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Section 2. Recommendations for Care of Children in Special Circumstances
INJURIES FROM DISCARDED NEEDLES IN THE COMMUNITY
Contact with and injuries from hypodermic needles and syringes discarded in public places, presumably by injection drug users, are perceived by some people as posing a significant risk for transmission of bloodborne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Although nonoccupational needlestick injuries may pose less of a risk than needlestick injuries that occur in health care settings, the injured person needs evaluation and counseling. In addition, people exposed in this manner may not realize they need evaluation. Even if the potential that the discarded syringe contains a bloodborne pathogen can be estimated from the prevalence rates of these infections in the local community, the need to test the injured or exposed person usually is not influenced significantly by this assessment.
Management of people with needlestick injuries includes acute wound care and consideration of the need for antimicrobial prophylaxis. Standard wound cleansing and care is indicated; such wounds rarely require closure. Tetanus toxoid vaccine and Tetanus Immune Globulin should be administered as appropriate for the immunization status of the exposed person (see Tetanus, p 648).
Consideration of the need for prophylaxis for HBV and HIV is the next step in exposure management. There is no recommended postexposure prophylaxis for HCV. Risk of acquisition of various pathogens depends on the nature of the wound, the ability of the pathogens to survive on environmental surfaces, the volume of source material, the concentration of virus in the source material, prevalence rates among local injection drug users,
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