Inoculation Injury

Microbiology

Specimen

Blood sample (serum)

Specimen container

Gold top clotted (5ml)

To Request On EPIC

For electronic requesting using EPIC (RDUH ONLY):

Search for: ‘Needlestick / inoculation injury‘ or test code ‘LAB9419‘

Use this request for all samples (ie at 0, 4 and 12 weeks)

Special Instructions

Ideally a blood sample from both the victim and donor should be sent to the laboratory as soon as possible

Samples from patients known to have blood transmissible viral infections should be clearly labelled “High Risk” or “Danger of Infection”.

Please provide following details:

Is this test following a Needle stick injury?
Is this sample from the donor or victim?
What was the date of the needle stick incident?
Please state name of the other party involved in the needle stick incident.
Please state Hepatitis B vaccination status of victim
Refer to Occupational Health if RDUH staff member
Consider referral to GUM if sexual assault as additional screening may be indicated: Ref: BASHH UK guidelines for PEP https://www.bashhguidelines.org/media/1269/pep-2021.pdf

Test Usage

This test should be used to investigate blood borne virus infection following inoculation injuries and Sexual Assaults at 0, 4 12 and 24 weeks

Full clinical guidance is available for the RDUH on the intranet: Inoculation Injuries Toolkit.docx (royaldevonstaff.nhs.uk)

Blood borne viruses, in particular Hepatitis B, Hepatitis C and Human Immunodeficiency Virus (HIV), are at risk of being transmitted to health care workers in inoculation incidents. Management of these incidents includes testing a blood sample from the donor for Hepatitis B surface antigen (HBsAg), antibody to Hepatitis C and HIV as soon as possible after the incident.

Donor of Needle stick- Tested for HBsAg, Anti HCV, HIV, and sample stored.

Victim of needle stick injury – sample stored.

Repeat samples should be sent according to the following table (Use the same requesting code – see above) :

Donor status	Immediate Testing	Further Testing
	For all: Send blood within 48 hours. This sample is stored for 2 years. Risk assess for HIV PEP: test d0 blood for HIV, HCV, HBsAg if starting PEP. Risk assess for need for HBV vaccine.
Unknown donor		12 weeks: HIV, HCV antibody Add HBsAg if HBV unvaccinated/non-responder
Known donor – BBV negative		Nil
Donor HIV positive		4 & 12 weeks: HIV and/or 7 weeks after cessation of PEP
Donor HBV positive		4 & 12 & 24 weeks: HBsAg and HBsAb; if HBsAb neg – do HBcAb
Donor HCV positive		4 & 12 weeks: HCV PCR 12 & 24 weeks: HCV antibody

Availability

Processed locally in Microbiology at RDUH

Turnaround Time

24-48 hours

Urgent Specimen Instructions

Treated as urgent

Specimen Labelling Procedure