Table 1: Requirements of a safety engineered device15,17
– 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 the product requires you to use the safety feature (bypassing any safety actions is not possible)
– The product does not require more time to use than 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
– This device provides a better alternative to traditional recapping
– 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 permanently blunted or covered after use and prior to disposal – This device is no more difficult to process after use than non-safety devices
– The user does not need extensive training for correct operation of the device, that is, it is intuitive to use
– The design of the device suggests proper use – It is not easy to skip a crucial step in proper use of the device
These criteria represent optimal target features that may not be achievable in every device – they do not represent an exhaustive list and may evolve over time.
● Introduce an inoculation injury prevention committee; occupational health and safety, infection prevention and control, clinical users, pharmacists, risk management, etc.
● Remove any devices deemed as unsafe. ● Use of needle-free devices (such as the Vfend®
200mg powder and solvent for solution for infusion)
● Improve occupational exposure awareness such as risks associated with exposure to blood, body fluids, cytotoxic chemotherapies and radiopharmaceuticals.
● Health monitoring and vaccination should be provided where available. 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.19
pharmacists might not have everyday contact with patients/clients they may be exposed to the risk of a ‘downstream injury’ (an injury not
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
occurring to the original user, for example, from a discarded needle in waste bag). Therefore, vaccination should be both provided and uptake encouraged.
● Encourage occupational exposure reporting.
● Inoculation injuries should be reported promptly and appropriately, and risks identified following a root cause analysis into each case.
● Employers are responsible for ensuring all staff are aware of the risks associated with occupational exposure from inoculation injuries.
Work practice controls ● Review staffing levels to ensure they are appropriate for the work level.
● All staff should have access to training on the safe handling and disposal to sharps.
● Establish means for safe handling and disposal of sharps prior to beginning a procedure.
● No needle recapping. The preparation of medications such as cytotoxic chemotherapies and
radiopharmaceuticals can be potential causes of exposure via NSI to HCW.5,20 Therefore, while 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.
Personal protective equipment ● Place barriers and filters between the healthcare professional and the hazard, for example, eye goggles, face shields, gloves, masks and gowns.
Measures to be taken following an inoculation injury
Sucking of the wound by mouth is not recommended. If exposure, such as splashing, 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 their removal. HCW 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 an inoculation injury.
The initial action advised following a sharp/NSI is to encourage the wound to bleed.21
Compliance with Council Directive 2010/32/EU Mindmetre22
has identified that around
one-sixth of acute hospital Trusts in the UK have not revised their sharps policies in response to the UK regulations. Furthermore, one-third of Trusts are still not encouraging their staff to use safety devices ‘wherever possible’, despite this being a major feature in the regulation. Moreover, the HSE have served five
Figure 2: Risk assessment matrix and analysis18 IV catheter
RISK by amount of blood exposure per device
Medium Low IM injection Acupuncture (Blood splashes)
No patient contact
Sometimes Often FREQUENCY of NSI in healthcare settings
Blood collection Lancet
Insulin injection Frequently
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