HEALTH AND SAF E T Y
control measures, as well as avoiding the unnecessary use of sharps. In addition, if it is not reasonably practical to avoid the use of sharps, then the employers should provide safer sharps which incorporate protection mechanisms.
These safer sharps mean there are features or mechanisms which minimise the risk of accidental injury. These are quite familiar in many hospitals now, but there are still workplaces which do not have them. The next regulation, which is particularly apposite, is the re-capping of needles as it remains in the literature as one of the processes that appears to hold the greatest risk of injury to HCWs.
One study identified that re-capping of needles was the most frequent cause of NSIs among HCWs (30.5% of the total).3 The Regulations state that injuries can occur after a needle has been used if the HCW holds the needle in one hand and attempts to place a cap on the needle with the other hand (so-called two-handed recapping). Needles must not be recapped after use unless the employer’s risk assessment has identified that recapping is itself required to prevent a risk (e.g., to reduce the risk of contamination of sterile preparations). In these limited cases, appropriate devices to control the risk of injury to employees must be provided. For example, needle-blocks can be used to remove and hold the needle cap and so allow safe one- handed recapping.
The regulations also state that secure containers and instructions for safe disposal of sharps close to the work area, should be readily available. This may seem to hospital workers as extraordinary that this has to be stated – but consider the workplace of ambulance staff or domiciliary healthcare professionals where the workers have no
When the Royal College of Nursing asked its members in 2020 about their experience with needlestick injuries, 21% said that the injury happened during disposal, which included during transport of sharps to the sharps container.
control over the environment. Obviously, suitable portable equipment needs to accompany the worker, in order to ensure that contaminated waste is appropriately and safely disposed of. However, data supplied by the recent meta- analysis showed that disposing of waste accounted for most NSIs or 37.17 % of the total, followed by injections (33%) and suturing (7.2%).4 When the Royal College of Nursing asked its members, in 2020, about their experience with needlestick injuries, 21% said that the injury happened during disposal, which included during transport of sharps to the sharps container, and all those related to the use and handling of the container. However, when “during disposal” and “improper disposal” are combined as “disposal-related” (transport + containment+ improper) – it becomes the highest category at 32%. Disposal related sharps injuries are considered preventable adverse events. With correct and immediate activation of safety devices, and with British Standards-compliant sharps bins close at hand, these injuries should approach zero. The Health and Safety Executive
undertook an inspection of NHS organisations in 2015/16 to review the
common causes of non-compliance with the 2013 Regulations. Health and Safety breaches were identified in 90% of the organisations visited, with 83% failing to fully comply with the Regulations. More than 30 of the sites visited did not comply with the regulations relating to use and disposal of medical sharps. Generally, there was a failure to use safer sharps, where reasonably practicable, or inconsistent use of safer sharps across the organisation.5 Information and training are an important aspect of ensuring that employees stay up to date with information on safe operating systems, safety guides and best practice. The Regulations state that information provided to staff must include: l The risks from injuries involving medical sharps.
l Relevant legal duties on employers and workers.
l Good practice in preventing injury. l The benefits and drawbacks of vaccination.
l The support available to an injured person from their employer.
Training should be in an appropriate form to ensure that employees know how to work safely and without risks to health with the specific sharps equipment and procedures that they will use, as well as specifically: l The correct use of safer sharps. l Safe use and disposal of medical sharps. l What to do in the event of a sharps injury. l The employer’s arrangements for health surveillance and other procedures.
During the HSE Inspections mentioned above, on information and training, they found that there were instances of: l Staff not been provided with adequate information and instructions on what to do when presented with patients’ own insulin and standard needles.
l Although sharps management was included on mandatory training, staff had difficulties demonstrating levels of compliance.
l Checks had not been made to ensure that employees were practising the correct techniques.
l Employees who had been trained to use safer sharps were not consistent in
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