Every year across Europe more than a million healthcare workers risk their lives when they are pricked while administering injections or spike themselves during disposal of ‘sharps’. As well as the risk of contracting potentially-deadly infections such as hepatitis and HIV, so-called ‘needlestick injuries’ also come at a high cost to the NHS – with low-risk cases costing £50-£100 each and incidents involving contamination estimated to cost more than £15,000. Here, JO MAKOSINSKI looks at the problem and the technologies that are available to help reduce the risk of injury
ACCORDING to figures from the Royal College of Nursing (RCN), since the late 1990s in the UK 11 healthcare staff have contracted hepatitis C from needle jabs and five HIV transmissions have been confirmed. Most of these cases involve nurses, who deliver the largest proportion of patient care and, as such, report the most incidents involving such injuries.
In an RCN survey carried out in 2008, it was revealed that 48% of nurses have been stuck by a needle or sharp which had previously been used on a patient. Fifty two per cent said they feared injury either ‘a great deal’ or ‘a fair amount’, and 45% admitted they had not had any training on safe needle use.
An RCN spokesman said: “While the majority of needlestick injuries are non-life threatening, the possibility of developing infectious diseases can cause immense distress, anxiety and anguish for nurses and other healthcare workers.”
While the majority of needlestick injuries are non-life threatening, the possibility of developing infectious diseases can cause immense distress, anxiety and anguish for nurses and other healthcare workers
In the US, the Needlestick Safety and Prevention Act 2000 now requires employers to monitor the incidence of needlestick injury and provide safety engineered medical devices and related equipment to protect staff.
The World Health Organisation, European Agency of Occupational Safety, Health Protection Agency and Health and Safety Executive also stress the importance of a preventative approach. This means trusts adopting safer practice guidance and considering procuring new technologies which help to reduce the risk of an incident occurring.
Prevention better than cure
RCN executive director of nursing and service delivery, Janet Davies, said: “Sharps policies, training and investment in safer needles can help prevent these accidents from happening in the first place. Nurses must also receive proper support from their employers when they sustain an injury to prevent the isolation, which can add to their distress. By making these changes and safeguarding the health of all staff, we will improve patient care in the UK and throughout Europe.”
In March 2010, EU employment and social affairs ministers adopted a directive to further enhance safety. László Andor, EU commissioner for employment, social affairs and inclusion, said: “The healthcare sector is one of the biggest employers in Europe and needles represent a real risk to workers, both in terms of injuries and increased rates of life-threatening infections like HIV or hepatitis. This new directive will better protect workers and their families while reducing the burden of injuries on European health services.”
Sharps policies, training and investment in safer needles can help prevent these accidents from happening in the first place
The new directive, which came into force last June and must be implemented by 11 May 2013, sets up an integrated approach to assessing and preventing risks and to training and informing workers. If a risk assessment reveals a risk of injury, the workers’ exposure must be eliminated by taking measures such as implementing safe procedures for using and disposing of sharp medical instruments and the disposal of contaminated waste, eliminating the unnecessary use of sharps and banning the practice of recapping1.
Meeting this directive is being made easier through the introduction of new technologies such as safety syringes and needles, retractable blades and shields.
Reducing the risk
Leading the way is The University Hospital of North Staffordshire NHS Trust, which has introduced BDVenflon Pro Safety Needles and Sharpsmart bins.
Helen Jenkinson, the trust’s deputy director of infection prevention and control, said: “We have all seen Hollywood films like Outbreak, where someone with a terrible illness is being treated by a clinician and something causes them to accidentally pierce their skin, transferring the infection. The reality is that this could happen to any one of our staff working with needles and infections can be life-threatening.
“The biggest dangers are when inserting, removing and disposing of needles. If a clinician uses a safety device and disposes of it properly, the risk of causing them to pierce their own skin with an infected needle is reduced. Since the introduction of the new needles and sharps waste bins we have significantly reduced the numbers of sharps injuries in the trust. This provides the trust with a complete safety cycle to reduce the risk of injury to staff and patients.”
The healthcare sector is one of the biggest employers in Europe and needles represent a real risk to workers, both in terms of injuries and increased rates of life-threatening infections like HIV or hepatitis
The BD Venflon solution was the winner of a red dot Award honouring outstanding design quality and trendsetters from across industries. Once activated, the needle tip is fully encapsulated inside the protection mechanism. The system also includes a unique feature to help guard against blood splatters that can occur during the cannulation process, and snap caps and non-touch features prevent ports being left open.
The Sharpsmart bins, which are manufactured by Daniels International, aim to address the problem of overfilled containers. A company spokesman said: “Sharpsmart containers eliminate risk with a patented split-tray mechanism that automatically closes when the ‘fill’ level is reached, preventing any chance of overfilling. A clear-view window shows the level of contents prior to the collector becoming full.
“The bins come pre-assembled, avoiding risk of poor assembly affecting performance and, when full, they are locked by engaging tamper-proof side locks, which cannot be opened manually and are only unlocked in our Washmart robotic processing machines.”
HexArmor is another example of a company that has come up with solutions to help trusts avoid costly injuries, manufacturing a range of needle-resistant gloves and arm guards.
Other innovations include retractable safety scalpels, such as those produced by Swann-Morton. They are colour coded and feature a temporary forward lock position to prevent uncontrolled retraction when contacting with bone during use; an additional notch to hold the blade more securely in the passing position; and a rear permanent lock to be engaged prior to final disposal in a sharps container.
A company spokesman said: “Needlestick injuries impose a substantial and growing cost burden on the UK and European healthcare systems and the demand for compensation in the event of an injury is now a real threat, even if no infection actually occurs. This is particularly true for downstream accidents among laundry and portering staff as a result of carelessly-discarded sharps.
“A study by the RCN study showed that 5% of all accidents recorded fell into this category, with settlements of €8,400 being the norm. The potential litigation in a case where HIV or HCV infection is confirmed is likely to be much more severe.”
He added: “An expanding range of safety devices is now available and trusts need to consider three main criteria when evaluating such equipment: whether the device works effectively and reliably, whether it is acceptable to the healthcare workers; and whether it adversely affects patient care.”
To provide additional guidance, NHS Employers has published The Blue Book2, which looks at the management of health and safety issues among staff, including a chapter devoted to needlestick risk.
It warns that many incidents are not reported and lays out guidelines for improvements to monitoring, stating: “All exposure incidents should be reported promptly. This is important for three reasons; it ensures appropriate management to reduce the risk of blood-borne virus transmission; it documents the incident and circumstances in case of a later claim; and it provides accurate surveillance so that data analysis can inform measures to reduce the risk of further exposure.”
Independent studies show that a combination of training, safer working practices and the use of medical devices incorporating sharps protection mechanisms can prevent more than 80% of needlestick and sharps injuries
It adds: “Independent studies show that a combination of training, safer working practices and the use of medical devices incorporating sharps protection mechanisms can prevent more than 80% of needlestick and sharps injuries.
“Studies in the United States and Europe have also shown significant reductions in the numbers of needlestick injuries from improving sharps disposal. It is not acceptable, particularly for cost reasons, to reduce the number of sharps bins to such an extent that staff are forced to carry used needles to the sharps bin to dispose of them. There should be enough portable sharps bins for staff at all times to allow the used needle to be disposed of safely at the point of use. This should also reduce the number of incidents resulting from needles being left in bedding.”