Discarded needles

Published: 01 October 2011
  • There are no documented cases of HIV infection through contact with a needle or syringe discarded in a public place.
  • Infection is theoretically possible, but injuries are usually superficial and blood in syringes may no longer be infectious.

When injecting drug users or other people leave used needles or syringes in public places, this can often lead to anxieties and concerns about the risk of HIV transmission. In parks, play areas, beaches, public toilets or streets, people may step on discarded needles or children may handle them. Refuse workers are also at risk of coming into contact with discarded needles.

Moreover, studies have shown that HIV can survive in syringes for up to six weeks,1,2 while hepatitis C can remain detectable for two months.3 Virus is more likely to survive when there are lower temperatures, greater volumes of blood and within larger syringes.

There have only been two reported incidents of blood-borne viral infections thought to be due to discarded needles. One was a case of hepatitis B in a child,4 the other of hepatitis C in an adult.5

There have been no reported cases of HIV infection through contact with a needle discarded in a public place.

A review of the literature up until September 2007, conducted by the Canadian Paediatric Society, identified twelve case series (articles describing what happened to a series of individuals who had had contact with discarded needles). Each came from an area of high prevalence of blood-borne viruses, in a range of countries. These involved a total of 483 children who had follow-up testing for HIV, 452 children who tested for hepatitis B and 265 tested for hepatitis C. Only a minority of children (130) received post-exposure prophylaxis (PEP) for HIV. There were no infections for any blood-borne virus.6

Subsequent to this, clinicians in Montreal published the largest single case series yet to describe the outcomes of contact with discarded needles.7 Beginning in 1995, 274 paediatric patients (aged 0 to 18) had presented to hospitals in the city after being injured by a needle. Most of the children had picked up or played with a needle (64%), while 9% had stepped on one. A quarter of the children had an injury which bled, but the needle or syringe was reported to have visible blood in just 13% of cases.

Eighty-two children took post-exposure prophylaxis for HIV. In the 189 children who came back for HIV testing six months later, none were HIV positive, whereas HIV prevalence in Montreal injecting drug users is 16%. Moreover, no child tested positive for hepatitis B or C.

The Canadian Paediatric Society6 note a number of reasons why injuries from discarded needles in community settings are less likely to lead to HIV infection than injuries in healthcare settings: injury does not occur immediately after the needle was first used; the needle rarely contains fresh blood; any virus present has been exposed to drying and environmental temperatures; and injuries are usually superficial.

Although infection is theoretically possible, they consider that “it is extremely unlikely that HIV infection would occur following an injury from a needle discarded in a public place.”

They recommend that the following factors are considered when making an assessment of the risk of HIV transmission:

  • Source: consider the prevalence of HIV among injecting drug users in the local area.
  • Device: consider the size of needle, whether it is hollow-bore, presence of visible blood in the needle or syringe, probability of exposure to drying, heat and freezing since use. Larger devices with visible blood are highest risk.
  • Injury: consider depth and extent of trauma (scratch or deep cut, injection of blood and bleeding at the site). Injuries with actual blood injection are high risk. Superficial scratches are low risk.

Post-exposure prophylaxis for HIV is only recommended in cases where there is a high risk of HIV transmission. But post-exposure prophylaxis for hepatitis B, vaccination for hepatitis B and vaccination for tetanus is recommended in a larger number of situations.

In the UK, draft guidelines on HIV post-exposure prophylaxis from BASHH and BHIVA do not recommend the provision of PEP following injury with a needle discarded in a community setting. At the time of writing (October 2011), the final version of the guidelines has not been issued.

Related Links
Tell us why you visited aidsmap today
minimise

Could you help us by answering three questions on why you’ve visited aidsmap today?

You can close this questionnaire and come back to it later. Just click on the pink circle.

What prompted you to visit aidsmap today?

What exactly are you looking for? What specific questions do you need answered?

Have you found what you were looking for?

close

Thank you for your feedback

Thank you very much for taking time to fill in this questionnaire. NAM really values your feedback. It helps make the information we provide better.

If you have any other comments on the content of this website, we would be interested to hear from you. Please email info@nam.org.uk.

References

  1. Abdala N et al. Survival of HIV-1 in syringes: effects of temperature during storage. Subst Use Misuse Aug;35(10):1369-83, 2000
  2. Abdala N et al. Survival of HIV-1 in syringes. J Acquir Immune Defic Syndr Hum Retrovirol 20(1):73-80, 1999
  3. Paintsil E et al. Survival of Hepatitis C Virus in Syringes: Implication for Transmission among Injection Drug Users. J Infect Dis. 202(7): 984-990, 2010
  4. García-Algar O et al. Hepatitis B virus infection from a needle stick. Pediatric Infectious Disease Journal 16:1099, 1997
  5. Libois A et al. Transmission of hepatitis C virus by discarded-needle injury. Clinical Infectious Diseases 41: 129-130, 2005
  6. Canadian Paediatric Society Needle stick injuries in the community (position statement). Paediatric Child Health 13: 205-210, 2008
  7. Papenburg J et al. Pediatric Injuries From Needles Discarded in the Community: Epidemiology and Risk of Seroconversion. Pediatrics 122: e487-e492, 2008
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
close

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.