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    Patent Pending

    HIV Needle Stick Risk Assessment Stratification Protocol (RASP)

    Quantifies HIV exposure risk by source and exposure type and need for prophylaxis.
    Favorite
    When to Use
    Why Use
    • High vs low risk exposure; helps determine whether or not to start PEP.
    • Always try to test the source patient for HIV, and other infectious diseases such as Hepatitis C and Hepatitis B.

    The HIV Needle Stick Risk Assessment Protocol quantifies gives healthcare workers a more objective risk assessment of getting HIV after a needle stick.

    Known HIV+: acute AIDS illness
    +1
    Known HIV+: asymptomatic HIV
    +10
    Unknown HIV status: high-risk situation
    +100
    Unknown HIV status: low-risk situation
    +1000
    Fresh blood
    +1
    Other high-risk fluids (e.g., semen)
    +10
    Dried old blood
    +100
    Low-risk secretions (e.g., tears, urine, saliva)
    +1000
    Intravenous
    +1
    Deep intramuscular
    +10
    Deep transcutaneous with visible bleeding
    +100
    Superficial transcutaneous without bleeding
    +200
    Mucosal contact only
    +500
    Intact skin
    +1000
    Massive (e.g., transfusion)
    +100
    Measurable (>1 mL)
    +10
    Moderate (large-bore, hollow needle >22 g)
    +5
    Small (small-bore, hollow needle <22 g)
    +3
    Trace surface only (e.g., suture needle)
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    If indicated, PEP should be started in conjunction with infectious disease consultation, as well as gathering information about the source patient and his or her medication regimen. 

    Formula

    Basic risk = 1 / (Source population x Inoculum type x Method of transmission)

     

    Total risk = Basic risk x Volume of inoculum

     

    Where variables are as follows:

    Variable

    Points

    Source population*

    Known HIV+: acute AIDS illness

    1

    Known HIV+: asymptomatic HIV

    10

    Unknown HIV status: high-risk situation

    100

    Unknown HIV status: low-risk situation

    1000

    Inoculum type

    Fresh blood

    1

    Other high-risk fluids (e.g., semen)

    10

    Dried old blood

    100

    Low-risk secretions (e.g., tears, urine, saliva)

    1000

    Method of transmission

    Intravenous

    1

    Deep intramuscular

    10

    Deep transcutaneous with visible bleeding

    100

    Superficial transcutaneous without bleeding

    200

    Mucosal contact only

    500

    Intact skin

    1000

    Volume of inoculum

    Massive (e.g., transfusion)

    100

    Measurable (>1 mL)

    10

    Moderate (large-bore, hollow needle >22 g)

    5

    Small (small-bore, hollow needle <22 g)

    3

    Trace surface only (e.g., suture needle)

    1

    *Acute AIDS illness defined as “end stage AIDS, hospitalized, high viral load”. Unknown HIV status, high-risk situation defined as “suspected HIV, IV drug user, unknown needle with high local HIV prevalence”.

     

    Facts & Figures

    Interpretation:

    Total risk

    PEP recommendation

    1/1000

    Definitely indicated

    1/1000-1/10,000

    Recommended but optional

    1/10,001-1/100,000

    Optional but not recommended

    1/100,000

    Not indicated

     

    The author also cites some everyday life risks to help provide risk perspective:

    Risk of dying in the next 12 months

    Overall risk of dying in the next 12 months (all causes)

    1/3,000

    Specific causes of death in the next 12 months

    From a lightning strike

    1/2,000,000

    In an accident in your bathtub or shower

    1/1,000,000

    From a previously unknown allergy to a prescribed drug

    1/1,000,000

    By choking to death on food

    1/160,000

    In a bicycle accident (if you own a bicycle)

    1/130,000

    From toxic shock if you use tampons

    1/100,000

    By drowning

    1/50,000

    From a fire

    1/50,000

    As a pedestrian hit by a car or truck

    1/40,000

    In a work-related accident (office workers)

    1/37,000

    From a fall

    1/20,000

    In a work-related accident (overall)

    1/11,000

    By being murdered

    1/11,000

    While jogging (average 2 h/wk)

    1/10,000

    In a road accident

    1/6,000

    From any kind of accident

    1/3,000

    Other risks

    Risk of dying on your next commercial jet flight

    1/5,000,000

    Lifetime risk of being on a bridge when it collapses

    1/4,000,000

    Risk of dying if you get influenza

    1/5,000

    Risk of being diagnosed with cancer in the next 12 months (overall death rate 50%)

    1/3,600

    Risk of being diagnosed with lung cancer in the next 12 months if you are (or were) a smoker (overall death rate about 90%)

    1/250

    Risk of having a heart attack in the next 12 months if you are over 35 years of age

    1/77

    Dr. Les Vertesi

    About the Creator

    Les Vertesi, MD, is the executive director of British Columbia's Health Services Purchasing Organization and a part-time emergency room physician. He is on the faculty of Simon Fraser University's Institute for Health Research and Education and is associate director of Health Research with the Fraser Health Authority of British Columbia. Dr. Vertesi published a book in 2003: Broken Promises: The Trouble with Canadian Medicare...and How to Fix it.

    To view Dr. Les Vertesi's publications, visit PubMed