Sharps & Splash Injuries

Sharp and splash injuries opener.jpeg

Infection Prevention and Control (IPC) during procedures includes the safe management of ‘sharps’, encompasses high-level measures such as health facility design and management, protocol-based measures such as adherence to national and facility level guidelines, and individual actions by each health care provider and ancillary staff member. The health care provider is encouraged to familiarise themselves with their facility’s specific IPC protocols and reporting systems, which is outside the scope of this module.

This module describes how to manage sharps injuries and body fluid exposure/splash injuries.


  1. Administer first aid:

    • For injuries: allow to bleed freely. Wash with soap and water.
    • For splashes in eyes, mouth and nose: rinse with water or saline for 15 minutes. Do not rub or disinfect the area.
    • For splashes on skin: wash with soap and water. Do not rub or disinfect the area.
  2. If you are the victim, get someone to

    .

  3. Together with the assistant, assess the

    of occupational exposure. Generally:

    • If the skin is intact and the source patient is HIV negative, no Post Exposure Prophylaxis (PEP) is indicated.
    • For a mucosal splash, non-intact skin or a percutaneous injury with a positive patient (or patient with unknown status), PEP is indicated.
    • If the patient tests HIV negative, but has clinical features of seroconversion illness, commence PEP until further tests are done.
    • If you become HIV infected, assess for ART initiation.
  4. Take the first dose of

    tablets as soon as possible, preferably within minutes of exposure, up to 72h later. All other steps can be delayed if necessary.

  5. An assistant should draw your

    for base-line measurements.

  6. The assistant should draw blood from the

    .

  7. Register a folder as a patient, or draw your folder if already registered.

  8. Obtain a

    for PEP for one month and commence treatment.

  9. Follow up on your blood results and have your PEP prescription modified accordingly.

  10. on your vaccination status and antibody response as well as the Hepatitis B surface antigen (HBsAg) result of the source patient. Get vaccinated or obtain hepatitis B immunoglobulin (HBIG) according to institutional guidelines.

  11. Familiarise yourself with the

    and further management.


  1. Report the injury or exposure to your immediate superior.

  2. Complete the

    . These may vary between provinces, but usually include:

    • Adverse Incident Reporting and Risk Management Tool
    • The W.Cl.2 Employer’s Report of an Incident (complete details in the “Employee” section)
    • The W.Cl.4 First Medical Report (to be completed by a designated person, or the clinician who assisted you).
  3. Put all the forms in your hospital folder.

  4. your folder and the completed documents.


The source patient is HIV positive and failing 2nd line treatment.

Patients failing second line ART usually have no resistance to protease inhibitors so lopinavir/ritonavir should still be effective, but rather consult with a virologist or infectious disease physician for advice on which PEP to use.

The PEP drugs are causing side-effects such as nausea and diarrhoea.

Seek counselling and prescription for the side-effects. If unsuccessful, consult with the occupational health clinic/practitioner to consider a change in regimen. Do not stop using the PEP unless you have consulted a virologist or infectious disease physician.


  1. WHO Best Practices for Injections and Related Procedures Toolkit. World Health Organization: Geneva; 2010.

  2. Department of Health South Africa. Post Exposure Prophylaxis, Occupational. In: Standard Treatment Guidelines: Essential Medicines List for South Africa. Available from: EML Clinical Guide Mobile Application.

  3. Oosthuizen A. The PEP Box. A practical application for Northern Tygerberg Sub District, Cape Metropole. 2019.