Needles & Sharps

Needles & Sharps

Disposal of needles:

Immediately after use the entire unit must be placed into the sharps bin.  The trolley must be sanitized and gloves changed

Disposal of waste

All waste should be disposed of in an enclosed pedal operated waste bin fitted with a polystyrene bin liner durable enough to resist tearing. The bin should be regularly disinfected in a well-ventilated area. Hazardous waste must be disposed of following the COSHH procedures and training by the employer.

Clinical Waste

Clinic waste is derived from human tissues this can include blood and tissue fluids. This should be disposed of as recommended by the environmental agency. In accordance to the Waste controlled regulations (1992

What are sharps

 

The definition of a sharp is any item that could result in a cut or puncture wound to an individual. The type of sharps you may encounter include:

  • Needles and hypo dermic needles
  • Syringes
  • Scalpels
  • Blades including knives insoles
  • Broken glass
  • Nails and screws

 

Who is at risk of a sharp’s injury?

 

In the healthcare sector the high number of needlestick and sharps related injuries continues to be a problem. NHS nurses are of particular high risk of sharps related injuries as many of their daily activities involve the use of needles and sharps.

Many other health professionals, and those who work in healthcare settings are also at risk, including: Dentist and dental nurses & aesthetic practitioners

Also:

  • Doctors
  • Paramedics
  • Laboratory workers and technicians
  • Cleaners
  • Veterinary staff

Though the use of needles, scalpels and other medical sharps is closely tied with work in the health service industries, these workers are not the only ones at risk.

Other workers who are at risk include:

  • Police officers
  • Prison offices
  • Customer offices
  • Social workers
  • Waste refuse collectors and street cleaners
  • Body piercing and body art specialist

Any worker who meets sharp materials that could be contaminated with blood or other bodily fluids is also at risk.

 

The main risk associated with sharps injuries

There are several health risks associated with sharps injuries. Accidental punctures can have serious mental and physical repercussions. Even very small amounts of bodily fluids for the sharps can transmit diseases.

The health risks associated with the sharp’s injury include:

  • Exposure to blood-borne viruses (bbv) including human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV)
  • Exposure to other pathogens. Sharps injuries can transmit several bacteria, fungi and parasites. These include malaria, tuberculosis and cutaneous gonorrhoea.
  • Psychological stress on the person and they close family. This stress could extend for several months as testing is carried out in the seriously impact on people ‘s lives.

If an employee suffers sharps injury, it can also have a large impact on the company they work for, such as:

  • Lost Working time. This could be a result of stress, anxiety or contracted illness that results in extended sick leave.
  • Carrying out investigations. After an incident, investigations must be carried out to understand how and why the incident occurred. These investigations come because in.
  • Replacing a staff member. It can be very costly to a business if they need to recruit and train new staff.

Human immunodeficiency virus (HIV) is a virus that damages the cells in your immune system, weakening your ability to fight infections and diseases.

Presently, there is no cure for HIV. However, by using the effective drug treatments available, most people with HIV can continue to live long, healthy lives.

If left untreated the HIV virus can severely damage, your mean system and can lead to aids (acquires immunodeficiency syndrome). Aids occurs when your immune system is so weak that you are unable to fight off infections and cancers, or your CD4 cell count drops to under 200.

HIV is one of the most serious risks associated with receiving an accidental puncture from a used shark. HIV is a transmitted through blood and other body fluids, therefore, there is a risk of contracting the virus if you have a sharps injury. It’s important to seek medical advice as soon as possible if you have a sharp syndrome.

Blood borne virus (BBV)

Hepatitis B is a virus that can affect the liver and can result in serious liver damage. It’s transmitted through blood and other bodily fluids, so there is a risk of contracting hepatitis B if you have a sharps related accident.

Many people will not experience any symptoms and might fight off the virus without ever knowing they were infected. However, the consequences can be serious, you should seek medical advice if you believe you’ve been exposed.

Hepatitis B is also a virus that can Infect the liver. It is transmitted through blood and, if left on treated, can result in serious damage to the liver.

Hepatitis C can usually be cured, with the infected individual often retaining a normal lifespan. However, like hepatitis B, hepatitis C often does not have any symptoms. Therefore, if you have had a sharps related injury, it is important you are tested as soon as possible.

The facts

In 2008, the Royal College of nursing card out a survey or 4407 nurses about needlestick injuries. It found that coat on

  • 48% of those asked had been injured with a used needle at some point in their career
  • 10% had received an injury in the last year
  • 28% of those that Had sustained an injury was given no advice on the risk of BBV’s post injury

The publication also highlighted the lack of training that those work in the sharps are provided with. It was found that only 55% of nurses have been provided with some former sharps training bother employer.

Training is essential for ensuring that those at risk of an injury are provided with the knowledge needed to carry out their work safely.

As we have seen, injuries can have a serious impact on the life of the infected individual and on the company, they work for. Therefore, it’s vital that you’re aware of how to reduce your risk of a sharps injury and ensure your safety.

Sharps and the law

Sharps are dangerous. Improper use can have serious mental, physical and monetary consequences. Therefore, it’s important that sharps use is carried out safely and in accordance with the law.

There are several pieces of legislation that cover the use of sharps and provide guidelines and guidance for implementing safe systems of work in the workplace.

This module is designed to help you understand the responsibilities that healthcare Employers must protect their workers from sharps related injuries, the duties placed on employees and the consequences of not complying with the law.

  

 

Topics to be covered

Health and safety (sharp instruments in healthcare regulations 2013)

Employers who organise, manage or provide healthcare have a legal responsibility to comply with the health and safety regulations 2013. This includes:

  • NHS providers
  • GP practices
  • Independent health care providers including Aesthetic Practitioners
  • Hospices
  • Nursing homes
  • Healthcare workers who visit patients at home

These regulations also cover contractor organisations that provide services for the healthcare industry. In this situation, the healthcare employer has the responsibility of cooperating with the contractors and providing any relevant sharps information.

However, there are some healthcare professionals who are not covered by the regulations, including:

  • Prison nurses
  • School nurses
  • Local authority nurses

The regulations implement the principles of the EU Council directive 2010/32/EU and place several duties on the employers to ensure the safety of the workers. Employers must:

Assess the risk of sharps injuries under the control of substances hazardous (COSHH)to health regulations.  Employers should attempt to avoid the use of sharps but, if this is not reasonably practicable, they must introduce other controls. This includes the use of safe sharps when the principal, presenting the recapping of needles and ensuring secure disposable containers, alongside the implementation of other safe work systems.

Appropriately train all employees and provide them with information on the risks associated with sharps injuries, employer and employee legal responsibilities, good working practices, the benefits and drawbacks of vaccination and what support is available for rent an injury.

Have a set of procedures in place for what employees must do in the event of an injury

Record the details of the incident, carry out an investigation and decide what actions should be taken to prevent a reoccurrence.

Periodically review their health and safety procedures and controls.

Employee duties

As an employee you have the following responsibilities:

  • protect the health safety and welfare of yourself and others, as far as is reasonably practical.
  • Adhere to the safety procedures, policies, risk controls and safety systems of work set out by your employer
  • Work safely and responsibly. You must cooperate with your employer and follow all health and safety advice.
  • Cooperate with the periodic reviews of control measures and risk assessments that your employer must carry out.
  • Attend all relevant training opportunities and read the safety information provided to you.
  • Report any defective equipment workspaces or unsafe systems of work to the responsible person. You should be made aware of who the responsible person is.

Additionally, you have a legal responsibility to inform your employer of any sharps related injuries and near misses soon as you can.

 

Reasonably Practicable

 

The term reasonably practice appears several times when describing both employer and employee duties Regarding sharps safety

What does reasonably practicable mean?

Reasonably practicable means that the money and time required to reduce or eliminate a risk must be weighed against how great the risk is. The greater the risk the more money and time your employer should spend reducing it.

What happens if you don’t comply?

Health and safety laws are criminal law. By ignoring the requirements to prevent sharps injuries, healthcare providers could be liable to face enforcement action, significant fines and compensation payments

Further key sharps related legislation

 

Control of substances hazardous to health regulations 2002

Employers are required to identify and assess the risk of, and control and monitor the exposure to, any substances hazardous to health. This includes biological hazards, such as exposure to BBVS.  There is no such way to eliminate exposure completely, employers must implement safety procedures to prevent exposure, including safety engineered devices, safe systems of work and protective clothing.

Employees must also ensure that all staff members receive appropriate training for positions and must have systems in place to carry out follow up health checks in the event of exposure.

Health and safety [first aid] regulations 1981

Employees must Have suitable equipment, facilities and personnel to provide their employees with immediate attention if they suffer a workplace illness or injury.

First aid treatment must be immediately available following a sharps injury and employees must have access to out of our support

Provision and use of work equipment regulations 1998

Employees must provide task appropriate equipment and information on how to safely use it.

Management of health and safety at work regulations 1999

Employees must ensure that their employees are properly trained for their roles. Workers must be provided with the information needed to understand the risks associated with sharps injury and how they can reduce the risk of sustaining an injury.

Personal protective equipment (PPE) regulations 1992

Employers must provide task appropriate PPE for all risks that cannot be reduced or illuminated by other measures. This could include goggles aprons and gloves

You should also understand:

Reporting of diseases injuries and dangerous occurrences regulations 2013

Employees must formally report any sharps injuries to the health and safety executive where the injured person is known to have been exposed to a BBV, such as where the patient is a known BBV carrier. Employers must also report any cases where a worker is injured by a sharp and develops the BBV.

Safety representative of safety committee reservations 1977

Employers are required to consult with safety representatives to ensure that all control methods, Equipment and PPE are suitable for their intended tasks. Safety representatives must be given paid time off to carry out their duties.

Strategy to reduce sharps related injuries

Your organisation should be thoroughly invested in reducing shots related injuries in the workplace. Senior management should ensure that the necessary funding and resources are made available to prevent injuries, as prevention is cost-effective.

Sometimes a steering group is created to look at the implementation of sharps regulations across the organization, monitor and review the risk assessment processes and make decisions regarding the purchase of equipment.

This steering group should be made up of:

  • Safety representative
  • Management
  • Procurement staff
  • Infection prevention and control committee
  • Health and safety committee
  • Estates and facilities representatives
  • Frontline staff who directly use sharps

Even if your organisation does not have a steering group, safety representatives should be fully involved in all decisions on initiatives to reduce sharps related injuries

 

 

Safe use of needles and sharps

Introduction

Sharps related injuries pose many hazards, including the risk of contracting a BBV and the stress and emotional burden that the aftermath of an injury can cause.

Bad practice cannot only result in an injury to yourself it can also be dangerous to patients and other employees. Therefore, it’s important that you understand how to use and dispose of sharps safely to minimize the risk to yourself and others.

This module will help you to understand the main bad behaviours that result in needlestick injuries and will provide you with the best practice guidelines for safe sharps usage.

Work practices that are likely to result in a sharps injury are:

  • Improper use of a sharp. Sharps should always be used according to best practice guidelines and only after appropriate training
  • Recapping a used needle. Recapping a needle is dangerous as you can easily miss the cap and puncture your skin you should never recap a needle
  • Other post use activities before disposal. This could include dismantling a sharp or when cleaning up after using one.
  • Improper disposal. You must always follow the correct procedure to dispose of a needle immediately after you have finished using it. Improper disposal of a needle is not only dangerous for the needle user: by disposing of a needle in a non-sharps bin, you increase the risk of a sharps related injury for anyone removing that refuse.

By following best practice guidelines for sharps yes, you can help to protect yourself and others from the emotional and physical burdens of receiving a sharps injury.

 

Best practices for sharps use

 

Eliminating unnecessary sharps use is the most effective way to prevent sharps related injuries and reduce the number of sharps waste we produce.

Therefore, you should always consider if there is a way to carry out the treatment, such as orally or rectally, that can remove the need for sharps. When it is necessary for you to use a sharp it’s important that you follow your best practice guidelines to reduce the risk of injury.

To carry out your sharp’s procedure safely, you must:

  • Always carry out proper hand hygiene practices, including wearing gloves when necessary.
  • Dispose of all single use PPB immediately after use. One pair of gloves should be used per procedure for patient.
  • Carry out appropriate skin preparation and disinfection before administering an injection, such as water for 60–70% alcohol solution, depending on the injection.
  • Discard all used devices immediately into the correct sharps receptable in the area in which they were used. Single use syringes and needles a one unit and must be discarded together.

 

You must also:

  • Examine the packaging of all sharps to be used. Check that they have not been tampered with, punctured or damaged by exposure to moisture. If they have, discard them
  • Avoid recapping any sharps. If recapping a needle is unavoidable, you must use the one-handed scoop method
  • Keep your sharps bin within arm’s reach and at eye height
  • Only use sharps containers until they are 3/4 full. Do not overfill sharps containers. Once it is 75% full, seal it and arrange for its disposal
  • Use forceps to reposition a sharp that is sticking out of a sharps box. You should never use your hands
  • Seal all sharps containers with a tamper proof lid When they are full.
  • Immediately report any sharps related injuries or accidents. PEP treatment, given after exposure to HIV becomes ineffective after 72 hours. Therefore, it’s vital that you promptly seek medical help.

 

Hand hygiene

Hand hygiene is a very important step in preventing the spread of microorganisms. Hand hygiene covers handwashing, anti-septic hand wash or hand rub and surgical hand antisepsis

Hand hygiene should always be carried out before:

  • Prepare injection material
  • Give injections
  • Come into direct contact with patients
  • Put on gloves. Gloves must only be put on clean, dry hands.

Hand hygiene should always be carried out after you:

  • Finish an injection session.
  • Have any direct contact with the patient
  • Remove your gloves

You must always carry out hand hygiene steps between clients. You should avoid giving injections if you are experiencing a local infection or other condition. Any small cuts should be covered with an appropriate covering.

Hand hygiene is vital. You must carry out hand hygiene procedures before and after contact with every patient.

The world health organization recommends that:

  • If your hands are visibly dirty or contaminated, you should wash them with antibacterial wash or plain soap and running water, then dry them using a single use paper towel.
  • If your hands are clean and are not visibly soiled, you should clean them with an alcohol-based hand product to decontaminate them and dry them using a single use paper towel.

If you have non-intact skin and have been exposed to blood or bodily fluid you must use antibacterial or plain soap, running water and paper towels, even if your hands are clean.

Hand Hygiene and PPE

Before starting any task of putting on gloves you should ensure that your hands are completely dry.

You need to wear gloves when:

  • you are at risk of coming into contact with blood or other bodily fluids like saliva or non-intact skin
  • you are performing Venepuncture or venous access injections, as you are at risk of blood exposure
  • your patients skin is not intact, for example if they have eczema, a skin infection or burn

If both your skin and the skin of your patient is intact and you’re carrying out intradermal, subcutaneous and intramuscular injections you should not wear gloves.

There is also no need to wear eye protection, masks or special protective clothing unless there is the risk of blood or bodily fluid splashes when carrying out the procedure.

Practices that increase accidents

Using sharps poses many risks to the user. Therefore, it is important that you’re aware of the actions that could increase your risk of experiencing a sharps related injury.

You are at an increased risk if you:

  • Carry out unnecessary injections
  • use two hands to recap used needles
  • Position your patient poorly
  • Have a poor phlebotomy technique
  • Have a lack of sharps boxes within arm’s reach
  • Try to dismantle used sharps
  • Do not properly segregate your sharps waste. This will be covered in more detail in the next module.

It’s important that you adhere to correct technique’s and good practices. They will reduce your risk of experiencing a sharps injury.

 

 

Sharps injuries

Accidents that cause a sharps injury can have serious consequences and it’s important that you know what you should do in the event of one occurring.

If a used needle puncture’s or pierces your skin, you should:

  • Run the wound under water to encourage the wound to bleed
  • wash the wound under clean, running water and use plenty of soap to clean the area.
  • Once washed, you should dry the affected area and cover it with a waterproof dressing or plaster.

If you experience a sharps injury, you must never:

  • Suck the wound
  • scrub at the wound when you are washing

After you have cleaned and dressed the wound, you might need treatment to reduce the chance of getting an infection. Therefore, you should seek urgent medical advice by contacting your employer’s occupational health service and should report the injury to your employer.

Safe disposal of sharps

Introduction

Managing healthcare waste securely is essential. Improperly disposing of your sharps waste could have significant consequences, as it poses a risk of infection and injury.

This module details how to segregate your sharps waste in accordance with UK guidelines. It helps you to identify ways that you can minimise your sharps waist and reduce your environmental impact.

The colour coding system outlined in this module is not mandatory or specified in the waste management regulations, however, businesses in England and Wales are legally, required to segregate their waist according to the categories outlined.

Topics to be covered

  • Waste stream segregation
  • Regulatory bodies
  • Implementing waste segregation systems
  • Sharps boxes
  • Recapping a needle
  • Disposing of sharps
  • Disposing of a sharps box

Non medically contaminated waste

Orange-lidded, yellow sharps boxes

In England and Wales, the sharps receptacles should only be used for non-medicinally contaminated sharps.

However, in Scotland and Northern Ireland, these can be used to dispose of those non-Medicinally early contaminated and fully discharged medicinally contaminated sharps if the waste is to be disposed of regionally. The conditions of this are:

  • They must be fully discharged
  • You must not intentionally discharge syringes just to put them in orange-lidded, yellow sharps boxes. All partially discharged syringes must be disposed of in yellow-lidded, yellow sharps boxes.

In all regions, no sharps contaminated with cytotoxic or cytostatic substances may be disposed of in these boxes. Orange-lidded, yellow sharps boxes are usually treated upon disposal to be rendered safe; however, they may also be incinerated.

 

 

Yellow lidded sharps box

This type of sharps box should be used to dispose of medicinally contaminated sharps, including vials, bottles and ampules of medicine, clinical sharps and pharmaceutical waste.

Infectious sharps waste should also be disposed on in this waste stream, but it must not be used to dispose of sharps contaminated with cytotoxic or cytostatic substances.

Waste disposed of in a yellow-lidded, yellow sharps box will undergo disposal by incineration.

Infectious sharps waste and cytotoxic and cytostatic waste

Purple lidded sharps box

This type of sharps box should be used to dispose of clinical waste, mixed sharps, infectious waste and cytotoxic and cytostatic waste.

This also includes vials, bottles and ampules of cytotoxic and cytostatic medicine:

Cytotoxic substances are substances that are toxic to living cells, such as chemotherapy treatments that are used to destroy cancer cells.

Cytostatic substances are used to suppress cell growth. For example, some cancer hormone therapies are cytostatic as they inhibit the multiplication of cancer cells and stop the cancer growing.

Waste disposed of in a purple-lidded, yellow sharps box will undergo disposal by incineration.

Regulatory bodies

UK standards are well regulated, so it’s important that everyone using sharps complies with the standards detailed in the health technical memorandum 07-01

Any failure to comply with the standards will be dealt with by the appropriate regulating body:

Care quality commission (England)

Controls assurance (Northern Ireland)

Care inspectorate (Scotland)

Standards for health services (Wales)

 

When your employer Implements a segregation system into your workplace, it’s important that they consider several factors to ensure that appropriate waste segregation because

When designing a waste segregation system, the following issues should be considered:

  • Waste receptacles should be as close to the point of sharps production as possible
  • Waste bins should not be placed in visitor-accessible areas, including next to hand basins in patient bays
  • All sharps receptacles should be replaced when three-quarters full and never overfilled
  • Sharps receptacles must always be securely sealed
  • Sharps receptacles must be properly labelled to indicate their origin before they are used
  • Collection of sharps receptacles should be arranged at an appropriate frequency
  • All staff must be trained on Waste segregation systems and why they are important

 

 

Sharps boxes

 

All sharps receptacles must be:

  • Approved by the infection prevention and control team. All sharps bins must comply with the UN 3291 requirements
  • Easily accessible (at eye level and within easy reach) wherever clinical sharps are in use. They must be accessible by children.
  • Correctly assembled, solid, and secure
  • Stored securely while awaiting collection. They must not be accessible to children
  • Properly labelled prior to use. All boxes must be labelled with the organizations name, ward/department/clinic name, the name of the individual who assembled the box, the date the box was assembled and the name of the individual who closed, locked and disposed of the box
  • Dated before being sent to disposal

Recapping a needle

Recapping a needle is dangerous as it puts you at high risk of a puncture wound. Therefore, you should always avoid resheathing a needle

However, if you must resheath a needle for overriding safety reasons, then you should use the one-handed scoop technique

  1. Place the cap onto an even surface
  2. Using one hand, slide the needle into the cap. You should not be holding the cap when doing this.
  3. When the needle is fully within the cap, scoop it off the surface and use your other hand to ensure the cap is securely fastened 4. Once the cap is securely fastened, dispose of the needle in the correct sharps bin.

Disposing of sharps

It is important that you dispose of all sharps safely to reduce the risk of injury or infection. When disposing of a sharp, you must:

  • Ensure you can safely handle and dispose of your sharps before you begin a procedure.
  • Take the sharps container to your patient, wherever possible, rather than taking the sharps to the container
  • Discard all sharps items into the correct sharps box immediately after use.
  • Never separate single use needles and syringes prior to disposal. You should place the complete needle and syringe unit into the correct sharps bin
  • Not put large pieces of broken glass or crockery into a sharps bin.

For non-disposable sharp items, you must always ensure they are rendered safe after use. You can do this by:

  • Using purpose-made blade or needle removal kits or forceps to safely remove scalpel blades and needles
  • Dispose of the scalpel blade or needle in the correct sharps bin

 

You will need to use a medical waste disposal company  we provide details of how at the end of this presentation.

When a sharps box is 3/4 full, no more sharps should be disposed of in it. Doing so puts you at an increased risk of injury

When a sharps box is full, you should:

  • Seal it with a tamper-proof lid
  • Ensure that it is correctly labelled
  • Follow your workplace procedures for storing the full sharps box while Awaits collection

Full sharps box should be stored in a secure area, away from the public, where no children or young people can access them. It’s important you follow your workplace guidelines to ensure that the sharps box is disposed of correctly.