Needle stick injury from Hepatitis C positive patient-Risk and Management

Health workers have a great risk of having a needle stick injury and Management of Needlestick Injuries in the Health Care Setting is a challenge. Needlestick injuries are a major cause of transmission of pathogens from patient to health care professional. HIV, Hepatitis B and Hepatitis C are the most feared infections that are transmitted through needlestick injuries.
In this article, we will discuss the possibility of transmission of hepatitis C after getting a needle stick injury from a hepatitis C positive patient and what should be done after getting a needle stick injury from a hepatitis C positive patient.
1. Possibility of transmission of hepatitis C after a needle stick injury
Many research studies have been conducted to answer this question. These studies demonstrate that the risk of transmission of hepatitis C is greatly lesser than that of hepatitis B after having a needle stick injury. For hepatitis C, this risk varies from 0 – 4 % in different studies. In an older study, carried out by Germanaud J (1994), it was demonstrated that the risk of hepatitis transmission from needle stick injuries varies from 0 – 3 %. In another study, (Published in, J Gastroenterol, 2003) the researchers studied 684 subjects who had got a needle stick injury from a hepatitis C positive patient. Out of these 684 individuals, only 2 became seropositive for hepatitis C. In this study, the risk of transmission was 0.2 %. Thus, it has been clearly demonstrated by research studies that the risk of hepatitis C transmission after needle stick injury from a Hepatitis C Patient is lower as compared to Hepatitis B transmission (7 - 30 % before the use of the vaccine)
2. What to do after getting a needle stick injury from a hepatitis C positive patient.
This is the most important question, after getting a needle stick injury, first of all, report it to your hospital administration. and do the following steps.

1. Wash the wound thoroughly with soap and antiseptic solution.
   
2. Inquire about the patient hepatitis status, that is, whether he is suffering from an acute phase or chronic phase.
   
3. If patient hepatitis status is unknown then do his tests to establish his safety profile.
   
4. If his hepatitis status comes positive then wait for 2-3 weeks and get your “liver function tests” done, if liver enzyme levels are elevated then interferon therapy can be started. Keep in mind that the risk of transmission is low.

The study which was published in the journal of Gastroenterol in 2003 demonstrated that after exposure, the use of early interferons for short duration  (within 12 days of exposure) doesn’t reduce the risk of transmission of hepatitis B.
The Immunization Practice Advisory Committee of the United States of American proposed that polyvalent gamma-globulins should be administered after Hepatitis C exposure. But its efficacy and success haven’t been demonstrated yet.
The bottom line of this article is that the risk of transmission of hepatitis C after having a needle stick injury from a hepatitis C-positive patient is low. It depends upon the quantity of RNA In the fluid and after exposure, you have to wait for few weeks to get yourself tested for hepatitis C and if the test comes positive, then interferon therapy should be started.

References:

1. Risk of HCV transmission after needlestick injury, and the efficacy of short-duration interferon administration to prevent HCV transmission to medical personnel. Gastroenterol 2003 LinK: www.ncbi.nlm.nih.gov/pubmed/14569445
   
2. Transmission of hepatitis C by accidental needlestick injuries. Evaluation of the risk. Link: www.ncbi.nlm.nih.gov/pubmed/7526372