In healthcare, sharps—needles, scalpels, syringes and other sharp medical instruments—pose significant risk of injury to patients and healthcare workers. It is estimated that the NHS deals with 100,000 needlestick and other sharps-related injuries per year, with many more going unreported.
This blog post addresses sharps safety, highlighting the potential risks, common injuries, and the importance of proper sharps disposal.
We will explore the legislation and guidelines governing sharps use in the UK and discuss strategies for preventing sharps injuries, training, engineering controls, safety equipment, and how to create a culture of sharps safety.
What are the risks of sharps in healthcare and nursing homes?
The risk of a sharps injury is infection from blood-borne viruses (BBV) or viruses that travel in the blood. Transmission can happen if the injury involves a sharp contamination of a patient's blood or body fluid. The most severe blood-borne viruses are:
- Hepatitis B (HBV)
- Hepatitis C (HCV)
- Human immunodeficiency virus (HIV)
Several factors influence the likelihood of infection transmission, including the person's natural immune system.
Although there are many injuries each year, only a tiny percentage of them are known to have caused infections that resulted in serious illness. However, health workers may be affected by the injury and worry about what might happen next, such as possible side effects from treatment. These concerns can have a significant impact on them.
Common sharps injuries
Injuries caused by medical needles are sometimes called needle-stick or sharps injuries.
A 'needlestick' is a break in the skin caused by a hypodermic needle or other sharp item touching blood, body tissues, or body fluids. Sharps in healthcare include needles for injections, scalpels, and razors, but can be anything with a point or cutting edge.
Sharps injuries are most commonly caused by using sharp equipment in a fast-paced, stressful, and perhaps understaffed situation.
Injuries can also occur when sharps are not disposed of safely.
The importance of proper sharps disposal
Research into injury reports indicates that sharps injuries frequently occur when medical sharps are moved or disposed of inappropriately. Most sharps injuries to facility and support employees occur when medical sharps are disposed of in unauthorised or overfull containers.
Adequate systems and procedures for the safe disposal of sharps should exist in all healthcare and social care settings.
Using sharps bins
Any sharp objects should be safely disposed of at the point of usage. To help with this, appropriate sharps containers should be portable enough to be close to the procedure involving the sharp.
Sharps bins design should avoid overfilling and unintentional spillage of contents. They should be simple to close both temporarily and permanently, and there should be little chance of container puncture.
As healthcare settings are often open to members of the public, sharps bins should be secured where non-healthcare workers, particularly children or vulnerable individuals, can reach them.
Creating a culture of sharps safety in healthcare
To ensure that a culture of sharps safety exists in a healthcare organisation, management must:
- Complete suitable and sufficient risk assessments
- Implement control measures
- Prevent exposure where possible
- Control risk exposure where prevention is not possible
- Provide sharps devices that are safe
- Provide appropriate information, instruction and training
- Provide suitable clinical waste disposal procedures
- Follow standard precautions for infection control
- Have clear systems for responses to sharps injury
- Report work-related sharps injuries
What is the legislation for sharps use in the UK?
UK Health and Safety laws apply to sharps and sharps injuries, as do all other work-related risks and hazards.
The legislation to be aware of are:
In 2013, the Health and Safety Executive produced regulations focusing on sharp instruments in a healthcare setting. These are:
These regulations only apply to healthcare employers, contractors, and other workers in the healthcare sector. The 'Sharps Regulations' will apply to NHS Trusts and Boards, independent healthcare businesses, and other employers whose primary function is managing, organising, and providing healthcare.
Strategies for preventing sharps injuries in healthcare settings
The best method for preventing sharps injuries is preparation for the risks that storing, using, and disposing of sharps presents.
To do this, identify the nature of the task and the specific sharp instrument to be used. Once you have established what is involved in the task, implement some control measures. You can do this by:
- Preventing the risk of exposure by carrying out a risk assessment, providing appropriate training, using any sharps safety features and PPE and ensuring that used sharps have been safely disposed of.
- Control the risk of exposure by creating safe work processes, policies and systems.
- Provide safe sharps devices that are reliable, easy to use, and include appropriate safety mechanisms.
How to implement engineering controls to reduce sharps injuries
If management cannot prevent risk, they must control the risk of an injury. To engineer controls to reduce sharps injuries, consider the following:
- The design and use of appropriate work processes, systems and engineering controls and the provision and use of suitable work equipment and materials, like providing safer sharps devices
- Control exposure at source, for example, by having a clinical waste policy that ensures safe collection, storage, transport and disposal of waste.
- The provision of suitable personal protective equipment (PPE)
Training and education on sharps safety
Training should be a fundamental element when it comes to sharps risk management strategy. Employers are responsible for providing adequate and appropriate training to their employees. The training should cover the biological elements that employees could be exposed to and their associated risks. It should also include the findings of any sharps risk assessments, precautions to protect themselves and others like patients and colleagues, how to use sharps Personal Protective Equipment (PPE) provided, and procedures to follow in emergencies.
All staff should know the internal and external processes for reporting and documenting sharps injuries.
Moreover, the training provision should recognise potential changes affecting risks and provide further instruction as required. Refresher training should also be provided within appropriate timeframes.
Induction for all new and temporary staff is also essential. The importance of proper training cannot be overstated, as it plays a vital role in preventing needlestick injuries and other sharps-related accidents in healthcare settings.
Reporting and investigating sharps incidents
Some, but not all, sharps injuries need to be reported to external authorities. To promote a focus on safety, internal procedures may include reporting minor incidents and near-misses.
Sharps injuries must be reported to the HSE under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) if:
- An employee is injured by a sharp known to be contaminated with a blood-borne virus (BBV), e.g., hepatitis B, C, or HIV. This event is reportable as a dangerous occurrence.
- The employee receives a sharps injury, and a BBV produces specific antibodies in the blood. This occurrence is reportable as a disease.
- The injury itself is so severe that it must be reported.
If the sharp is not contaminated with a BBV, or the source of the sharps injury cannot be traced, it is not reportable to HSE unless the injury causes an injury lasting over a week.
If the employee develops a disease attributable to the injury, it must be reported.
To learn more about how to handle a sharps injury, read…
Conclusion
Preventing sharp injuries in healthcare settings is crucial to ensure the safety of both patients and workers. The strategies outlined in this blog post can help healthcare organisations take necessary measures to prevent these injuries. Adopting a proactive approach to prevent sharps injuries is essential. By implementing safe handling practices, providing training and education, and using appropriate engineering controls, healthcare providers can promote a culture of safety. All healthcare settings should prioritise the prevention of sharps injuries and take steps to mitigate risks to create a safer environment for everyone involved.
