Professional bodies and medical firms should take a lead role as pressure mounts on healthcare organisations to prepare for implementation of the EU Directive on sharps injuries.
Every day, nurses face the threat of sharps injuries, which can result in life-threatening infections such as HIV and hepatitis (European Parliament, 2010). Sharps injuries are a serious occupational hazard faced by healthcare workers across Europe, the most common of which are injuries from used needles.
An estimated one million sharps injuries occur in the European Union each year (EU Commission, 2010), with more than 100,000 of these taking place in the UK (Health and Safety Executive, 2010).
The Royal College of Nursing (RCN), along with medical technology company BD, is confronting this issue by bringing together a group of leading nursing professionals in a series of educational workshops aimed at helping healthcare workers learn how to avoid such injuries.
The RCN and BD workshops are being held in the following locations:
During the workshops, participants will learn more about the sharps Directive and how to make their working environment safer for themselves and patients. Carrying out risk-assessment procedures, introducing safety-engineered medical devices and improving training and education can all help to achieve a significant reduction in the number of sharps injuries.
The EU Directive (2010/32/EU) on sharps injuries prevention provides a much needed opportunity to establish a mandatory framework for eliminating these types of injuries. This must be implemented into national law in the UK by May 2013 at the latest, and the RCN has published guidance to support the process.
Commenting on the current situation, RCN senior employment relations adviser Kim Sunley said: “Nurses and healthcare assistants continue to be at risk in the workplace from sharps injuries, and this is unacceptable and easily prevented.
“The RCN played a key role in calling for the EU Directive, which presents a great opportunity to lead the way, and there’s no reason why hospitals in the UK can’t set the standard. Employers have a duty to do all they can to protect staff from sharps injuries and we would not want to see them shirk from this responsibility.
“By working together with healthcare professionals and management, we can create a culture of safety for all nursing staff.”
A study showed that sharps injuries were the most commonly reported type of significant exposure, with 68% of those injuries in the UK caused by hollow-bore needles (Health Protection Agency, 2008). It also revealed that 45% of sharps injuries occurred among nursing professionals and 37% among other medical professionals. Another European-based study (Buchholz, 2006/07) showed that the highest risk area for the likelihood of sharps injury is venous blood drawing (more than 38%), and that only 20% to 50% of all sharps injuries are reported.
Only 1/10,000ml of infected plasma is required for hepatitis B (HBV) transmission (Wittmann A et al, 2009) and many times this amount is present within the barrel or on the sides of medical sharps, even in devices not used expressly for blood drawing or vascular access. A surprising number of sharps injuries occur after use, during the disposal process. HBV is stable in dried blood for at least seven days and hepatitis C for at least 16 hours (Centers for Disease, 1994, Morbidity and mortality weekly report, 1995). Thus, sharps injury from devices that were used within these timescales can still be infectious. Not all healthcare workers are covered by HBV vaccination; in fact, the European range is from 30% to 90% depending on the country and branch of medicine (Prüss-Üstün et al, 2003).
As well as sharps injuries, healthcare workers are at risk of mucocutaneous blood exposure – mucous membranes and non-intact skin. This form of accidental blood exposure is not as widely acknowledged as percutaneous exposure (physical injury from a sharp), with daily exposure to small amounts of blood being tolerated and considered an acceptable job-related risk by many healthcare workers. However, the dangers of mucocutaneous blood exposure are just as high as an actual sharps injury, despite the absence of a physical injury.
It is also important to remember the risks present in wider healthcare environments, such as the safety and protection of specialist diabetes nurses and community staff when they are administering treatment.
The new EU Directive on sharps injury prevention will legally oblige healthcare organisations to take measures to prevent sharps injuries to their staff.”
The new EU Directive on sharps injury prevention will legally oblige healthcare organisations to take measures to prevent sharps injuries to their staff. Healthcare organisations are required to assess the risks of exposure to blood-borne infections from sharps injuries and eliminate and prevent exposure. The Directive requires exposure to be prevented through: the use of safety-engineered medical devices, such as needles, phlebotomy devices and intravenous catheters that incorporate shielding or retraction of the needle; implementing safe procedures for using and disposing of sharp medical instruments; providing sharps-disposal equipment as close as possible to areas where sharps are being used; and a ban on the practice of recapping.
The Directive specifically refers to the role played by safety devices in preventing such injuries. A wide variety of studies demonstrate that the adoption of safety-engineered devices, such as catheters and syringes, radically reduces injury levels.
This, in turn, creates an environment for staff and clinicians that provides proper protection against injuries that are, at best, distressing, and, at worst, can ruin careers and destroy lives.
Accounting for costs
Although adoption of safety-engineered medical devices does have an additional investment implication, they provide a viable return on investment (Armadans Gil L et al, 2006).
Sharps injury costs can be substantial when treatment, lost working time and staff turnover are taken into account. Not only can the use of safety-engineered devices help to reduce these related costs, but they can also help to avoid damaging legal action, costly compensation claims and adverse publicity, all of which divert attention away from core objectives of delivering high-quality healthcare.
Despite pressure on health budgets across Europe, many leading healthcare organisations have already begun the process of formulating a strategy for compliance, and have started to contact suppliers to research transition strategies and support. Their reasoning usually combines economic, risk and ethical factors.
The RCN provides sharps safety guidance on its website.
About the RCN
The RCN is the largest professional union of nursing staff in the world. The RCN promotes the interest of nurses, healthcare assistants and patients on a wide range of issues and helps shape healthcare policy by working closely with the UK Government and other national and international institutions, trade unions, professional bodies and voluntary organisations.
BD is a leading global medical technology company that develops, manufactures and sells medical devices, instrument systems and reagents. BD is focused on improving drug delivery, enhancing the quality and speed of diagnosing infectious diseases and cancers, as well as advancing research, discovery and production of new drugs and vaccines. The company serves healthcare institutions, life science researchers, clinical laboratories, the pharmaceutical industry and the general public.
Armadans Gil L, Fernandez Cano MI, Albero Andres I, Angles Mellado ML, Sanchez Garcia JM, Campins Marti M, Vaque Rafart J (2006). “Safety-engineered devices to prevent percutaneous injuries: cost-effectiveness analysis on prevention of high-risk exposure”. Gac Sanit Sep-Oct; 20(5):pp.374-81.
El consejo general de enfermería de España y la fundación Española de riesgos laborales salud e higiene”. Estudio Epinetac 1996-2002.
Buchholz L (2006/07). “How to avoid needlestick injury”. International Hospital Federation Reference Book.
Centers for Disease. “Case-control study of HIV seroconversion in health-care workers after percutaneous exposure to HIV-infected blood”. France, the UK and the US. January 1988-August 1994. Morbidity and mortality weekly report, 1995 Dec. 22; 44(50):pp.929-33.
EU Commission for Employment, Social Affairs and Inclusion. “New legislation to reduce injuries for 3.5 million healthcare workers in Europe”. 8 March 2010.
EU Council Directive 2010/32/EU.
European Parliament. “Preventing needle-stick injuries in the health sector”. 11 February 2010.
Glenngard AH, Persson U (2009). “Costs associated with sharps injuries in the Swedish health care setting and potential cost savings from needle-stick prevention devices with needle and syringe”. Scandinavian Journal of Infectious Diseases, vol.41, issue 4, pp.296-302.
Health and Safety Executive. “Management and prevention of sharps injuries: inspection of NHS trusts 2010/2011 by occupational health inspectors”. 1 July 2010-11.
International Council of Nurses. Nursing Matters Fact Sheet, ICN on selecting safer needle devices.
Prüss-Üstün A, Rapiti E, Hutin Y (2003). “Global burden of disease from sharps injuries to health-care workers”; Environmental Burden of Disease Series, no.3; World Health Organisation Protection of the Human Environment Geneva. Table 9, Hepatitis B vaccine coverage among health-care workers.
Health Protection Agency (2008). “Eye of the needle”.
Wittmann A, Köver J, Hofmann F, Kralj N (2009). “Übertragene Blutvolumina nach Nadelstichverletzungen an s.c. Kanülen”. Dokumentations-CD-ROM über 49. Jahrestagung der DGAUM 2009: pp.382-384.