Health and safety
If the organisation truly does believe it is the individual’s human right to be protected at work, it is surprising then that little attention appears to be placed on checking the validity of the data collection system. It would be expected that under-reporting of AIs, which includes sharps injuries, would be investigated, analysed and resolved to the benefit and respect of the individual. If it is the case that sharps injuries are under-reported, this might be one reason for NHS management not providing safety engineered devices as a matter of mandatory policy to remove the risks of personal injuries to its staff. Perhaps they don’t know about them? All the above points lead to the obvious question: what is an acceptable risk to the employee of a sharps injury? Has any organisation or departmental manager ever asked the employee “what is acceptable to you?” If the employee is handling needles that have patients’ blood on them, is it an acceptable risk to get a sharps injury once per shift, once a week, once a month, or once a year? Can the risk even be quantified given the unreliable nature of the AI reporting system? Is even a 1% chance of being infected by a dangerous pathogen an acceptable risk? And who is the risk acceptable to; management or the employee? This moral dilemma does not need to always be faced. The default position of managing risk can be changed to a culture of “no neccessary risk” if safety- engineered devices are properly evaluated and adopted.
In blood banking, needleguards are universally used to protect the phlebotomist. No authority challenges this or tries for a workaround. The blood bag companies have added the guards to their bags and the needleguard is part of the whole unit supplied. In the US, this became mandatory for Blood Banks when President Clinton enacted a law, in 2000, and the US Congress passed the “Needlestick Safety and Prevention Act”.10
Healthcare employers are
required to document in their exposure control plan that they have evaluated and implemented safety-engineered sharp devices and needleless systems. Safety-engineered devices that never expose contaminated needles are generally, in themselves, more expensive for hospitals to buy, but the true cost of managing the risk of sharps injury surely vastly exceeds the additional pennies in device cost, as do the savings in operational efficiencies. The reach of risk with unprotected needles is long, involving several individuals. All these people will be subjected to risk mitigation procedures, placing them, and not
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Devices exist that shield the contaminated butterfly needles, but it appears that management’s focus is managing down the risk rather than eliminating it.
their employers, at the sharp end (pardon the pun) of ensuring their own safety, by following cumbersome procedures and reporting incidents. Consider also the manpower costs of maintaining the reporting system, collecting the data, developing, implementing and auditing the risk management procedures, for AIs. We also need to consider how risk mitigation,
using procedures, can have effects on the validity of blood culture results. Unsafe devices are used to avoid increasing up-front device spending, so workarounds exist that require additional devices
and more process steps to obtain the samples. Unnecessary devices used means more touch
points. This means there is a higher risk of the transfer of pathogens to the culture bottle and consequently its contents. A positive result showing bacteria is present in the blood sample can result in unnecessary prescribed antibiotics. The fundamental right of the individual to
be protected against injury at work has been shown to affect other areas. Key issues include: potential false positives from blood culturing; the responsibility to reduce the risk of sharps
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