Health and safety
The need for zero tolerance for sharps injury risk
David Laffar argues that managing risk can be changed to a culture of “no neccessary risk” if safety-engineered devices are properly evaluated and adopted.
Is protection against sharps injury at work a human right? Is it on an equal footing with the articles enshrined in the United Nations Human Rights Act 19981
of a right to life, liberty, security
of person, freedom from torture and slavery, freedom of thought and expression, and the right to a fair trial? The International Labour Organization (ILO), a specialised agency of the United Nations, says it is on that equal footing.2 The ILO has included a safe and healthy working environment as its fifth Fundamental Principle and Right at Work and this recognition signifies that a safe and healthy workplace is not just a desirable practice but a fundamental right that all workers are entitled to, regardless of their location or industry. It underscores the importance of protecting workers from work-related injuries and illness, giving them a stronger legal and moral basis to demand safer working conditions. Closer to home, UK RIDDOR3
(Reporting of
Injuries, Diseases and Dangerous Occurrences Regulations) is the law that requires employers, and other people in charge of work premises to report and keep records of all work-related injuries. Either the Health and Safety Executive (HSE) or the local authority can respond to ensure compliance with health and safety law. To emphasise the United Nations and UK
law, the Institution of Occupational Safety and Health (IOSH),4
the UK chartered body for health
and safety professionals, states that a safe and healthy working environment is a fundamental principle and right, at work. Occupational safety and health can no longer be considered an optional extra. The 2023 NHS Constitution for England (in the Staff: your rights and NHS pledges to
section:5
you), states that “the rights are there to help ensure that staff have healthy and safe working conditions”. Given these fine words of legal and
moral imperatives on employers, it is surprising that hospitals and medical environments do not embrace these tenets and legal requirements fully with respect to sharps safety. Instead, often they choose to work around them by implementing procedures to “manage” those risks, despite the availability of safety engineered devices (SEDs) that remove them. A common response to the question of managing sharps injury risks seems to be “I manage the risk of sharps injuries by training my staff to be aware of the danger points and how to reduce the chance of a needlestick. I have numerous procedures and control points, and I have a reporting system”.6,7
Lack
of affordability and wanting cost neutrality is frequently the answer for not implementing new, safety engineered devices. These procedures to manage the safety risk
typically result from a review of the processes surrounding the area of risk. Care in handling
A safe and healthy working environment is a fundamental principle and right at work. Occupational safety and health can no longer be considered an optional extra.
sharps is an obvious one. Reporting of injuries should help flag any rising issues. However, the nurse conducting the procedure can only work with what she has and, if management do not observe the detailed day-to-day processes, real risks to the person will not be apparent. For example, when taking blood samples in a hospital for culturing, the nurse uses (among other things) a small adapter inside the blood tube holder to bridge between the size of a culture bottle and the different size of the vacutainer, both of which receive blood samples. The needle inside the blood tube holder can therefore be contaminated during and after the procedure. Placing the adapter carries a high risk of needlestick injury because it sits inside the vacutainer and is very close to the exposed luer needle, which has blood on it, when the adapter is removed by hand. An alternative device that eliminates the
adapter is oversized, so it can take the bigger culture bottles, as well as the vacutainers. Here, there is also a risk of needlestick injury because the contaminated luer needle is also exposed, but much more so. The original problem is not solved but worked around by adding devices, adapting existing devices, and overlaying administrative procedures. Now, we look at the
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