needlesticks and eliminate all unnecessary injections.
● Can the risk of exposure be reduced by using alternative devices? For example, medications that are dispensed from pre-filled syringes will require the syringe/needle to be a safety engineered device (SED) where available. Assess if there is a potential use for alternative practices such as glass ampule openers to protect from broken glass cuts, blunt fill needles, closed system drug-transfer devices and replacing glass products with plastic where this suitable.
Figure 1: Occupational groups exposed to blood or other high-risk body fluids by virus in 2011.4
Scotland following percutaneous exposure to a virus-infected patient.4
cases of HIV sero-conversions resulting from percutaneous exposure were reported in HCW in the UK up until 2007, none since 1999.4
Who is at risk from sharps injuries? Nurses have been identified as the occupational group most exposed to high risk blood and body fluids4
subcutaneous injection also present a risk.
● The amount of blood or body fluid inoculated.
● Whether the device was previously in the patient’s vein or artery.
● How infectious the patient is at the time of the injury.
(Figure 1). The
evidence demonstrates that the risk to pharmacists is much lower. Nonetheless, 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. Over a ten-year period in a US nuclear medicine/ pharmacy department, 41 nuclear medical technologists reported 27 radiotherapy- associated NSI.5
Furthermore, in the UK,
almost 40% of sharps/NSI occurred to someone other than the original user of the device.6
Therefore, HCW may be
exposed to sharps/NSI while in the clinical areas, such as an incorrect disposal of a device, collision with a colleague.
Risk of transmission of infection The risk of transmission of infection following sharps/NSI may be affected by several major factors:7 ● Depth of injury. ● Type of sharp used – hollow bore needles are associated with increased risk, although needles used for
In addition, the lifespan of blood- borne viruses outside the body is significant. Hepatitis B virus may survive for up to one week;8 up to four days;9
hepatitis C virus for HIV is not thought to
survive well outside of the body.10 Therefore, sharps/NSI from what may be considered an ‘old’ device may still lead to the transfer of blood-borne viruses.
Reducing the risk of sharps/NSI Sharps/NSI occur for a number of reasons, including: types of devices used, procedures undertaken, lack of training on safe use and disposal of needles and sharps and lack of knowledge of the consequences of such injuries. The World Health Organization11
hierarchy of controls to reduce the risk of sharps/NSI.
Elimination of hazard ● Identify if there is a risk of injury, exposure to a blood or other potentially infectious material from sharps or needlesticks both within the department, or when undertaking clinical visits.
● Where possible, substitute injections by administering medications through another route. Remove sharps and
Engineering controls used to isolate or remove the hazard ● Employing a SED. It is important that healthcare providers develop a robust conversion strategy when changing from one device type to another, which includes potential users of the device should be part of the SED-evaluation process,12
development of systems,
processes and protocols, a robust education and training process and on-going support/resources identified.
● Following the introduction of any SED it is essential to ensure that continuing product reviews are undertaken, to determine if there are any risks associated with use of the device such as splashing on activation.12,13
● The Health and Safety Executive14 has ● TDICT,15
undertaken a systematic review of the efficacy of SEDs and their impact on sharps/NSI. The findings identified that when educational programmes were implemented alongside a safer sharps device, lower rates of sharps injuries were sustained for longer. European Biosafety
Network16 and Strauss and WISE17
have identified the main requirements of a SED (Table 1).
Administrative controls ● Wittmann18
developed a standardised
risk-assessment matrix for medical sharps that identifies the potential risks of blood-borne virus
transmission associated with devices/ procedures and the appropriate level of sharps safety required (Figure 2).
● Ensure the organisation has developed an overall occupational exposure policy that includes the safe handling and disposal of sharps and that staff are aware of both it, and the actions they are expected to perform should such an incident occur.
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