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Needle-free systems


The Department of Health has advised encouraging the wound to bleed as the initial action following a sharps injury.11 Sucking of the wound by mouth is not recommended. If exposure has occurred to the eyes or mouth, these areas should be copiously irrigated with water. If contact lenses are being worn, then eyes should be irrigated both before and after lens removal.


Healthcare workers should then immediately follow local policy and protocol regarding receiving further expert advice in order to reduce their risks associated with potential viral transmission following the sharps or NSI.


Passive versus active safety engineered devices


Passive SED do not require any additional actions by the user to activate the safety feature. Active SED require the user to activate the safety feature.12


Active devices


are only as good as the operator using them. If the operator fails, for whatever reason, to activate a safety feature, then the device is not protected and, therefore, the HCW is at risk from a sharp/NSI. It is essential that SED are appropriately evaluated by the clinical user using a recognised evaluation form, such as the one developed by Training for Development of Innovative Control Technologies13


prior to introduction to


ensure that they meet user requirements, do not interfere with their original use and function and reduce risk of NSIs.14 The main requirements of a needle SED have been identified as:13


During use: ● The safety feature can be activated using a one-handed technique


● The safety feature does not obstruct vision of the tip of the sharp


● Use of this product requires you to use the safety feature


● This product does not require more time to use than does a non-safety device


● The safety feature works well with a wide variety of hand sizes


● The device is easy to handle while wearing gloves


● This device does not interfere with uses that do not require a needle


● This device offers a good view of any aspirated fluid


● This device will work with all required syringe and needle sizes


22


● This device provides a better alternative to traditional recapping


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Training: ● The user does not need extensive training for correct operation


● The design of the device suggests proper use


● It is not easy to skip a crucial step in the proper use of the device


The Health and Safety Executive has recently undertaken a systematic review of the efficacy of SED and their impact on sharp and NSI.15


Following the


introduction of any SED, it is essential to ensure that continuing product reviews are undertaken. This will help to determine if there are any risks associated with use of the device. Adams and Elliott14 identified that some SED may cause splashing on activation. Roff and Health and Safety Laboratory also demonstrated that the activation of bench-top activated SED (devices which may be activated using surfaces such as tables or bedside lockers rather than by the operator’s hand) may cause environmental contamination, which can accumulate on the surface near where the device has been activated.16


Training is essential to


ensure that HCW are aware of the risks associated with particular devices.


The study demonstrated that the increased cost of the SED was offset by the reduction of costs associated with


Financial costs associated with the implementation of SED A study of the costs associated with implementation of SED to reduce the risk of NSIs was undertaken in 18 hospitals in Sweden.17


Key points • 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.


• Sharps and needlestick injuries (NSI) have accounted for 17% of accidents to NHS staff (NAO, 2003). • The Directive aims to prevent healthcare workers’ injuries caused by all medical sharps. • It is important that pharmacists be protected from the risks associated with sharps and NSI; risk of transmission of infection and toxic materials.


After use: ● There is a clear and unmistakeable change (audible or visible) that occurs when the safety feature is activated


● The safety feature operates reliably ● The exposed sharp is either permanently blunted or covered after use and prior to disposal


● This device is no more difficult to process after use than are non-safety devices


the investigation and treatment of a potential NSI.


Failure to implement the Directive Failure to implement the Directive will be seen as a criminal offence. In 2004, in the case of Skinner versus the Scottish Ambulance Service (Skinner v Scottish Ambulance Service 2004SC 790)18


the


Court took the view that the NHS refusal to introduce SED on cost grounds alone was a breach of employment and safety laws. More recently in 2010, The Worcestershire Acute Hospitals NHS Trust has been fined following an incident where a HCW contracted hepatitis C in 2007 from a NSI while taking blood from an infected patient. The issues highlighted were related to accessibility of sharps boxes, risk assessments and training/supervision. The Trust had been found to breach section 2 (1) of the Health and Safety at Work Act 1974 and regulation 6 of the Control of Substances Hazardous to Health Regulations 2002 and was fined £12,500 and ordered to pay £9,000 costs.19


Conclusion


All HCW are at risk from sharps and NSIs. It is essential that pharmacists be protected from the risks associated with sharps and NSI, risk of transmission of infection and toxic materials. Continuing implementation of safe working practices is paramount, as are risk assessment, risk elimination, training in use of devices and awareness of consequences of sharps and NSI. Pharmacists have a pivotal role in assessing risks and evaluating any new SED introduced in their areas of practice.


The Directive sets out the minimum standards required with regards to the Prevention from Sharps Injuries in the Hospital and Healthcare Sector;20


at the


time of writing this article the Health and Safety Executive (HSE) are consulting on the proposed regulations to implement Council Directive 2010/32/EU in the UK. ●


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