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You are asked to see a previously well 5-year-old boy who presented to the accident and emergency department. While playing in a public park he picked up a discarded 1 mL syringe with an attached 27-gauge needle and punctured the skin of his hand. His mother asks, “Will he catch AIDS? What should we do now?”
Structured clinical question
In a child with a community-acquired needlestick injury (CA-NSI) (patient, intervention), what is the risk of blood-borne virus (BBV) transmission (outcome)?
CA-NSI in children causes significant parental anxiety. The risk of HIV and hepatitis virus transmission following NSI in healthcare settings is well established. The risk of BBV transmission to a child from a CA-NSI is substantially less than from occupational exposure. Despite this, many clinical guidelines are based on occupational NSI.
Search strategy and outcome
Medline was searched using the Ovid interface (1946 to present/no limits set) using MeSH subject headings: (*needlestick injuries/ or *needles/ or *syringes/) and (*blood-borne pathogens/ or (*hiv infections/ or *acquired immunodeficiency syndrome/ or *hiv seropositivity/) or (*hepatitis/ or *hepatitis, viral, human/ or *hepatitis b/ or *hepatitis c/) or (community.mp. or *community-acquired infections/ or *environmental exposure/)). No age limits were imposed for reported cases of BBV transmission from CA-NSI, on the basis that confirmed transmission at any age would support the theoretical possibility of transmission in children. Only papers addressing non-healthcare-related CA-NSI were included. Cross-sectional studies with no longitudinal follow-up and those reporting exclusively BBV transmission from injecting drug use were excluded. The search date was 11 May …
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