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Prevention of sharps injuries: Inspection of NHS organisations by occupational health inspectors – 2014/15

 

Summary

This Operational Guidance (OG) provides guidance for Occupational Health Inspectors planned inspection campaign of NHS organisations in England, Scotland and Wales to assess compliance with the Health and Safety (Sharps Instruments in Healthcare) Regulations 2013. 

Introduction

Purpose

The overall purpose of the work is to assess how organisations manage the risks of exposure to employees from blood borne viruses as a consequence of sharps injuries. It aims to:

Justification

In May 2013, the Health and Safety (Sharps Instruments in Healthcare) Regulations 2013 came into force in the UK. The Regulations were transposed by HSE from EU Council Directive 2010/32/EU on the prevention of sharps injuries in the hospital and healthcare sector.

Since implementation of the Regulations there have been a small number of HSE interventions with NHS organisations, mainly on a reactive basis. These interventions have resulted in six improvement notices being issued, four on the provision of safer sharps, one on training in safe use of safer sharps and one on investigating sharps incidents.

However, in the last six months, HSE has been receiving evidence from a number of external sources that some healthcare organisations are not complying with the requirements. This has been supported by some recent research published by Mindmetre. In summary, the research reported that one third of hospital trusts in England were failing to comply with safety regulations designed to reduce the risk of needlestick injuries to nurses and other frontline staff. (Based on 159 Acute trusts assessed under FOI requests between July - Dec 13).

The healthcare sector is not currently subject to proactive inspection by HSE. However, this inspection campaign targeting poor performers will help secure much greater levels of compliance with the Sharps Regulations nationally, and is likely to improve the management of health and safety more generally.

In 2010/2011 Occupational health inspectors undertook a joint inspection initiative looking at the management of Dermatitis and Sharps injuries. The sharps guidance associated with this initiative can be found in SIM 07/2010/01. This may contain useful background information, including letter templates, etc. and can be found on TRIM, record number: 2010/227618.

A summary report was published on the findings of the inspection campaign and a link to it can be found via the website.

Action

Inspectors are asked to assess how organisations manage the risks of exposure to employees from blood borne viruses caused by sharps injuries. An inspection proforma, based on the requirements of the Sharps Regulations has been developed to help you complete this assessment, see Appendix 1.

Please inform local FOD Principal Inspectors of plans to visit local NHS organisations. This will ensure you are aware of any on-going or planned interventions or investigations, and also identify any potential development opportunities for FOD Band 3 inspector’s joint visiting.

Background

Injuries from sharps contaminated with patients’ blood can transmit blood borne viruses; including Hepatitis B, C and HIV. It is difficult to know the true number of sharps injuries occurring in the NHS as many go un-reported each year. Previously NHS Employers has reported a figure of approximately 40,000 needlestick injuries a year, and suggested that it may be twice this. In 2008, the Royal College of Nursing (RCN) estimated 100,000 needlestick injuries a year.

The different reporting mechanisms for sharps injuries also make it difficult to understand the true picture. RIDDOR is a limited indicator as dutyholders are only required to report certain incidents. Public Health England (previously HPA) is probably the best source. They run a national surveillance scheme collecting information on significant occupational exposures caused by sharps injuries and publish the results in its Eye of the Needle report. The 2014 report showed:

Organisation

Targeting

OHIs should select 40 poorly performing healthcare employers from the intelligence provided in this OG, by the Sector and from local knowledge.  The campaign is aimed primarily at Acute NHS organisations, but Mental Health, Care Trusts or Ambulance Trusts can also be visited if this can be justified.

Initial Contact with the Duty-holder

The initial approach to the organisation should be made to the Chief Executive by letter and copied to the Health and Safety Manager. The letter should suggest the date for the inspection and request copies of the relevant documents that describe how the organisation complies with the Sharps Regulations. Key staff needing to be contacted during the visit may include the managers responsible for:

Effective worker involvement is an essential part of good management and should be a core component of FOD interventions. During the visit OHIs should meet with:

Enforcement Expectations

Enforcement decisions should be made on a case by case basis in accordance with the HSE Enforcement Policy Statement and the Enforcement Management Model (EMM).

The majority of the Sharps Regulations are very prescriptive in their requirements, for example, training must be included, sharps bins must be placed, and investigations must be completed.

A greater degree of judgement may be required in relation to Regulation 5(1) (b) – the provision of safer sharps. Safer sharps devices are available for almost all healthcare activities now, although there is the odd exception.

The Regulations have been in force since May 2013, therefore it is expected that all organisations will have assessed the risks where sharps devices are used and prioritised the implementation of safer sharps devices in the identified high risk areas. These are likely to include areas such as phlebotomy.

In these high risk areas it is expected that organisations will be providing safer devices and staff be appropriately trained in their safe use. If non-safe devices are still provided for use in exceptional circumstances, this must be monitored to ensure non-safe devices are not used as the norm over safer devices.

If they have not already implemented safer sharps across the whole organisation, it is expected they will have plan in place to roll out safer sharps.

Further information on the application of health risk can be found in:

Example Improvement Notices have been provided in Appendix 2. Additionally, appendix 3 is a table showing HSE enforcement on sharps since April 1998. If you have any concerns on issuing an Improvement Notice or further enforcement action please contact HSCSU.

Timing

Visits can begin in Q4 of 2014/15, rolling into the 2015/16 work year.

Recording & Reporting

OH Inspectors should record the inspection using the proforma in Appendix 1.  The completed electronic proforma along with the basic details of the inspection should be attached to and recorded on the COIN case as a Single Topic inspection Service order. This should then be linked to the Master case for the Sharps Inspection Programme – Case Number 4401713.

Additionally OHI inspectors should also inform HSCSU by email or telephone if any improvement notices are issued on an organisation.

Further References

Further guidance on assessment and control of risk from blood borne viruses (BBV) can be found on HSE’s website.

Contacts

OPSTD, Public Services Sector, Health and Social Care Services Unit.

Appendices

Appendix 1: Inspection Proforma – Prevention of sharps injuries

Appendix 2: Notice templates

Appendix 3: Enforcement action taken by HSE in health and social care on the management of sharps injuries

Updated 2015-03-20