Inspection Campaign 2010/2011

Healthcare workers can be at risk of exposure to blood borne viruses due to the nature of the work. Although rare, injuries from sharps contaminated with an infected patient's blood can transmit more than 20 diseases, including Hepatitis B, C and human immunodeficiency virus (HIV). We know the number of sharps injuries each year is high, but only a small number are known to have caused infections that become serious illnesses. However, because of the transmission risk, sharps injuries can worry the many thousands who receive them.

An inspection initiative was carried out in 2010/11 to assess how NHS organisations managed the risks of sharps injuries. A summary report titled 'Management and Prevention of Sharp Injuries: Inspection of NHS Trusts/Boards' was produced.

Summary of initiative

The report summarises how the twenty-two NHS organisations visited managed the risks of sharps injuries which can expose employees to blood borne viruses (BBVs). It is aimed at healthcare professionals, their professional bodies and Trusts / Boards. This report will also be of use to regulators and other health and safety professionals involved with the health service. The initiative focused on six key areas:

• Does the organisation have policies and procedures on the management of sharps that explains roles, responsibilities and arrangements?
• Has the organisation completed suitable and sufficient risk assessments?
• Has suitable and sufficient instruction and training been provided to effectively minimise the risk of infection?
• Is the organisation undertaking active monitoring, e.g. inspecting and checking that arrangements are being implemented and controls are working?
• Is the organisation undertaking reactive monitoring, e.g. investigating relevant sharps incidents?
• Has the organisation audited implementation and compliance with policies and procedures and does it have an improvement plan?

Key findings

Of the twenty-two NHS organisations visited:

• sixteen had a specific policy for the prevention of BBVs;
• ten had clear corporate strategic aims and objectives to prevent and reduce the risk/incidence of exposure to BBVs through sharps injuries;
• only six had staff at all levels who demonstrated a good understanding of their roles and responsibilities;
• competent advice was available in all organisations, however, the arrangements and resourcing were not always adequate;
• in four, the safety representatives were not consulted.
• specific training on the prevention and control of BBVs was not provided to all staff and/or uptake of training was patchy.
• risk assessments were generally generic. Only four organisations undertook specific assessments for BBVs and sharps injuries;
• 'safer devices' were used in eighteen, but in some their use was limited;
• less than half undertook proactive monitoring. Those who did monitorcould demonstrate a reduction in injuries.
• only half carried out some form of auditing and review. This ranged from full health and safety audits to more limited audits of post-incident procedures.

Improving standards

All organisations should ensure they are complying with legislation that is relevant to managing the risks to employees from exposure to blood borne viruses. Particular attention should be paid to:

• Providing written policies and procedures with clear lines of accountability.
• Carrying out suitable and sufficient risk assessments, following the COSHH hierarchy, including use of safer devices.
• Assessing the contribution and role of competent advisors, i.e. health and safety, risk management, occupational health and infection control.
• Ensuring staff are informed of the risks and implement control measures, including reporting sharps injuries.
• Ensuring suitable monitoring and auditing arrangements are in place.