Sharps injuries - What you need to do
As an employer, you will need to take action to manage the risks if your workers;
- use sharps to provide care or other services to people;
- provide care or other services to people who are likely to use sharps;
- are involved in handling such equipment after use (eg in sterile services and waste disposal);
- are likely to inadvertently come across used sharps (eg during laundering).
If you are a healthcare employer you will also need to look at the Health Services Information Sheet produced to help you comply with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
Complete a risk assessment
You must assess the risks. This process will help you identify the hazards; consider the nature of the work; evaluate the risks; and implement, monitor and review control measures to reduce the risk.
What is a suitable and sufficient risk assessment?
The assessment needs to be appropriate for the nature of the work. The more hazardous the work, the more in-depth the assessment should be. For example, procedures that have a higher risk of injury include intra-vascular cannulation, venepuncture and injections and involve the use of devices such as IV cannulae, winged steel-butterfly-needles, needles and syringes and phlebotomy needles. These procedures should have detailed assessments.
Who completes your assessment, and who it applies to, will depend on the nature of the work and the complexity of the organisation. For example:
- In an acute hospital, a generic hospital-wide assessment may be suitable where the activity and the type of sharps instrument used is common across the organisation, for example, use of cannula.
- In a small GP practice, generic assessments may be suitable for the small numbers of staff and activities undertaken.
- In an operating theatre, where the sharps instrument and activity are very specific, it may be suitable to have a local assessment.
You should consider risks to all those who may use the sharps including, where relevant, those who dismantle, sterilise or dispose of the medical sharps.
Implementing control measures
The risk control measures identified by the risk assessment should follow the hierarchical approach in the Control of Substances Hazardous to Health Regulations (COSHH) 2002:
Preventing the risk of exposure
Your primary duty is to prevent exposure to the risk of a sharps injury.
Controlling the risk of exposure
If the risk cannot be prevented, then the risk of an injury must be adequately controlled. There is a general hierarchy of controls that needs to be considered as follows:
- The design and use of appropriate work processes, systems and engineering controls and the provision and use of suitable work equipment and materials, eg providing safer sharps devices
- The control of exposure at source, eg having a clinical waste policy which ensures safe collection, storage, transport and final disposal of waste.
- Where adequate control of exposure cannot be achieved by other means, provision of suitable personal protective equipment (PPE) in addition to the measures required by (a) and (b) above.
The hierarchy reflects the fact that eliminating and controlling risk by using physical engineering controls and safeguards is more dependable than relying solely on systems of work.
Studies have shown that in the health and social care sector, a combination of training, safer working practices and the use of safer sharp products can prevent the majority of sharps injuries.
Providing safer sharps devices
Factors to consider when selecting appropriate safer sharps:
- the device must not compromise patient care;
- the reliability of the device;
- the care-giver should be able to maintain appropriate control over the procedure;
- other safety hazards or sources of blood exposure that may arise from use of the device;
- ease of use (taking into account the existing clinical practices commonly in use by the relevant health professionals – but not assuming custom and practice is safest):
- the design of the safety mechanism is suitable for the application, taking account of the following issues:
- if activation of the safety mechanism is straightforward, it is more likely to be used;
- if the safety mechanism is integral to the device (ie not a separate accessory) it cannot be lost or misplaced;
- for many uses, a single-handed or automatic activation will be preferable;
- an audible, tactile or visual signal that the safety mechanism has correctly activated is helpful to the user; and
- the safety mechanism is not effective if it is easily reversible.
Involving the relevant staff in the selection of safer sharps will help ensure that they use the new equipment safely, and that any reduction in the number of sharps injuries is maintained for longer.
Information, instruction and training on safe use of sharps
Training should be a key part of your approach to managing the risk of sharps injuries. You have a responsibility to provide suitable and sufficient information, instruction and training. As a minimum, the training should cover:
- the biological agents employees could be exposed to and the risks created by any exposure;
- the findings of any risks assessments;
- the precautions they should take to protect themselves and other persons. For example, the use of medical devices, safe systems of work or local procedures and the correct use and disposal of sharps;
- how to use any PPE and clothing provided; and,
- what procedures to follow in the event of an emergency. For example, measures to be taken in the event of a sharps injury, how to report incidents and what response should be expected from the organisation?
The training provision should also take into account:
- any changes that may take place that could affect risks and, if necessary further training;
- appropriate intervals for refresher training; and,
- induction for all new and temporary staff.
Ensure that suitable clinical waste disposal procedures, including use of sharps containers, are followed
- Evidence shows that sharps injuries often occur when the used medical sharp is being transported or when disposed of incorrectly. Most sharps injuries to ancillary and support staff usually involve disposable medical sharps that have not been placed in an appropriate sharps container or have been placed in an overfull container.
- You should have appropriate arrangements and procedures in place for the safe disposal of clinical waste, including sharps.
- All sharps should be disposed of carefully at the point of use. This means that suitable sharps containers should be portable enough to take to the activity, and designed specifically to allow needles and sharp instruments to be disposed of easily and safely at the point of use.
- Ideally sharps bins should be designed to prevent overfilling and accidental spillage of contents. They should be easy to close temporarily and permanently, and there should be no risk of puncture of the container.
- Sharps bins should not be left unattended in areas where non-healthcare workers (especially children) can access them.
Ensure standard precautions for infection control are in place
The majority of incidents where the transmission of blood-borne viruses occur are caused by failure to adhere to standard precautions.
The guidelines on standard precautions (Guidance for Clinical Health Care Workers: Protection against infection with blood-borne viruses) were published by the Department of Health in 1998. They are aimed at preventing the transmission of blood-borne viruses by considering that blood and certain body fluids are potentially infectious and adopting specific procedures where contact is anticipated.
Following standard precautions alone will not help you prevent sharps injuries, but following them alongside other control measures, ie using safer sharps devices, safe disposal and training etc. will help reduce the risk.
Have clear procedures for response to sharps injury, including speedy access to appropriate prophylaxis treatments
As mentioned previously, you have a responsibility to provide suitable and sufficient information, instruction and training and as a minimum, this must cover what procedures to follow in the event of an emergency. For example, measures to be taken in the event of a sharps injury, how to report incidents and what response should be expected from the organisation.
When preparing response procedures you should consider what prophylaxis treatments are available and how they will be provided.
Reporting work-related sharps injuries
Sharps injuries must be reported to 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), eg hepatitis B or C or HIV. This is reportable as a dangerous occurrence;
- the employee receives a sharps injury and a BBV acquired by this route seroconverts. This is reportable as a disease;
- if 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 itself causes an over-seven-day injury. If the employee develops a disease attributable to the injury, then it must be reported.