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Needle-free systems


What does this mean for the pharmacy team?


Member States of the European Union (EU) have until May 11 2013 to implement Council Directive 2010/32/EU - Implementing the Framework Agreement on Prevention from Sharps Injuries in the Hospital and Healthcare Sector. This article examines the issues surrounding sharps injuries and some of the implications for pharmacy teams


Debra Adams RN PhD Independent Consultant Advisor/Programme Specialist; Healthcare Associated Infection, NHS Midland and East, St Chads, Hagley Road, Birmingham, UK


Keywords: needlestick injuries; sharps; Council Directive 2010/32/EU


The National Audit Office in 2003 identified that sharps and needlestick injuries (NSI) accounted for 17% of accidents to NHS staff.1


injuries. It is important to understand these areas to ascertain how best to reduce occupationally acquired sharps and NSIs in the healthcare setting.


Who is at risk from sharps injuries? From the data reported in 2012, the Health Protection Agency2


have identified


that the professions most at risk from a sharps injury are: ● Nursing professional – 44% ● Medical/ dental professionals – 43% ● Professions allied to medicine e.g. pharmacists – 8%


Sharps and NSI


can transmit disease and therefore are a significant occupational hazard for healthcare workers (HCW). Between 1997 and 2011, there have been 20 reported cases of HCW sero-converting to hepatitis C in England and Scotland following percutaneous exposure to a virus-infected patient.2


Five cases of HIV sero-


conversions resulting from percutaneous exposure were reported in HCW in the UK up until 2011, and none since 1999.2 In addition, the danger of an accidental needlestick injury when working with hazardous drugs can present a significant health risk. Over a ten-year period in an American nuclear medicine/pharmacy department, 41 nuclear medical technologists reported 27 radiotherapy-associated NSI.3


Factors influencing sharps and needlestick injuries


20


Sharps and NSI occur for a number of reasons, including: types of device used and procedures undertaken; lack of training on safe use and disposal of needles and sharps, and lack of knowledge of the consequences of such


www.hospitalpharmacyeurope.com


● Ancillary staff – 2% ● Unknown occupation – 3% While the evidence demonstrates that the risk of blood-borne virus (BBV) transmission to pharmacists is low, it remains necessary to protect them from exposure to transmission of infection, and to avoid exposure to other toxic medications such as cytotoxic


chemotherapies and radiopharmaceuticals. Legislation


All Member States of the EU will need to implement the Council Directive 2010/32/EU to prevent injuries and infections to HCW in both private and public domains, including prisons, as a result of sharps/NSI. This Directive applies to all workers in the hospital and healthcare sector, and all who are under the managerial authority and supervision of the employers. The purpose of this Directive is to: ● achieve the safest possible working environment


● prevent workers’ injuries caused by all medical sharps (including needle-sticks)


● protect workers at risk ● set up an integrated approach


establishing policies in risk assessment, risk prevention, training, information, awareness raising and monitoring


● put in place response and follow-up procedures


Implementing the Legislation As identified, the key risks associated with sharps and NSI are both injury and the potential risk of BBV transmission from infected blood and body fluids. Key requirements that need to be implemented include:


Risk assessment ● Undertake a risk assessment. Identify if there is a risk of injury, exposure to blood or other potentially infectious material from sharps or NSI, both within the department and when undertaking clinical visits?


● Can the risk be eliminated or minimised?


Risk elimination and prevention ● Firstly, eliminate the unnecessary use of sharps


● Can the risk of exposure be reduced by using alternative devices or amending practices and procedures? For example, medications that are dispensed from pre-filled syringes such as low molecular weight heparin, will require the syringe/needle to be a safety engineered device (SED) where available. In addition, assess where there is a potential use for alternative practices, such as glass ampule openers to protect from broken glass cuts, closed system drug transfer devices to mix medications and replacing glass products with plastic where suitable.


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