# Sharps Injury Management

> Sharps injury management for NEET-PG Surgery: transmission risks, PEP with TLD regimen, HBIG and vaccination, HCV follow-up and prevention.

- Canonical URL: https://prepelephant.com/topics/neet-pg/surgery/sharps-injury-management
- Exam / course: NEET-PG · Subject: Surgery
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Sharps Injury Management", PrepElephant, https://prepelephant.com/topics/neet-pg/surgery/sharps-injury-management

## Direct answer

The needle that slips through the glove starts a clock: post-exposure prophylaxis against HIV works best within two hours and fails after 72. First aid is deliberately dull — wash under running water with soap, irrigate splashed eyes 10-15 minutes, never squeeze. Then report: the source is tested for HIV, HBsAg and anti-HCV, and the exposed worker gives baseline serology. The deciding numbers: HIV risk is about 0.3% per percutaneous exposure and under 0.1% mucosally; hepatitis B carries roughly 30% risk from an HBeAg-positive source (6% if HBeAg-negative); hepatitis C averages under 2% and has no PEP, only early detection and cure. India's NACO protocol now uses the fixed-dose TLD tablet — tenofovir, lamivudine and dolutegravir — daily for 28 days.

## What you must remember

- **First aid:** wash with soap and water; flush mucosa 10-15 minutes; do not squeeze the wound or apply antiseptics — the teaching changed, and exam answers must change with it.
- **Transmission risks (quotable):** HIV — percutaneous about 0.3%, mucosal about 0.09%, intact skin negligible; HBV — up to 30% from HBeAg-positive sources, about 6% from HBsAg-positive/HBeAg-negative; HCV — roughly 1.8% average percutaneous risk.
- **HIV PEP regimen (WHO 2022 and NACO India):** tenofovir (TDF 300 mg) + lamivudine (3TC 300 mg) + dolutegravir (DTG 50 mg) as one tablet daily for 28 days — India's fixed-dose TLD; start ideally within 2 hours, mandatory within 72; counsel on adherence and side effects (nausea, insomnia with DTG).
- **Follow-up serology:** HIV testing at baseline, 6 weeks, 3 months (and 6 months where applicable) with fourth-generation antigen-antibody assays.
- **HBV PEP is vaccine-driven:** unvaccinated or anti-HBs under 10 mIU/mL — HBIG 0.06 mL/kg IM promptly plus accelerated vaccination (0, 1, 2 months with a 12-month booster); documented responders need nothing.
- **HCV has no PEP:** HCV RNA at 2-6 weeks and antibody at 3-6 months; seroconverters go straight to direct-acting antivirals (cure above 95%).
- **Prevention engineering (asked as a list):** no recapping (one-handed scoop if unavoidable), hands-free neutral zone in theatre, double gloving (halves contamination despite punctures), blunt suture needles for fascia, immediate safe disposal, hepatitis B vaccination of every health worker — an Indian national health-mission priority — and an institutional exposure register under the hospital infection control committee.
- **Source unknown or unavailable:** treat as potentially infected for HIV decision-making; initiate PEP if exposure was significant, and re-evaluate with evolving information.

## The first hour handled correctly

A nurse sustains a deep needlestick from a known HIV-positive, HBsAg-negative, anti-HCV-positive patient. Minute one: gloves off, wash under running water, no squeezing. Minute five: report to infection control; the wound classifies as severe. Minute twenty: baseline bloods from nurse and consenting source. Within the hour: TLD started with adherence counselling; her documented anti-HBs titre above 10 mIU/mL spares her HBV prophylaxis; HCV RNA testing is booked at 4 weeks. Day 28: PEP completed; week 6 and month 3 HIV tests negative — exposure closed, documented, fed back to the sharps-safety committee. The teaching point is tempo: every defensible decision was made inside the first hour.

## Perspective: exam and Indian practice

Theory questions pull the numbers — 0.3% HIV, 30% HBV from e-antigen-positive sources — and the regimen name (TLD, 28 days, dolutegravir-based since NACO aligned with WHO; older zidovudine-based answers are wrong). The viva trap is first aid: "allow to bleed, squeeze out" loses marks. Indian practice deserves honesty: under-reporting remains the norm, percutaneous injuries among trainees are common, hepatitis B coverage of support staff is incomplete outside accredited institutions, and examiners increasingly ask the system, not just the drug — who do you call, where is the starter pack, how is the event recorded.

## Frequently asked questions

### What immediate first aid follows a needlestick injury?

Wash the wound under running water with soap (irrigate mucosa for 10-15 minutes) without squeezing or applying antiseptics into the wound, then report to infection control immediately.

### What is the current HIV PEP regimen in India and for how long?

One fixed-dose TLD tablet daily (tenofovir 300 mg, lamivudine 300 mg, dolutegravir 50 mg) for 28 days, started ideally within 2 hours and no later than 72 hours after exposure.

### When is HBIG with hepatitis B vaccine given after exposure?

When the exposed worker is unvaccinated or has anti-HBs below 10 mIU/mL — HBIG 0.06 mL/kg IM promptly plus an accelerated vaccine course; documented responders need no prophylaxis.

### What is the risk of HIV transmission after a percutaneous needlestick?

Approximately 0.3% from an HIV-positive source (0.09% for mucosal exposure), rising with deep injury, visible blood and high source viral load.

### How is hepatitis C exposure followed up?

No prophylaxis exists — test HCV RNA at 2-6 weeks and antibody at 3-6 months; confirmed infection is treated with direct-acting antivirals, which cure over 95% of cases.