Your FY1 sustains a needle-stick injury from a known HIV/Hep C positive patient at 04:00. She is exhausted and asks if she can 'just deal with it in the morning'. How do you respond?

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I would treat this as both a **patient-safety** and a **staff-welfare** issue.

First, immediate first aid: encourage the wound to bleed, wash with soap and running water, do not scrub or use antiseptic. Cover with a waterproof dressing.

Next I would risk-assess: this is a **high-risk hollow-bore exposure from a known HIV/HCV positive source**, so post-exposure prophylaxis is time-critical — **ideally within one hour, no later than 72 hours**. I would phone the on-call occupational health number or, out of hours, the ED consultant / on-call virologist as per local needle-stick policy. The source patient needs to be consented for a current viral load and HCV PCR.

I would gently but firmly explain to the FY1 that she cannot 'deal with it in the morning' — PEP timing matters, and her safety matters. I would take her off the rota for the next two hours, hand her tasks to the SHO and myself, and walk her to ED if needed. She should have baseline bloods drawn.

From a **SPIES** perspective: I would **support** her — exhaustion at 04:00 is a contributing factor, not a character flaw — debrief her, complete a **Datix**, ensure she has access to occupational health follow-up and counselling, and discuss with the educational supervisor. I would also reflect on whether rota fatigue contributed and raise it through the LNC / guardian of safe working.

Needle-stick injury in an exhausted FY1 at 04:00

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