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sharps safety;
A training package to protect
healthcare staff from harm
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A quick tour Safety devices/
of the issues: engineering
risk and safety controls
Overview of the
session
Standard
Reporting & Precautions &
vaccination status waste
management
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Outline of the session
► The session will deliver knowledge for evidence based
safer practice and will cover the following areas:
►the most common procedures where needlestick
injuries occur.
►Types of devices and injuries that affect risk of
infection.
►methods for preventing exposure.
►critical review of the use of sharps and their necessity.
►how changes in work practice can prevent injuries
(includes the role of safer needle devices).
►current protocols and guidance, including standard
precautions.
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Objectives of the session
The session is designed to equip staff for safer
practice. By the end of the session staff should
be able to:
►Demonstrate knowledge of the risks of
exposure to potentially harmful viruses
►Explain the importance of safe practices
(demonstrating awareness of policies and
protocols).
►Identify the efficacy of preventative and
control measures.
►Describe the process of evaluation of
needlestick injury and post-exposure follow
up using real life examples
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Who is at risk:
►Who is at risk of needlestick injury?
►Any worker who may come in contact with
needles or other sharp instruments used
on patients, including nursing staff,
laboratory staff, doctors, porters and
housekeepers.
NIOSH 1998
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Definitions and scene setting
► Sharps injuries describe any incident in which a
healthcare worker is stuck by a needle or other sharp
instrument which penetrates the skin and which is
contaminated with potentially infected blood
► The National Audit Office (2003) stated that sharps
injuries are second only to back injuries as a cause of
harm to staff – 17% of all injuries
► Contaminated needles can transmit more than 20
dangerous blood-borne pathogens including HIV,
Hepatitis B and Hepatitis C
► At least 4 health care workers are known to have died
following occupationally acquired HIV
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Risk management
► An integrated risk management policy is a must
► Risk assessment:
►identify the risks
►Manage and minimise – eliminate unnecessary injections
► Safer technology
► Standard precautions
► Immunisation & vaccination
► Training
► A legal framework does exist (Health and Safety at Work
Act (HASAWA), 1974, and the Management of Health
and Safety at Work Regulations (1991)
► Control of Substances Hazardous to Health (COSHH
regulations (2002) reinforce risk assessment and
preventative strategies
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Reporting sharps injuries
►Managing exposures -
►What is the local policy
►All cases of exposure from blood or body fluid
from patients infected with blood-borne
viruses (HIV, HCV, HBV) should be reported
to the HPA national surveillance scheme
►HCW anonymity is guaranteed
Source: NSH Employers 2005
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Identifying alternatives
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Training
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National UK Guidelines
Standard Principles for the Safe Handling
and
Disposal of Sharps:
►Part of a waste management strategy to
protect staff, patients and visitors from
exposure to blood borne pathogens.
►All sharps injuries are considered to be
potentially preventable.
The UK Evidence Based Prevention of HCAI in Primary and
Guidance (2001): EPIC Community Care (2003)
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National UK Guidelines
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Standard precautions
1. Sharps must not be passed
directly from hand to hand and category 3/H&S
handling should be kept to
minimum
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Standard precautions:
Aprons & eye protection
16. Plastic aprons should be worn as single
use items for one procedure or episode
of patient care and then discarded and category 3/H&S
disposed of as clinical waste.
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Safer needle devices
►Needle safety devices must be
used where there are clear
D/H&S
indications that they will provide
safer systems of working for
health care personnel.
Recent estimates suggest that safety devices exist in 11
different product groups.
Safety devices on the whole minimise risks in association
with venepuncture, IV therapy, injections and "downstream"
injuries following disposal (housekeeping and portering
staff)
► First aid
► Place under running water
► Flush splashes to nose, mouth with water
► Irrigate eyes with clean water or saline
► Report to occupational health
► Know your Hepatitis B vaccination status.
► Prompt reporting is important in all cases to
determine whether post exposure prophylaxis is
required (this needs to be started as soon as
possible)
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Root Cause Analysis (RCA)
►The key to RCA is asking the question
"why?" as many times as it takes to get
down to the root cause of an event:
►What happened?
►How did it happen?
►Why did it happen?
►What can be done to prevent it happening in
the future?
►Human Immunodeficiency
0.31% or 1 in 319
Virus (HIV):
1. Deep injury
2. High viral titre in the patient on whom the
device had been used
3. Visible blood on the device
4. Device in artery/vein
Source: CDC, MMWR 6/98
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The Health Protection Agency (HPA) study 2005:
Occupational Exposure to Blood-borne viruses
(BBV)
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The Health Protection Agency (HPA) study 2005:
Occupational Exposure to Blood-borne viruses
(BBV)
►2% of exposures were to porters, security
and housekeeping staff
►Largely from sharps in rubbish bins
►Medical professions: 37%
►Injuries sustained during the procedure were
dependent on the procedure – many not generally
amenable to prevention.
►Injuries sustained after the procedure and during
disposal – much more preventable – usually related
to failure to comply with procedures relating to the
safe handling and disposal
Source: HPA 2005
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Outcome of exposure to BBVs
►Nine seroconversions following significant
occupational exposure over a 7 year period
►Six involved male injection drug user source
patients
►All seroconversions followed percutatous
exposure mostly to fresh blood and involved
hollow bore needles
►Six occurred after the procedure and five were
preventable
►Many were preventable with adherence to
standard precautions (38%)
Source: HPA 2005
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The importance of surveillance of Occupational
Exposure to Blood Borne Viruses in Health Care
1. Data collection Workers
2. To identify risk factors necessary for seroconversion to
occur
3. To examine type of exposure, staff involved and
circumstances surrounding the exposure
4. To use the data to inform national prevention policies
5. To monitor implementation of national HIV post
exposure prophylaxis (HIV PEP) guideline and
influence future policy
6. To raise awareness of reports of occupational
exposure and encourage all trusts and other health
care providers to take part
7. To use data collected on HBV immunisation to monitor
adherence to policy
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Learning checks:
► Avoid the use of needles wherever possible
► Avoid recapping needles – instead immediately place the
uncapped needle into a sharps box
► Think ahead and plan the safe handling and disposal of
sharps before using them – is there a sharps container in
the vicinity
► Never fill a sharps container more than three quarters full
► Carry used sharps containers carefully
► Don’t open or empty sharps containers
► Store sharps containers in a secure place until ready for
removal for incineration
► Make sure your immunisations are up to date
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Recap – hierarchy of controls
►Remove the Hazard
►Isolate the hazard – protective
devices/engineering controls
►Use needles that retract, sheath or blunt
immediately after use
►Work practice controls and personal
protective equipment (Hep B vaccination)
Source: CDC Workbook. Sharps Injury Prevention
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Summary:
►While studies show that reductions of
needlestick injuries are achievable, it is difficult
to identify the efficacy of individual control
measures in studies with numerous
interventions.
►Reducing sharps injuries by the greatest amount
possible will entail a combination of
►Elimination of procedures using sharps
►Education
►Safer devices
►Positive work conditions
►Standard precautions
► Websites:
► EPIC Guidelines: http://www.epic.tvu.ac.uk/epicphase/1.html
► ICNA Audit Tools: Infection Control Nurses Association (2004) available from: www.icna.co.uk
► The European Forum for protection of Healthcare Professionals in a safer working environment http://www.needlestickforum.net
► NHS Purchasing and Supplies Agency product related information relating to sharps safety: www.pasa.nhs.uk/medicalconsumables/sharps/
► WHO (2005) Protecting Healthcare Workers, Preventing Needlestick Injuries Toolkit. Occupational and Environmental Health Unit
http://www.who.int/occupational_health
► CDC Workbook for designing, implementing and evaluating a sharps injury prevention programme (2004): http://www.cdc.gov/sharpssafety/
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