We do the sorting. You do the medicine.
OSCE: actor and procedure stations · Core15 / 22

Needlestick from a patient with HIV: advising a colleagueActor: a junior anaesthetist who has just had a hollow-needle injury while placing a central line in a patient with known HIV

Actor: advising a colleague after a high-risk needlestick injury

From memory: the diagnosis and the notes are hidden. Answer each question aloud, then press Show.

Know this first

  • Percutaneous HIV transmission: about 0.3% (0.23% in PHS 2025); mucous membrane 0.09%.
  • Higher risk: hollow-bore needle, visible blood, needle in a vessel, deep injury.
  • Start PEP at once; it can still begin up to 72 h; 28-day course; don't wait for the source result.
  • Baseline HIV Ag/Ab, creatinine and liver tests; final HIV test at week 12.
  • Barrier contraception and no blood donation until the final test.

The patient

Actor: a junior anaesthetist who has just had a hollow-needle injury while placing a central line in a patient with known HIV. The needle was visibly bloody and the wound bled. They want to finish the list first. Task: advise them.

The examiner asks

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  1. Open

    How do you start?

    Show the answerHide the answer
    • I'm speaking to a junior colleague who's had a hollow-needle injury from a patient with known HIV. Patient
    • Stop now. Make the patient safe and let me take over the line. Communication
    • How deep was it, which needle, and was there blood on it?

  2. Explain

    Explain what needs to happen.

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    • Wash it now with soap and water; don't squeeze it or use antiseptic. (Communication)
    • This is a high-risk injury: a hollow needle, from a vein, visibly bloody.
    • The average HIV risk after a needlestick is about 3 in 1,000, and treatment lowers it.
    • Report it now and go straight to occupational health, or the emergency department out of hours.
    • Preventive HIV medicine should start as soon as possible, no later than 72 hours.
    • The course lasts 28 days. Don't wait for the patient's results to start.
    • They'll take baseline blood: an HIV test, kidney and liver tests.

  3. Respond

    They say: 'I'll just finish the list first.'

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    • No. The medicine works best started early; delay makes it less effective. (Communication)
    • I'll cover your list. This comes before every case today.
    • Go now; I'll phone occupational health to say you're coming.

  4. Respond

    They ask: 'What about my partner?'

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    • Use condoms until your final test, and don't donate blood in that time. (Communication)
    • The final HIV test is at 12 weeks; a negative result then closes the follow-up.
    • Occupational health can counsel you both if you'd like.

  5. Close

    How do you close?

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    • Everything stays confidential with occupational health. Communication
    • They'll review you within 72 hours for side effects and support.
    • I'll fill in the incident form with you and check on you tomorrow.
    • I make sure the source patient's details reach occupational health quickly. After surgery

Fatal mistakes

  • Delaying prophylaxis.
  • Not reporting the injury.
  • Carrying on with the list without assessment.

Checked against: Barash 9e · 2025 US Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Post-exposure Prophylaxis in Healthcare Settings · Miller 10e

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