Required section · Section 4 of 6
Guided case: a needlestick during a coagulation draw
Setting: a hospital core laboratory, day shift. A phlebotomist collecting a routine blue-top coagulation tube experiences a needlestick from the used phlebotomy needle while engaging the safety shield. No blood is visible on the outer glove; a small puncture with minor bleeding is present on the left index finger.
0 minutes: the phlebotomist stops the draw safely, discards the needle into the sharps container, and washes the puncture site immediately with soap and running water, without squeezing the wound. This first-aid step is universal and does not wait for anyone's permission.
1 to 2 minutes: the phlebotomist notifies the charge technologist or supervisor per the exposure control plan. This notification starts the clock on a confidential medical evaluation; the standard requires that evaluation not be delayed once the exposure is reported.
3 to 5 minutes: the supervisor documents the route of exposure, the date and time, the device type, and the circumstances, and identifies the source patient for consented testing where feasible and legally permitted.
Within the shift: the employee reports to occupational health or the emergency department for baseline blood collection and evaluation. If the employee consents to collection but declines HIV testing at that time, the sample is held for at least 90 days in case testing is later requested.
Within 15 days of the completed evaluation: the examining clinician's written opinion, limited to confirming the employee was informed of results and of any condition needing further follow-up, is provided to the employee.
What this case does and does not ask of the bench worker: first aid (wash the site, do not squeeze) is immediate and universal, and reporting the exposure without delay is the second universal step. Everything after that, source testing, any prophylaxis decision, the 15-day written opinion, is a clinician-and-employer process governed by the bloodborne pathogens standard, not a bench-level clinical judgment. The phlebotomist is not asked to estimate infection risk or recommend treatment; the phlebotomist is asked to sequence the correct immediate actions and know who to notify.
The two things a person can control in the first two minutes after a needlestick are washing the site correctly and reporting it immediately; both of those determine whether everything that follows happens on the timeline the standard expects.
| Time | Action | Who acts |
|---|---|---|
| 0 minutes | Discard needle safely and wash the puncture site with soap and running water; do not squeeze | Exposed employee |
| 1-2 minutes | Notify charge technologist or supervisor per the exposure control plan | Exposed employee |
| 3-5 minutes | Document exposure route, time, device, and circumstances; identify source patient | Supervisor |
| Within the shift | Baseline blood collection and evaluation at occupational health; sample held 90+ days if HIV testing is declined | Employee and occupational health |
| Within 15 days of evaluation | Written opinion provided to the employee | Examining clinician |
Ordering exercise
Put the needlestick response actions in the order they belong, from the moment of the puncture forward.
1. Written opinion delivered
Examining clinician's opinion provided to the employee within 15 days of the completed evaluation.
2. Baseline evaluation and collection
Occupational health or emergency department, within the shift.
3. Document the exposure
Route, time, device, circumstances, and source-patient identification.
4. Notify the supervisor
Report per the exposure control plan to start the evaluation clock.
5. Wash the puncture site
Soap and running water, without squeezing the wound.
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