alone takes time to produce protection.
- **Trap:** waiting for the source test result before starting HIV prophylaxis — **Correct:** prophylaxis should start promptly, within hours, and can be stopped later if the source tests negative.

## Frequently asked questions

### What is the risk of HIV transmission after a needlestick injury?
The transmission risk for HIV after a percutaneous needlestick injury is about 0.3 percent per exposure, which is well below the risk for hepatitis B. Prompt post-exposure prophylaxis is still recommended, because the infection is serious and prophylaxis is effective when started early.

### Which regimen is used for HIV post-exposure prophylaxis in India?
Current NACO guidance favours a three-drug regimen for 28 days, commonly tenofovir with lamivudine and dolutegravir for occupational exposure. The exact regimen should be checked against the latest NACO guidelines, and treatment should start as early as possible.

### Does hepatitis C need post-exposure prophylaxis?
No effective post-exposure prophylaxis exists for hepatitis C, so the exposed worker does not receive prophylactic drugs. Baseline testing and follow-up testing for hepatitis C infection form the standard response.

### What should an unvaccinated worker receive after hepatitis B exposure?
An unvaccinated worker exposed to an HBsAg-positive source should receive hepatitis B immunoglobulin together with the first dose of hepatitis B vaccine. The vaccine course is then completed on schedule, and antibody levels are checked afterwards.

### What is the first step after a needlestick injury?
The first step is to wash the wound with soap and running water and let it bleed freely without squeezing. The injury is then reported to occupational health so that the exposure can be assessed and prophylaxis started without delay.