The source patient should not be approached by the exposed healthcare worker.

Sensitive discussion is sometimes needed to explain the process, how and with whom the test results will be shared, and the impact of positive results in terms of future health implications and health or life insurance policies.

The BMA has published specific guidance on testing adults who lack capacity (8). The guidance states that all decision making should follow a structured process. It should not be undertaken without considering several key points, which include:

  • If a patient is expected to regain capacity before a decision on testing is needed, it should not happen until consent is obtained.
  • If a relevant advanced decision to refuse treatment is not in place:
    • In England, Wales, and Northern Ireland the doctor must assess whether testing is in the best interests of the patient.
    • In Scotland the doctor must assess whether testing will benefit the patient and is reasonable in the circumstances to safeguard or promote their physical or mental health.
  • In England, Wales and Northern Ireland, where there is no potential clinical benefit to the patient, in the absence of evidence otherwise, it is safe to assume that patients would want to ‘do the right thing’. In the same circumstance in Scotland it is not clear that the legislation would support the same approach.
  • If the patient regains capacity they should be informed that the test has been taken and provided with enough information to decide whether to receive the results.

Learning bite

Obtaining consent to test the source should be done by a doctor not involved in the needlestick injury. In patients without capacity the decision to test should be carefully considered and documented.


British Medical Association. Needlestick injuries and blood-borne viruses: testing adults who lack capacity. 2020. [accessed May 2020].