When should I refer a patient with a needlestick injury for specialist assessment?

A patient with a needlestick injury should be referred for specialist assessment immediately if there is a risk of exposure to blood-borne viruses such as HIV, hepatitis B, or hepatitis C. This includes situations where the source is known or suspected to be infected with these viruses, or if the patient's vaccination or immune status is uncertain.

Urgent referral is particularly critical for potential HIV exposure, as post-exposure prophylaxis (PEP) must be started as soon as possible, ideally within 24 hours and no later than 72 hours after the injury. The patient should be directed immediately to an HIV/sexual health clinic or an Accident and Emergency department for assessment and possible initiation of PEP.

Referral to a specialist (such as a consultant virologist, hepatologist, or infectious disease specialist) is also indicated for assessment of hepatitis B and C risk, especially if the patient is hepatitis B surface antigen (HBsAg) positive or if the source is known or suspected to have hepatitis B or C. Specialist assessment is important to guide testing, vaccination, and treatment decisions.

In children with potential exposure, specialist discussion is advised to potentially avoid unnecessary testing and anxiety.