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Needle-free systems


Wittmann has developed a


standardised risk assessment matrix for medical sharps which identifies the potential risks of BBV transmission associated with devices/procedures and the appropriate level of sharps safety required (Figure 1).4 ● Ban the recapping of needles The preparation of medications such as cytotoxic chemotherapies and radiopharmaceuticals can be potential causes of exposure via NSI to the HCW.3,5 Therefore, whilst preparation is undertaken in an aseptic suite utilising an aseptic non-touch technique (ANTT), these procedures frequently involve the re-capping of needles. Under this legislation, the re-capping of needles is banned with immediate effect. Consequently, procedures will need to be reviewed and alternative products, such as blunt fill needles/filters and re-capping blocks, should be considered. ● Improving education and awareness All staff should have access to training on the safe handling and disposal of sharps. The principles surrounding the safe use and disposal of sharps have been identified:6,7 – Handling of sharps should be kept to a minimum


– Syringes or needles are not dismantled by hand and are disposed of as a single unit straight into a sharps container for disposal


– Sharps are not passed directly hand to hand


– Sharps containers are readily available as close as possible to the point of use (sharps trays with integral sharps boxes are a useful resource)


– Needles are never re-sheathed or recapped


– Needles are not broken or bent before use or disposal


– Arrangements should be in place to ensure the safe disposal and transport of sharps used in a community setting such as patients’ homes


– All sharps containers should conform to UN standard 3291 and British Standard 7320


– Sharps containers are not filled to more than two-thirds of capacity


– Sharps containers are signed on assembly and disposal


– Sharps containers should be temporarily closed when not in use


– Sharps containers are stored safely away from the public and out of reach of children


– Sharps containers should be disposed


Figure 1: Risk assessment matrix and analysis IV catheter


RISK by amount of blood exposure per device


Critical Serious


Medium Low Acupuncture


No patient contact


Seldom Sometimes FREQUENCY of NSI in healthcare settings Required preventative actions:


Use of safety devices essential, vaccination against hepatitis B and proper information and training for staff obligatory.


Use of safety devices required, vaccination against hepatitis B and proper information and training for staff obligatory


Training for staff obligatory to achieve the highest possible safety level. Eliminate use of sharps if alternative available.


* Where safety devices do not exist, we recommend the use of double gloving, vaccination against hepatitis B and proper information and training for the staff.


of every three months even if not full


– Staff should report sharps injuries in line with local reporting procedures and policies


– Staff should attend training on the safe use of sharps and SED


● Reviewing staffing levels to ensure they are appropriate for the work level


● Ensure personal protective equipment (PPE) is available at the point of use


● Ensure appropriate sharps disposal systems are available at the point of use


● Ensure the organisation has developed an overall occupational exposure policy and that staff are aware of both it, and the actions they are expected to perform should such an incident occur


Training ● Incorporate use, safe handling and disposal of sharps procedures


● Improve occupational exposure awareness, such as risks associated with exposure to blood, body fluids, cytotoxic chemotherapies and radiopharmaceuticals


● Recognise the importance of hepatitis B virus immunisation


Pre-exposure vaccination to hepatitis B should be considered for all HCW who are at risk of exposure to the virus from contact with blood, blood-stained body fluids or tissue.8


While pharmacists


might not have every-day contact with patients/clients, they may be exposed to the risk of a downstream injury (an injury not occurring to the original user, for example, from a discarded needle in waste bag). Therefore, vaccination


should be provided and uptake encouraged. ● Encourage occupational exposure reporting


Under-reporting of sharps and NSIs may occur for several reasons, for example: staff finding the reporting procedure to be time consuming, staff being too busy, poor follow-up procedures, staff underestimating the risks associated with contaminated needlesticks or sharps, and fear that reporting might have negative repercussions for them professionally.9,10


Information ● Inoculation injuries should be reported promptly and appropriately, and risks identified following a root cause analysis into each case


Awareness raising and monitoring ● Employers are responsible for ensuring all staff are aware of the risks associated with occupational exposure from inoculation injuries


● Furthermore, health monitoring and vaccination should be provided where available


Measures to be taken following an inoculation injury


Healthcare workers are potentially at risk from receiving an inoculation injury. It is therefore essential that any occupational exposure to blood, body fluids, cytotoxic chemotherapies or radiopharmaceuticals be treated immediately, irrespective of whether there is any known risk.


www.hospitalpharmacyeurope.com IM injection (Blood splashes)


Heparin injection


Often


Blood collection Lancet


Surgical devices*


Insulin injection Frequently


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