In brief
After a needlestick, the wound is immediately washed with soap and plenty of water, not squeezed to make it bleed, and the incident is reported without delay. The hepatitis B, hepatitis C and HIV status of the source patient and the worker is assessed; HIV prophylaxis starts within the first hours, and the decision on hepatitis B vaccine and immunoglobulin depends on vaccination status. The incident is recorded, and prevention relies on safety-engineered devices and a no-recapping rule.
What to do after a needlestick: the first minutes
A needle being taken to the sharps bin after a blood draw went through a nurse's glove and into her finger. From this point on, every minute counts; but what is needed is a sequence, not panic. The answer to the question of what to do after a needlestick is a chain running from the first wash to the assessment of the source patient, from the prophylaxis decision to recording and prevention. This article explains that chain step by step for healthcare facilities and other workplaces where sharps are used.
Immediately after the injury:
- Stop work. Hand over the patient's safety to a colleague.
- Wash. Wash the puncture or cut site with soap under running water. If blood has splashed onto mucous membranes such as the eyes, mouth or nose, rinse with plenty of water or saline; remove contact lenses if worn.
- Do not squeeze or scrub. Squeezing the wound to make it bleed, scrubbing it or using irritants such as bleach is not recommended; it can damage the tissue and make things worse.
- Note the source. Which patient, which device (hollow-bore needle, suture needle or scalpel), how deep the injury was and whether there was visible blood.
- Report immediately. Inform the nurse in charge or unit manager and the unit designated by the institution (infection control, staff health unit or workplace physician) during the same shift.
Which exposures are risky?
The main concern in a sharps injury is the blood-borne viruses hepatitis B (HBV), hepatitis C (HCV) and HIV. The risk of transmission varies with the type of exposure, the amount of blood and the status of the source patient. Of the three agents, HBV has by far the highest probability of transmission; in a worker who has been vaccinated and shown to have a protective antibody level, however, the HBV risk is very low.
| Type of exposure | Example | Assessment |
|---|---|---|
| Percutaneous (under the skin) | Needlestick with a bloody needle, scalpel cut | The riskiest group; a hollow-bore needle with visible blood and a deep injury increase the risk |
| Mucous membrane | Blood splashed into the eye or mouth | Risky; assessed separately |
| Non-intact skin | Blood contact with cracked, eczematous or wounded skin | Risky; the duration and amount of contact are considered |
| Intact skin | Blood on the intact skin of an ungloved hand | Not considered a risk for blood-borne infections; washing is sufficient |
Assessing the source patient
If the source patient is known, HBsAg, anti-HCV and anti-HIV tests are requested in line with the institution's procedure and with the patient's informed consent. The source patient's known diagnoses, treatment status and recent test results also affect the prophylaxis decision. A quick result can prevent unnecessary use of medication.
If the source is unknown (for example, if a needle in a full waste bag pricked a cleaner), the decision is made by the infectious diseases physician based on the patient profile of the unit the needle came from and the characteristics of the injury. Sending needles of unknown source to the laboratory for testing is not recommended.
Information about the source patient and the injured worker is confidential. Test results are shared only with the physicians who need to make the decision; they are not written on the unit noticeboard, in the shift group or in a part of the incident report that everyone can see.
The post-exposure prophylaxis decision
Baseline tests are also taken from the injured worker: hepatitis B surface antigen and antibody (HBsAg, anti-HBs), anti-HCV and anti-HIV. These tests are also important for showing that any infection that develops later did not exist before the injury. The decision is made by an infectious diseases specialist in accordance with the institution's post-exposure protocol; the workplace physician coordinates the process and plans the follow-up.
| Agent | Post-exposure prophylaxis | Timing | Note |
|---|---|---|---|
| Hepatitis B | For an unvaccinated worker or one with an inadequate antibody response, vaccine and/or hepatitis B immunoglobulin depending on the source's status | As soon as possible, preferably within the first 24 hours | A vaccinated worker with documented protective antibodies usually needs no further action |
| HIV | Prophylaxis with antiretroviral drugs (usually 28 days) | Ideally within the first few hours; starting after 72 hours is generally not recommended | Can be started until the source patient's status is known and stopped depending on the result |
| Hepatitis C | No recommended prophylaxis | Early diagnosis through follow-up testing | If infection is detected, early treatment is planned |
The physician sets the timing of follow-up tests. During follow-up, the worker is given advice on matters such as blood donation and protection, drug side effects are monitored and their anxiety is addressed. Not leaving the worker alone during this process also makes it easier to complete the record and the follow-up.
Recording and needlestick reporting
Needlestick reporting is done at three levels:
- Internal safety reporting: In healthcare facilities, Art. 8 of the Regulation on Ensuring Patient and Employee Safety requires the safety reporting system to cover sharps injuries and contact with blood and body fluids, and corrective and preventive actions to be implemented for reported incidents.
- OHS record: Under Art. 12 of the Regulation on the Prevention of Risks of Exposure to Biological Agents, the worker reports any accident or incident involving a biological agent immediately to the workplace physician, the OHS specialist or the employer. Art. 14/1 of Law No. 6331 on Occupational Health and Safety requires the employer to record, investigate and report all occupational accidents.
- SGK notification: Incidents considered occupational accidents are notified to the Social Security Institution (SGK) within 3 working days after the accident. Assess on the day of the incident, together with the workplace physician and human resources, whether notification is required; do not postpone this decision so as not to miss the deadline. The notification steps are in our guide to the first 72 hours after an occupational accident.
If an infection is detected during follow-up, the case is treated as a suspected occupational disease; for the diagnosis and notification process, see our article what is an occupational disease. The 2026 administrative fine for not notifying an occupational accident on time is 44,443 TL and is imposed by SGK; other amounts are on the OHS administrative fines page.
Prevention: choosing safety devices and organising work
An incident record is not just bureaucracy; it is the most valuable data showing with which device, in which procedure and at what stage an injury occurred. Group and review the records every three months: do most injuries occur during injection, when disposing into the sharps bin, or in cleaning and the laundry? Choose measures in this order:
- Reduce unnecessary use of sharps. Needle-free connector systems and reducing unnecessary injections are the first step.
- Switch to safety-engineered devices. Retractable or shielding needles, safety blood collection sets, shielded scalpels. Choose them together with the nurses and physicians who use them, through trial use, and provide training.
- Do not recap needles. Recapping a used needle with two hands is a known cause of injuries; prohibit it as a rule.
- Place the sharps bin at the point of use. The sharps bin should be where the procedure is carried out, within arm's reach, and the manufacturer's fill line must not be exceeded.
- Do not pass sharps hand to hand in the operating theatre. Use a neutral zone (tray) for scalpels and needles.
- Vaccinate and provide PPE. Art. 16 of the Regulation on Biological Agents requires suitable vaccines to be given to workers who are not immune. The cost of OHS measures and PPE cannot be passed on to workers. For PPE obligations, see our article on the Regulation on the Use of PPE.
After each injury, carry out a short incident investigation and ask these questions: Was there a safety-engineered alternative to the device used? Was the sharps bin at the point of the procedure and below the fill line? Was the procedure carried out in a hurried, crowded or poorly lit environment? Had the worker been trained in using this device's safety mechanism? Was the patient agitated, and could help have been called? The answers should translate into a concrete change in the device, work organisation or training, rather than a general conclusion such as "more care should be taken". This investigation is also part of the occupational accident and incident investigation required by Art. 14/1 of the Law.
The risk is not limited to hospitals: dental clinics, laboratories, care homes, cleaning and waste collection work also encounter sharps injuries. Cleaning staff and care workers are often forgotten in training and vaccination programmes.
At healthcare facilities in Bursa and the surrounding provinces, writing the post-exposure procedure, monitoring workers' vaccination status and analysing incident records are part of our workplace physician service; baseline and follow-up tests are planned with authorised laboratories and health institutions as part of health surveillance. For periodic examination frequencies, see our article on periodic examinations and tests.
Frequently Asked Questions
Should I squeeze a needlestick wound to make it bleed?
No. Washing the wound with soap under running water is sufficient. Squeezing, scrubbing or using an irritant antiseptic does not reduce the risk of transmission and can damage the tissue. After washing, report it without delay.
Is there a risk of hepatitis from a needlestick?
Yes; hepatitis B and hepatitis C are transmitted by blood, and a needlestick is a known route of transmission. In a worker who has had the hepatitis B vaccine and has a documented protective antibody level, the risk of hepatitis B is very low. There is no prophylaxis for hepatitis C; the aim is early diagnosis through follow-up testing.
When should post-exposure prophylaxis start?
HIV prophylaxis ideally starts within the first few hours; starting after 72 hours is generally not recommended. For hepatitis B, the vaccine and immunoglobulin decision is made as soon as possible, preferably within the first 24 hours. The decision is made by the infectious diseases physician.
Is a needlestick reported as an occupational accident?
A needlestick is an incident occurring at the workplace and because of work, and it must be entered in the OHS records. When it is considered an occupational accident, the SGK notification is made within 3 working days after the accident; make this assessment on the day of the incident with the workplace physician and human resources.
A physician assigned for the time your hazard class requires: pre-employment and periodic examinations, fitness-for-work reports and health surveillance.
Bursa SİSTEMER OSGB Technical Team — written from the field experience of our OHS specialists and workplace physicians. Legal information is valid as of the publication/update date; contact us for an assessment specific to your business.