HIV Needle Stick Risk Assessment Stratification Protocol (RASP)

HIV Needle Stick RASP
Source HIV Status
Injury Type
Depth of Injury
Fluid Type
Device Type
RASP Score: –
Select all criteria
–
Quantifies HIV exposure risk by source and exposure type and need for prophylaxis.

Why Use

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

When to 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.

Formula

Basic risk = 1 / (Source population × Inoculum type × Method of transmission) Total risk, % = Basic risk × 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”.

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.

More Information

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

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