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Biohazard & Needle-Stick
Exposure Response

What to do first after a sharps injury or bloodborne pathogen exposure — fast, evidence-based steps that protect the nurse.

NCLEX-RN

What Is an Exposure Incident?

An exposure incident is any specific contact with blood or other potentially infectious materials (OPIM) that results from performing a worker's duties.

Key Terms

Bloodborne Pathogens
Microorganisms in human blood that cause disease: HBV, HCV, and HIV are the primary concerns.
PEP
Post-Exposure Prophylaxis — preventive medication started quickly after high-risk exposure.
Source Patient
The individual whose blood/fluid the worker was exposed to; tested with consent.

Why Speed Matters

Time after exposure PEP effectiveness 2 hrs (ideal) 72 hrs (limit)

The Golden First Rule

1. WASH soap + water 2. REPORT supervisor 3. EVALUATE PEP & testing

Mucous Membrane Splash

If blood or body fluid splashes into the eyes, nose, or mouth, the first action differs from a sharps stick.

First Action: Stick vs. Splash

Needle-Stick / Cut Mucous Splash
First actionWash with soap & waterFlush with water/saline
DurationWash thoroughly15 minutes
Squeeze wound?NoN/A
Next stepReport & evaluateReport & evaluate

The Full Response Sequence

1
Care for the site. Wash sticks with soap/water; flush mucosa for 15 min.
2
Report immediately to the supervisor and employee/occupational health.
3
Document the incident: route, source, device, and circumstances.
4
Evaluate the source patient (with consent) for HBV, HCV, HIV.
5
Baseline testing & PEP for the exposed worker, started rapidly if indicated.

Estimating Transmission Risk

Average transmission risk per percutaneous exposure from a known positive source varies widely by pathogen:

PathogenApprox. Risk
HBV (unvaccinated)\( \approx 6\% - 30\% \)
HCV\( \approx 1.8\% \)
HIV\( \approx 0.3\% \)

Example 1: Needle-Stick

Scenario: A nurse sticks her finger with a used hollow-bore needle while recapping. What is her first action?

Example 2: Eye Splash

Scenario: Blood splashes into a nurse's eyes during a trauma resuscitation. What does she do first?

Example 3: Source Unknown

Scenario: A nurse is stuck by a needle found in the linens; the source patient is unknown. After washing, what guides care?

Common Mistakes

✕ Reporting before washing
Wound care and irrigation come first, then report.
✕ Squeezing the site
Squeezing may increase tissue trauma; it is not recommended.
✕ Using bleach on skin
Caustic agents and antiseptic injection are not advised for puncture wounds.
✕ Recapping needles
A leading cause of sticks — discard directly into a sharps container.
✕ Delaying PEP evaluation
PEP works best within hours; never wait days to seek care.
✕ Skipping documentation
An undocumented exposure can compromise follow-up and benefits.

Response Summary

StepActionWhy
1Wash / flush siteReduce pathogen load
2Report to supervisorActivate protocol
3Document incidentLegal & medical record
4Test source patientGuide PEP need
5Baseline + PEPPrevent infection

Question 1 of 5

A nurse sustains a needle-stick from a used syringe. What should she do first?

Question 2 of 5

Blood splashes into a nurse's eyes. What is the appropriate first response?

Question 3 of 5

Why is starting post-exposure prophylaxis (PEP) quickly important?

Question 4 of 5

Which action by a nurse most likely caused a preventable needle-stick injury?

Question 5 of 5

The per-exposure HIV transmission risk from a percutaneous injury is about \( 0.3\% \). This is equal to:

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