The use of sharps is common in healthcare and therefore healthcare workers (HCW) and others are particularly at risk. Injuries frequently occur through accidental cutting or penetration of the skin or when disposing of sharps.
Sharps injuries are also referred to as percutaneous injuries. The greatest risk to healthcare workers is the transmission of blood-borne viruses (BBV).
Vaccination can be offered to protect staff from hepatitis B virus (HBV); however, not all staff respond to the vaccination and therefore cannot be guaranteed full protection. There is currently no vaccination to protect healthcare workers against hepatitis C (HCV) and human immunodeficiency virus (HIV).
Since 1997, 21 healthcare workers in the UK have experienced seroconversion as a result of exposure to HCV in blood/body fluids from infected patients. A further 1478 healthcare workers were exposed to an HIV-infected source patient. The risks to healthcare workers after injury with a needle contaminated by a BBV is estimated to be:
- 1 in 3 for hepatitis B
- 1 in 30 for hepatitis C
- 1 in 300 for HIV.
Percutaneous injuries are the most commonly reported injury, with hollow bore needles the most commonly reported device involved. Sharps used in midwifery care include:
- Hollow bore needles
- Intravenous cannulas
- Suture needles
- Scalpels/surgical blades
- Glass ampoules
- Vaccination needles
- Butterfly needles
Injuries may occur:
- During use
- After use, before disposal
- Between steps in procedures
- During disposal
- Whilst resheathing or recapping a needle.
Healthcare workers can also be injured as a result of poor practice of others – for example sharps disposed of in waste bags can injure domestic staff and others.
Some procedures carry a higher risk of causing a sharps injury, such as insertion of intravascular (IV) cannulas, venepuncture, making an episiotomy, perineal suturing, surgery (e.g. caesarean section).
Reducing the risk of sharps works best when staff consider the problem from the perspective of the ‘hierarchy of controls’. This framework, which can be applied across all employment sectors, guides staff to consider risks and how they can be manages by planning actions in an ordered way rather than jumping to what might seem to be the simplest option. The hierarchy of controls as applied to sharps injuries can be found in Figure 9.1.
A number of simple good practices, when used consistently, can help the midwife avoid the risk of sharps injury and the potential consequences. These include:
- Ensuring all healthcare workers are offered vaccination to prevent hepatitis B
- Having organisational policies in place to support staff to use and dispose of sharps safely
- Use of safer needle devices for procedures involving sharps (Figure 9.2)
- Providing education to all staff on safe sharp practices
- Encouraging staff to report all cases of sharps injuries, including those where a patient is not thought to pose a risk so that learning can be identified and future injuries potentially prevented.
Good practice to reduce the risk of sharps injuries:
- Handling of sharps is kept to a minimum.
- Syringes or needles are not dismantled by hand and are disposed of as a single unit straight into a sharps container for disposal.
- Sharps containers are readily available as close as possible to the point of use (sharps trays with integral sharps boxes are a useful resource to support this practice point) (Figure 9.3).
- Needles are never resheathed/recapped.
- Needles are not broken or bent before use or disposal.
- Arrangements should be put in place to ensure the safe disposal and transport of sharps used in a community setting such as patients’ homes.
- All single use sharps containers should conform to BS EN ISO 23907.
- Sharps containers are not filled to more than two-thirds full.
- Never dispose of sharps in waste bags.
- Sharps boxes are signed on assembly and disposal.
- Sharps bins are stored safely away from the public and out of reach of children (in other words, not stored on the floor or at low levels.
- Staff attend training on the safe use of sharps and safety engineered devices.
- Staff are aware and comply with their local sharps or inoculation injury policy.
The most important action after sustaining a sharps injury is to perform first aid. Only after this has taken place should the injury be reported.
- Encourage the wound to bleed, ideally holding it under running water.
- Wash the wound using running water – do not scrub the wound whilst you are washing it.
- Do not suck the wound.
- Dry the wound and cover it with a waterproof plaster or dressing.
- Seek urgent medical advice as per organisational policies.
- Report the injury as per local policies.