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Published on 12 April 2011

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Needlestick prevention/sharps disposal

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Hui-Ling Kerr
MRCS MBBS BSc
Orthopaedic Registrar
Queens Medical Centre
Nottingham

Sharps injuries are a serious concern for all healthcare workers. In 2005, the UK’s Health Protection Agency1 reported 2,140 incidents reported over eight years, of which nine healthcare workers were infected with hepatitis C through needlestick injuries. It is thought that 100,000 sharps injuries occur in the UK per annum in all healthcare workers2 making up approximately 17% of all accidents to NHS staff.3 It is thought that 4% of healthcare workers sustain one to six2 sharps injuries each year2 with these injuries occurring in clinical areas such as wards and theatres, but also occurring in non-clinical areas due to accidental handling of inappropriately discarded sharps,4 for example, protruding from waste disposal bags.

An audit conducted by the Royal College of Nursing collected data across 15 sites and found that the majority of sharps injuries are suffered by nurses, followed by senior house officers/house officers and then healthcare assistants.4 However, this audit did not take into account reporting rates and therefore may not reflect the true spread of sharps injuries in healthcare workers. Sharps injury reporting remains a continuing problem with reporting levels by healthcare workers cited as low as 15% and as high as 90%.2,5–7 Sharps injuries are common during surgery with rates cited between 1.7% and 6.9% of all surgical procedures8,9 and it has previously been shown that surgeons often under-report incidents.7 The author of this article conducted an audit of surgeons across three sites and found that more than 50% had not reported any of their sharps injuries.10

The device most like to be involved in a sharps injury is the disposable syringe and needle4 and is most likely to occur in the patient’s room or ward area4 and is in most instances related to poor practice in sharps use and disposal. This is also reflected in that up to one-third of reported injuries have also been sustained by a healthcare worker who is not the original user of the sharp. Examples of reported poor sharps use and disposal include: sharps left in inappropriate places; recapping used needles; sharps protruding from disposal containers; and sharps protruding from rubbish bags.

In 1998, the Department of Health11 published guidelines for healthcare workers for protection against infection with blood-borne viruses. It states that all employers have a legal obligation to ensure all employees are appropriately trained and proficient to work safely when at risk of contact with blood-borne viruses. This includes the distribution of an updated policy document, providing a safe environment for workers, risk management, incident reporting and appropriate training in infection control. The author of this article reports that 9.1% of surgeons in our published audit were not aware of the trust policy and 22.6% were aware but had not seen the document, despite a sharps policy document given out by the occupational health departments in the hospitals surveyed to all new doctors at induction. The document is left to the recipients to read in their own time so onus is given to the individual healthcare worker to remain up to date with local trust healthcare sharps prevention and treatment policy.

General recommendations to reduce the risk of sharps injury when handling sharps include:

  • 
Only use sharps when necessary
  • Do not pass sharps to anyone by hand
  • Do not resheath needles
  • Practise universal precautions (gloves, aprons, masks)
  • Once used, dispose of immediately in a sharps disposal container
  • Do not try to dispose of sharps in an already full sharps disposal container.

If a sharps injury has occurred, recommendations for treatment include:

  • Immediately wash the wound with soap and running water and encourage the wound to bleed
  • Cover the injured area with an appropriate dressing
  • Report the injury to the person in charge
  • Follow local Trust protocol with regards to sharps injury reporting to occupational health, testing (plus treatment if necessary) for blood-borne viruses from injured worker plus patient
  • Reflect on clinical practice to identify risks in sharps handling behaviour and reduce risk of sharps injury in the future.

Conclusion
Sharps injuries do pose significant risks to healthcare workers and in order to prevent sharps injuries, adherence to proper usage and disposal of sharps must take place. This responsibility rests with all healthcare workers, considering that up to one-third of all sharps injuries occur to persons who are not the original user of the sharp. Pharmacists work in clinical areas and are exposed to these threats in their environment and so vigilance for these dangers should be within their remit. To minimise the damage from sharps injuries, attitudes to reporting must improve. Regular updates on policy need to be given to all staff and consideration by all hospitals should be given to designing a simplified method to ease the process of sharps injury reporting. Healthcare workers should also report clinical areas where poor practice of sharps disposal is being carried out. Ultimately, despite there being a low risk of transmission of blood-borne viruses with a sharps injury, the consequences of transmission are high and it is up to the individual to practice appropriate precautions and report early.

References
1. Health Protection Agency press release 2005 (Online). Available online at: www.hpa.org.uk/hpa/news/articles/press_releases/2005/050125_needlestick.htm
2. Trim J and Elliott T. J Hosp Infect 2003;53:237–42.
3. The National Audit Office (NAO) report of April 2003. Available online at: www.nao.org.uk/publications/nao_reports/02-03/0203623.pdf
4. Watterson L. Nurs Stand 2004;19:33–38.
5. Williams S et al. Br J Surg 1993;80:714–16.
6. Makary M et al. N Engl J Med 2007;356:2693–99.
7. Haiduven D et al. J Hosp Infect 1999;41:151–54.
8. Gerberding J et al. N Engl J Med 1990;322:1788–93.
9. Tokars J et al. JAMA 1992;267:2899–904.
10. Kerr H et al. Ann R Coll Surg Engl 2009;91:430–32.
11. Department of Health. HSC 1998/063. Available online at: www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthservicecirculars/DH_4003818.



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