Accidental needlestick injuries—as well as any percutaneous (through the skin) injury that can expose a person to tainted blood or body fluids—have long been a concern to both healthcare workers and the public at large. Occupational accidental needlestick injuries are very common among U.S. healthcare workers, estimated to be over 600,000 annually.
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While theperception of risk may be highin cases of occupational accidental needlestick injuries, analyses from the Centers for Disease Control and Prevention (CDC) suggest that the actual risk may be far lower—so low, in fact, that it can now be considered rare.
Note that other forms of needle transmission of HIV, such as sharing needles to inject recreational drugs, have different rates of HIV acquisition.
Evolution of the “Three Out of a Thousand” Estimate
In a popularly referenced 1989 study, researchers suggested that the risk of acquiring HIV from a single needlestick injury involving HIV-contaminated blood was around 0.32 percent, or roughly three cases out of every 1,000 injuries.
That figure has remained in the consciousness of public health authorities despite growing evidence that the “three out of a thousand” estimate pertained more to untreated source patients withlate-stage, symptomatic disease—the more likely scenario in 1989—than to estimates based purely on needlestick injury alone.
A meta-analysis conducted in 2006 confirmed the reduction of the rate. In reviewing 21 different studies, the researchers found that the pooled estimates suggested that the risk of acquiring HIV was more along the lines of 0.13 percent if the needlestick injury was the only risk factor.
The other risk factors for acquiring HIV after an accidental needle stick injury are the amount of blood transferred, the concentration of the virus, and the depth of the penetration.
What was, perhaps, more important to note was that, of the 21 studies reviewed, 13 concluded an actual risk of 0%.Such disparities in research only served to add to the contentiousness already surrounding the issue of HIV risk in occupational healthcare settings.
CDC Examines Confirmed and Suspected Cases
In the January 9, 2015 issue ofMorbidity and Mortality Weekly, CDC officials identified 58 confirmed and 150 possible cases of occupationally acquired HIV in the United States between the years 1985 and 2013.In that time, over 16 million needlestick injuries likely occurred to U.S. healthcare workers.
Confirmed cases were those in which the healthcare worker was established to be HIV-negative while the source patient was shown to be HIV-positive. By contrast, possible cases were those in which the HIV status of the source patient was unknown or no documented link was established between the healthcare worker and source patient.
Of the 58 confirmed cases, all but four occurred between the years 1985 and 1995, just prior to the advent ofantiretroviral therapy (ART)and the release of the first U.S. guidelines for the use ofpost-exposure prophylaxis (PEP)in cases of accidental HIV exposure.
Since 1999, only one confirmed case of occupationally-acquired HIV has ever been reported to the CDC. (That case involved a lab researcher who, in 2008, was working with a live HIV culture.)
While the CDC report in no way lessens the importance of PEP in cases of needlestick and other percutaneous (through the skin) injuries, it does suggest that, in the words of the researchers, “more widespread and earlier treatment to reduce patientviral loads” has contributed to the almost complete mitigation of HIV risk insofar as occupational exposure is concerned.
PEP After Accidental Needlestick
After an accidental needlestick, see a healthcare provider immediately to start PEP. Every hour counts, and it must be started within 72 hours of exposure.You must take PEP medications daily for 28 days.
If you are unsure where to go for medical attention, you canuse the locator at HIV.gov. For a workplace exposure, immediately report it to the appropriate person and seek immediate medical attention. A healthcare provider can call the PEPline (1-888-448-4911) for advice on how to manage the exposure.
The medicines used for PEP are safe, but some people may experience side effects, such as nausea.Pregnant or lactating people can take PEP, but be sure to disclose your status to the healthcare provider so they can choose the most appropriate medications.
Healthcare insurance should cover the cost of PEP. If it is workplace exposure, workers' compensation should also cover it. If insurance is lacking or PEP is not covered, the healthcare provider prescribing PEP can request free PEP through the manufacturer’s programs.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Abadie RB, Brown EM, Campbell JR, et al.Incidence and risks of HIV infection, medication options, and adverse effects in accidental needle stick injuries: a narrative review.Cureus. 2024;16(1):e51521. doi:10.7759/cureus.51521United States District Court, Eastern District of Michigan, Southern Division. “JANE DOE and JOHN DOE, husband and wife, Plaintiffs, vs. ETIHAD AIRWAYS, P.J.S.C., Defendant.” Grand Rapids, Michigan.Becker CE, Cone JE, Gerberding J.Occupational infection with human immunodeficiency virus (HIV). Risks and risk reduction.Ann Intern Med. 1989;110(8):653-6. doi:10.7326/0003-4819-110-8-653Baggaley RF, Boily MC, White RG, Alary M.Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis.AIDS. 2006;20(6):805-12. doi:10.1097/01.aids.0000218543.46963.6dCenters for Disease Control and Prevention (CDC). “Notes from the Field:Occupationally Acquired HIV Infection Among Health Care Workers— United States.Morbidity and Mortality Weekly Report.Centers for Disease Control and Prevention.Preventing HIV with PEP.HIV.gov.Post-exposure prophylaxis.Additional ReadingCDC. “Updated U.S. Public Health ServiceGuidelines for the Management of Occupational Exposures to HIVand Recommendations for Postexposure Prophylaxis.“Morbidity and Mortality Weekly Report.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Abadie RB, Brown EM, Campbell JR, et al.Incidence and risks of HIV infection, medication options, and adverse effects in accidental needle stick injuries: a narrative review.Cureus. 2024;16(1):e51521. doi:10.7759/cureus.51521United States District Court, Eastern District of Michigan, Southern Division. “JANE DOE and JOHN DOE, husband and wife, Plaintiffs, vs. ETIHAD AIRWAYS, P.J.S.C., Defendant.” Grand Rapids, Michigan.Becker CE, Cone JE, Gerberding J.Occupational infection with human immunodeficiency virus (HIV). Risks and risk reduction.Ann Intern Med. 1989;110(8):653-6. doi:10.7326/0003-4819-110-8-653Baggaley RF, Boily MC, White RG, Alary M.Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis.AIDS. 2006;20(6):805-12. doi:10.1097/01.aids.0000218543.46963.6dCenters for Disease Control and Prevention (CDC). “Notes from the Field:Occupationally Acquired HIV Infection Among Health Care Workers— United States.Morbidity and Mortality Weekly Report.Centers for Disease Control and Prevention.Preventing HIV with PEP.HIV.gov.Post-exposure prophylaxis.Additional ReadingCDC. “Updated U.S. Public Health ServiceGuidelines for the Management of Occupational Exposures to HIVand Recommendations for Postexposure Prophylaxis.“Morbidity and Mortality Weekly Report.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Abadie RB, Brown EM, Campbell JR, et al.Incidence and risks of HIV infection, medication options, and adverse effects in accidental needle stick injuries: a narrative review.Cureus. 2024;16(1):e51521. doi:10.7759/cureus.51521United States District Court, Eastern District of Michigan, Southern Division. “JANE DOE and JOHN DOE, husband and wife, Plaintiffs, vs. ETIHAD AIRWAYS, P.J.S.C., Defendant.” Grand Rapids, Michigan.Becker CE, Cone JE, Gerberding J.Occupational infection with human immunodeficiency virus (HIV). Risks and risk reduction.Ann Intern Med. 1989;110(8):653-6. doi:10.7326/0003-4819-110-8-653Baggaley RF, Boily MC, White RG, Alary M.Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis.AIDS. 2006;20(6):805-12. doi:10.1097/01.aids.0000218543.46963.6dCenters for Disease Control and Prevention (CDC). “Notes from the Field:Occupationally Acquired HIV Infection Among Health Care Workers— United States.Morbidity and Mortality Weekly Report.Centers for Disease Control and Prevention.Preventing HIV with PEP.HIV.gov.Post-exposure prophylaxis.
Abadie RB, Brown EM, Campbell JR, et al.Incidence and risks of HIV infection, medication options, and adverse effects in accidental needle stick injuries: a narrative review.Cureus. 2024;16(1):e51521. doi:10.7759/cureus.51521
United States District Court, Eastern District of Michigan, Southern Division. “JANE DOE and JOHN DOE, husband and wife, Plaintiffs, vs. ETIHAD AIRWAYS, P.J.S.C., Defendant.” Grand Rapids, Michigan.
Becker CE, Cone JE, Gerberding J.Occupational infection with human immunodeficiency virus (HIV). Risks and risk reduction.Ann Intern Med. 1989;110(8):653-6. doi:10.7326/0003-4819-110-8-653
Baggaley RF, Boily MC, White RG, Alary M.Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis.AIDS. 2006;20(6):805-12. doi:10.1097/01.aids.0000218543.46963.6d
Centers for Disease Control and Prevention (CDC). “Notes from the Field:Occupationally Acquired HIV Infection Among Health Care Workers— United States.Morbidity and Mortality Weekly Report.
Centers for Disease Control and Prevention.Preventing HIV with PEP.
HIV.gov.Post-exposure prophylaxis.
CDC. “Updated U.S. Public Health ServiceGuidelines for the Management of Occupational Exposures to HIVand Recommendations for Postexposure Prophylaxis.“Morbidity and Mortality Weekly Report.
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