BravoCalc

HIV Needle Stick Risk Assessment Stratification Protocol (RASP)

Source Patient HIV Status

Source Patient Viral Load (if known HIV+)

Type of Exposure

Needle Type (if percutaneous)

Depth of Injury (if percutaneous)

Visible Blood on Device

Device Used In Vein/Artery

Type of Fluid

About the HIV Needle Stick Risk Assessment

The HIV Needle Stick Risk Assessment Stratification Protocol (RASP) is a tool designed to help healthcare providers assess the risk of HIV transmission following an occupational exposure to blood or body fluids, particularly through needle sticks or sharps injuries.

Clinical Significance

Occupational exposures to HIV pose a significant concern for healthcare workers. The average risk of HIV transmission after a percutaneous exposure to HIV-infected blood is approximately 0.3% (1 in 300), but this risk varies based on several factors including the type of exposure, source patient viral load, and other characteristics of the exposure.

This calculator helps stratify the risk into high, intermediate, or low categories, which can guide decisions regarding post-exposure prophylaxis (PEP) and follow-up testing.

Risk Factors

Several factors influence the risk of HIV transmission after an occupational exposure:

  • Source patient HIV status: Known HIV-positive source patients pose a higher risk than those with unknown status.
  • Viral load: Higher viral loads in the source patient are associated with increased transmission risk.
  • Type of exposure: Deep injuries, visible blood on the device, procedures involving needles placed directly in arteries or veins, and hollow-bore needles carry higher risks.
  • Type of fluid: Blood, bloody fluid, or other potentially infectious materials pose varying levels of risk.

Post-Exposure Management

Based on the risk assessment, healthcare providers can make informed decisions about:

  • Post-Exposure Prophylaxis (PEP): Typically recommended for high and intermediate risk exposures, PEP should be initiated as soon as possible, ideally within 72 hours of exposure.
  • Follow-up testing: HIV testing is typically performed at baseline, 6 weeks, 3 months, and 6 months after exposure.
  • Counseling: Psychological support and education about symptoms of acute HIV infection.

Limitations

This calculator provides an estimate of risk based on available evidence but cannot account for all possible variables. Clinical judgment should always be exercised, and consultation with infectious disease specialists is recommended for complex cases.

The decision to initiate PEP should consider not only the calculated risk but also the potential toxicity of antiretroviral medications, patient preferences, and local guidelines.

References

  1. Kuhar DT, Henderson DK, Struble KA, et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013;34(9):875-892.
  2. Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med. 1997;337(21):1485-1490.
  3. Centers for Disease Control and Prevention. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR Recomm Rep. 2001;50(RR-11):1-52.