Needlestick injury protocol for UK tattoo artists

A needlestick injury is rare in a well-run studio and serious when it happens. The first hour matters disproportionately. HIV post-exposure prophylaxis (PEP) is most effective within 60 minutes and ineffective beyond 72 hours. Every studio needs a written protocol that artists know by heart. This guide describes the protocol, the post-exposure decision-points, and the RIDDOR reporting duty under UK law.

If you have just sustained a needlestick or splash exposure: complete first aid (below), then go to A&E or call NHS 111 immediately. Do not wait until the next day. Take this article with you if useful.

Immediate first aid, the first 5 minutes

For a needlestick or sharp injury through gloves and skin

Stop the procedure. Do not return to the client until first aid is complete.
Encourage bleeding by gentle squeezing around (not on) the wound. Don't suck the wound, saliva can introduce additional contamination.
Wash with soap and copious running water for several minutes (3-5 minutes minimum). Cold or tepid water is fine; hot water may damage tissue.
Don't scrub aggressively, scrubbing can damage tissue and increase absorption.
Apply a waterproof dressing to the cleaned wound.

For a splash to broken skin

Irrigate the area with copious water for 3-5 minutes.
Wash with soap and water as for a needlestick.
Apply dressing.

For a splash to eye

Irrigate the eye with saline or running water for 10-15 minutes, this is non-negotiable. Use an eye-wash station if available, or hold the eye open under a gentle stream of water.
Remove contact lenses after starting irrigation if you wear them.
Do not rub the eye.

For a splash to mouth

Spit out what you can.
Rinse the mouth with copious water several times, don't swallow.
Do not eat or drink until medical assessment.

The decision-points, what happens next

Assess the source

After first aid:

Source client, are they known or unknown? Known low risk, known high risk, unknown status?
Specifically: did blood enter the wound from the client's blood directly? Was the needle in contact with the client's blood/serous fluid immediately before the injury?
Time of incident, note exactly. The HIV PEP clock starts now.

You will not ask the client about their HIV/hepatitis status (Equality Act 2010 considerations, see bloodborne viruses and vaccination). Decisions about PEP are made on risk assumption by occupational health or A&E staff, not on the client's disclosed status.

Time-critical decisions

HIV post-exposure prophylaxis (PEP)

Most effective within 1 hour of exposure.
Useful up to 72 hours in declining order of effectiveness.
No benefit beyond 72 hours.
Course is typically 28 days of antiretroviral medication.
Side effects can be significant, nausea, fatigue, headache. But the alternative is real HIV risk.
Decision made by clinical staff. A&E or occupational health, based on the nature of the exposure and source risk assessment.

For most tattoo needlestick exposures, the HIV PEP decision will depend on whether the source was known to be HIV-positive (genuinely unusual) or genuinely unknown. The clinical staff calling the decision will lean conservative, if in doubt, they prescribe PEP and start the course.

Hepatitis B post-exposure

Depending on your vaccination status and the source assessment:

Fully vaccinated, confirmed responder (anti-HBs ≥10 mIU/mL post-course): usually no further immediate action, your immunity is already in place. Document the exposure for the record.
Vaccinated but no confirmed response or unknown response status: may receive a booster vaccination and/or HBIG (hepatitis B immunoglobulin) within 7 days.
Unvaccinated or partial vaccination: HBIG plus accelerated vaccination course, start within hours, complete the course.

The Hepatitis B post-exposure window is longer than HIV PEP, but the booster/HBIG decision is still best made within 24-48 hours.

Hepatitis C

There is no vaccine and no post-exposure prophylaxis for HCV. The protocol is:

Baseline HCV antibody and RNA testing within the first week.
Repeat at 3 months and 6 months post-exposure.
If HCV is detected, modern direct-acting antivirals cure most cases with 8-12 weeks of treatment. Early detection matters because treatment is more effective the earlier it starts.

Tetanus

If the source needle was contaminated with soil or dirty equipment (unusual for tattoo work but possible), tetanus status should be checked.

Where to go. UK routes 2025-26

In hours of the incident:

A&E

The default route for tattoo studio needlestick injuries in 2025-26. A&E has access to:

PEP starter doses.
HBIG and hep B vaccine.
Baseline blood testing.
Specialist referral pathway.

Tell the triage staff "occupational needlestick injury", most A&E departments will fast-track this because of the time-critical PEP decision.

NHS Occupational Health (where available)

Larger NHS trusts have occupational health departments that handle BBV exposures for healthcare workers. Tattoo artists are not formally NHS staff, but some occupational health services accept tattoo studio referrals on a private or local-arrangement basis.

Private occupational health clinics

Some private OH providers handle BBV exposures. Variable cost, variable availability.

NHS 111

If unclear, call 111. They will direct you to the appropriate service. Don't delay seeking help to make this call, first aid first, then 111 or A&E.

Your GP

Useful for the follow-up testing schedule (3 months, 6 months for HCV; antibody check post-HBIG) but not the right first port of call for time-critical PEP decisions.

Documentation

For every exposure incident, document:

Date and time of incident.
Mechanism, needlestick from used cartridge, splash from cleaning sharps container, etc.
Source, client name (if known), procedure being performed.
Your vaccination status at the time.
First aid given, what, when, by whom.
Medical assessment, where you went, when, what was decided.
Treatment received. PEP started/not started, HBIG given, vaccine doses given.
Follow-up appointments scheduled.
Outcome, final status at 6 months.

This document goes in your personal health file AND in the studio's incident log.

RIDDOR reporting

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 require employers (and self-employed workers in some cases) to report:

Bloodborne virus infection acquired through work, reportable.
Major injuries including amputations, fractures (rare from a needlestick but possible from larger sharps).
Specified injuries under Schedule 1.
Over-7-day incapacity from a work-related injury.

For a routine needlestick where no infection results, RIDDOR reporting is generally NOT required, but document fully in your own incident log regardless.

If BBV infection is confirmed as a result of the incident, RIDDOR reporting is required, typically by the studio (employer) or by the self-employed worker via the HSE online reporting form.

Follow-up testing schedule

After a meaningful exposure, the typical testing schedule:

Baseline, within first week. HIV antibody, HBV antibody/antigen, HCV antibody/RNA. Establishes pre-exposure status (so any later positive can be attributed to the exposure).
6 weeks. HIV antibody (early window).
12 weeks (3 months). HIV antibody, HCV antibody, HBV markers if relevant.
6 months, final HCV antibody (longest window for HCV seroconversion).
12 months, only in specific protocols, not routine.

Stay engaged with the follow-up. Most exposures don't result in infection, but the follow-up testing is what confirms that.

Prevention, what would have stopped it

Most needlestick injuries are preventable. Common causes:

Recapping a used cartridge or needle. Never recap.
Overfilled sharps container preventing safe disposal. Replace at the fill line.
Sharps container too far from the workstation, drop should be immediate, not after a walk across the studio.
Cleaning up sharps from a previous artist's station without proper PPE.
Sharps left out instead of in the container.
Working tired, single sessions running over 6-8 hours without breaks, or working when fatigued, increases the slip rate.

See infection control basics and clinical waste and sharps for the prevention discipline.

Studio policy, what to write

Every studio needs a written needlestick protocol. Pin it to the wall in the staff area. Cover:

The immediate first aid steps (above).
The decision: A&E vs occupational health vs NHS 111, locally.
The phone number for the nearest 24/7 A&E.
The studio's incident log location.
Who is responsible for follow-up (typically the affected person, with studio support).
RIDDOR procedure if applicable.

Train every new artist and apprentice on the protocol in their first week.

What this guide cannot do

Clinical decisions on PEP, HBIG, and HCV follow-up are made by qualified clinical staff based on the specific exposure. This guide doesn't replace clinical advice.

Information, not advice. For your situation, if you have just had an exposure: complete first aid now, then go to A&E or call 111 immediately. Do not wait.