207 handling sharps

7/26/2019 207 Handling Sharps

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A safer working environment

sharps safety;

A training package to protect

healthcare staff from harm

Daniels Healthcare 2007

All rights of copyright in connection with this work and all parts of it are reserved to Daniels Healthcare Ltd !his work may "e reprod#ced "y the c#stomer only for the p#rpose of #tilising the

same for training p#rposes within the c#stomer$s own organisation and no copies may "e made for #se "y third parties witho#t the specific written consent of Daniels Healthcare Ltd %o

consent for s#ch f#rther reprod#ction of the material herein is deemed to have "een given &na#thorised #se of the material may lead to legal proceedings incl#ding a civil claim fordamages Daniels Healthcare Ltd will not accept any responsi"ility for any amendments to or alterations to the material in this pack other than those prod#ced and a#thorised "y Daniels

Healthcare Limited


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Overview of the

session

A quick tourof the issues:risk and safety

Reporting &vaccination status

Standard

Precautions &wastemanagement

Safety devices/engineering

controls


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'#tline of the session(!he session will deliver knowledge for evidence "ased

safer practice and will cover the following areas)

(the most common proced#res where needlestick

in*#ries occ#r

(!ypes of devices and in*#ries that affect risk of infection

(methods for preventing e+pos#re

(critical review of the #se of sharps and their necessity

(how changes in work practice can prevent in*#ries

,incl#des the role of safer needle devices-

(c#rrent protocols and g#idance. incl#ding standard

precautions.


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'"*ectives of the session!he session is designed to e/#ip staff for safer

practice y the end of the session staff sho#ld

"e a"le to)(Demonstrate knowledge of the risks of e+pos#re to

potentially harmf#l vir#ses(1+plain the importance of safe practices ,demonstrating

awareness of policies and protocols-

(dentify the efficacy of preventative and controlmeas#res

(Descri"e the process of eval#ation of needlestick in*#ryand post3e+pos#re follow #p #sing real life e+amples


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4ho is at risk)

(Who is at risk of needlestick injury?

(Any worker who may come in contact with

needles or other sharp instr#ments #sed

on patients. incl#ding nursing staff.

laboratory staff, doctors, porters and

housekeepers.

%'5H 68


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Definitions and scene setting

(5harps in*#ries descri"e any incident in which ahealthcare worker is st#ck "y a needle or other sharpinstr#ment which penetrates the skin and which iscontaminated with potentially infected "lood

(!he %ational A#dit 'ffice ,2009- stated that sharpsin*#ries are second only to "ack in*#ries as a ca#se ofharm to staff 67: of all in*#ries

(ontaminated needles can transmit more than 20dangero#s "lood3"orne pathogens incl#ding H


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>isk management

(An integrated risk management policy is a m#st(>isk assessment)

(identify the risks(?anage and minimise eliminate #nnecessary in*ections

(5afer technology

(5tandard preca#tions(mm#nisation @ vaccination(!raining

(A legal framework does e+ist ,Health and 5afety at 4orkAct ,HA5A4A-. 67=. and the ?anagement of Healthand 5afety at 4ork >eg#lations ,66-

(ontrol of 5#"stances Haardo#s to Health ,'5HHreg#lations ,2002- reinforce risk assessment andpreventative strategies

5o#rce) %H5 1mployers 200B


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!he detail)

(Assessing the risks

(>isk assessment sho#ld "e made of all sit#ations

where H4 might "e e+posed to "lood or other

potentially infectio#s material !he aim is to)

(dentify what technologies co#ld "e #sed to limit e+pos#res

(Allow consideration of possi"le alternatives

(1liminate the #nnecessary #se of sharps "y implementing

changes in practice and providing. where practica"le sharp

free devices or safer needle technologies which retract orshield needles after #se

5o#rce) %5H 1mployers 200B


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5#mmary of key risk management

strategies for safer practice

(Hierarchy of Controls

(1limination or s#"stit#tion of sharp

,eliminate #nnecessary in*ections-

(1ngineering controls ,a#to disa"lesyringes. safer needle devices-

(Administrative and work practice

controls ,standard preca#tions; no

recapping; provision and placement ofsharps containers-

(Cersonal protective e/#ipment ,eg

gloves-

5o#rce) 4H' 200B

Least effective

Most effective


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>eporting sharps in*#ries

(A core component of risk management)

(&nderreporting is a serio#s threat to management of

s#ch in*#ries

(5ome st#dies s#ggest #nderreporting as high as 8B:(Crompt reporting is critical following local policy

(!his ens#res /#ick management and red#ces risk of eporting sharps in*#ries

(?anaging e+pos#res 3

(4hat is the local policy

(All cases of e+pos#re from "lood or "ody fl#id

from patients infected with "lood3"orne

vir#ses ,H


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dentifying alternatives

(ndependent st#dies show that a com"ination oftraining. safer working practices and the #se ofdevices incorporating sharps protectionmechanisms can prevent more than 80: ofneedlestick and sharps in*#ries

(!he %H5 CA5A we"site offers an array of s#chdevices

(Crovision of porta"le sharps containers for allstaff at all times is cr#cial to allow #sed sharps to"e disposed of at the point of #se



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!raining

(nd#ction and ongoing training sho#ld cover

sharps safety for all staff and partic#larly)

(!he risks associated with "lood and "ody fl#id

e+pos#re(orrect #se and disposal of sharps

(!he #se of medical devices incorporating sharps

protection mechanisms

(>efresher training is important


Question is on the job training evident in the worklace?


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%ational &E F#idelines

!tandard "rinciles for the !afe Handling

and

#isosal of !hars$

(Cart of a waste management strategy to

protect staff. patients and visitors from

e+pos#re to "lood "orne pathogens

(All sharps in*#ries are considered to "e

potentially preventa"le!he &E 1vidence ased!he &E 1vidence ased

F#idance ,2006-)F#idance ,2006-) 1CCrevention of HA in Crimary andCrevention of HA in Crimary and

omm#nity are ,2009-omm#nity are ,2009-


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%ational &E F#idelines

(%ational and international g#idelines are

consistent in their recommendations)

(Assessment and management of risk

(5afe systems of working

(5afety devices ,engineering controls-

(Cost e+pos#re follow #p and prophyla+is

!he &E 1vidence ased!he &E 1vidence ased

F#idance ,2006-)F#idance ,2006-) 1CCrevention of HA in Crimary andCrevention of HA in Crimary and



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5tandard preca#tions

6 5harps m#st not "e passed

directly from hand to hand andhandling sho#ld "e kept tominim#m

2 %eedles m#st not "e "ent or"roken prior to #se or disposal

9 %eedles and syringes m#st not"e disassem"led "y hand priorto disposal

5o#rce) 1C 2006

category %&H'!

category %&H'!

category %&H'!

Crevention of HA in Crimary andCrevention of HA in Crimary and



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5tandard preca#tions

= %eedles sho#ld not "e recapped

B &sed sharps m#st "e discarded into asharps container ,conforming to &%926and 5 7920 standards- at the point of #se

G !hese m#st not "e filled a"ove the markindicating that they are f#ll ontainers inp#"lic areas m#st not "e placed on thefloor and sho#ld "e located in a safeposition

7 !hey m#st "e disposed of in comm#nitypractices "y the licensed ro#te inaccordance with local policy

5o#rce) 1C 2006

category %&H'!

category %&H'!

category %&H'!

category %&H'!




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5tandard preca#tions)

Hands @ gloves

8 Hands m#st "e decontaminatedimmediately "efore each and every episodeof direct patient contactcare and after anyactivity or contact that potentially res#lts inhands "ecoming contaminated

&se an alcohol "ased hand r#" on handsnot visi"ly soiled

60 Floves m#st "e worn for invasiveproced#res. contact with sterile sites. and

non3intact skin. m#co#s mem"ranes. andall activities that have "een assessed ascarrying a risk of e+pos#re to "lood. "odyfl#ids. secretions and e+cretions; and whenhandling sharp or contaminatedinstr#ments

5o#rce) 1C 2006

category %

category %

category %&H'!


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Hands @ gloves

66 Floves sho#ld "e worn as single #se items

C#t gloves on immediately "efore an

episode of patient contact or treatment and

remove them as soon as the activity is

completed

62 hange gloves "etween caring for different

patients. or "etween different

caretreatment activities for the same

patient

69 Floves m#st "e disposed of as clinicalwaste and hands sho#ld "e

decontaminated following the removal of

gloves

5o#rce) 1C 2006

category %&H'!

category %&H'!

category %


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Aprons @ eye protection

6= Disposa"le plastic aprons sho#ld "eworn when there is a risk that clothing or#niform may "ecome e+posed to "lood."ody fl#ids. secretions and e+cretions.

with the e+ception of sweat

6B I#ll "ody. fl#id repellent gowns sho#ld"e worn where there is a risk ofe+tensive splashing of "lood. "ody

fl#ids. secretions and e+cretions. withthe e+ception of sweat. onto the skin ofhealth care practitioners

category %&H'!

category %&H'!

5 d d i


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Aprons @ eye protection6G Clastic aprons sho#ld "e worn as single

#se items for one proced#re or episodeof patient care and then discarded anddisposed of as clinical waste

67 Iace masks and eye protection sho#ld"e worn where there is a risk of "lood."ody fl#ids. secretions and e+cretionssplashing into the face and eyes

68 >espiratory protective e/#ipmentsho#ld "e #sed when clinically indicated

category %&H'!

category %&H'!

category %&H'!


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5afer needle devices

(%eedle safety devices m#st "e#sed where there are clearindications that they will providesafer systems of working forhealth care personnel



>ecent estimates s#ggest that safety devices e+ist in 66different prod#ct gro#ps

5afety devices on the whole minimise risks in association

with venep#nct#re. < therapy. in*ections and JdownstreamJ

in*#ries following disposal ,ho#sekeeping and porteringstaff-

#&H'!


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5harps containers

(5ho#ld "e at eye level and within arms reach

(5ho#ld "e emptied "efore they are f#ll

(At ward or department level whose responsi"ility isthisK

(Are roles assigned and are checks madeK

(How wo#ld a sit#ation "e managed if there was a

fail#re to apply these simple meas#resK(s a monthly. /#arterly or ann#al a#dit eno#ghK

5o#rce) 1C 2006 Crevention of HA in Crimary andCrevention of HA in Crimary and


Questions for consideration$


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%ational strategies to promote infection

control) 5aving Lives

(A tool for eval#ation of c#rrent practices

(dentifies areas for improvement

(All about getting the infrastructure right:

(Coses a series of /#estions for hospitals and

clinical teams)

( are the 1C g#idelines for hand hygiene.

personal protection. and sharps disposal "eing

followedK

( is an a#dit tool ,eg %A a#dit tool in #se and

res#lts acted #ponK-

5o#rce) DH6200B

Q()

Q*)


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5aving Lives

(High mpact ntervention n#m"er 6

,elements of care. "ased on national

evidence "ased. 1C g#idance ,Cratt et

al 2006-)(!afe disosal of shars

(5harps container availa"le at the point of #se

(%o disassem"ling of needle and syringe(%ot passed from hand to hand

(ontainer sho#ld not "e overfilled

5o#rce) DH6200B


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After an in*#ry or e+pos#re

6 Local policy

2 Eey points)

( Iirst aid( Clace #nder r#nning water

( Il#sh splashes to nose. mo#th with water( rrigate eyes with clean water or saline( >eport to occ#pational health( Enow yo#r Hepatitis vaccination stat#s( Crompt reporting is important in all cases to determine whether post

e+pos#re prophyla+is is re/#ired ,this needs to "e started as soon

as possi"le-


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>oot a#se Analysis ,>A-

(!he key to >A is asking the /#estion

JwhyKJ as many times as it takes to get

down to the root ca#se of an event)

(4hat happenedK

(How did it happenK

(4hy did it happenK

(4hat can "e done to prevent it happening inthe f#t#reK

5o#rce) D 200=


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Average risk of transmission

(Hepatitis


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>isk Iactors that increase the likelihood of Hecap hierarchy of controls

(>emove the Haard

(solate the haard protective

devicesengineering controls

(&se needles that retract. sheath or "l#nt

immediately after #se

(4ork practice controls and personal

protective e/#ipment ,Hep vaccination-5o#rce) D 4ork"ook 5harps n*#ry Crevention


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5#mmary)

(4hile st#dies show that red#ctions ofneedlestick in*#ries are achieva"le. it is diffic#ltto identify the efficacy of individ#al controlmeas#res in st#dies with n#mero#s

interventions(>ed#cing sharps in*#ries "y the greatest amo#nt

possi"le will entail a com"ination of(1limination of proced#res #sing sharps

(1d#cation(5afer devices(Cositive work conditions(5tandard preca#tions

5o#rce) 4H' 200B


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oncl#sion

(!he risk of a sharps in*#ry "egins at the moment

a sharp is first e+posed and ends once the sharp

is permanently removed from e+pos#re in the

work environment(5taff need to have an awareness of the risk of

in*#ry thro#gho#t the time a sharp is e+posed

and #se a com"ination of strategies to protect

themselves and their co3workers

5o#rce) D 200=


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d i l k f

5o#rces of material and references

( "ublications$( Health Crotection Agency ,200B- 1ye of the %eedle) 5#rveillance of 5ignificant 'cc#pational 1+pos#re to lood"orne M. Cellowe . Loveday HC. >o"inson %. 5mith F4. et al ,2006- !he 1C Cro*ect ) developing national evidence "aesed g#idelines for

preventing healthcare associated infections Chase 6 g#ideliens for preventing hospital3ac/#ired infections M Hosp nfect 2006; =7) 593582

( %H5 1mployers ,200B- !he management of health. safety and welfare iss#es for %H5 staff. chapter 6) %eedlestick ?anagement

( %A' ,2009- A safer place to work improving the management of health and safety risks of staff in %H5 !r#sts

( %'5H ,68- How to Crotect No#rself Irom %eedlestick n*#ries Department of Health and H#man 5ervices C#"lic Health 5ervice enters for Disease ontrol and

Crevention %ational nst#t#te for 'cc#pational 5afety and Health

( 4il"#rn 5. 1i*kemans F ,200=- Creventing needlestick in*#ries among H4s) A 4H' % colla"oration nt M 'cc#p 1nviron Health vol 60 no =wwwi*oehcom

( Websites$( 1C F#idelines) http)wwwepictv#ac#kepicphase6html

( %A A#dit !ools) nfection ontrol %#rses Association ,200=- availa"le from) wwwicnaco#k

( !he 1#ropean Ior#m for protection of Healthcare Crofessionals in a safer working environment http)wwwneedlestickfor#mnet

( %H5 C#rchasing and 5#pplies Agency prod#ct related information relating to sharps safety) wwwpasanhs#kmedicalcons#ma"lessharps

( 4H' ,200B- Crotecting Healthcare 4orkers. Creventing %eedlestick n*#ries !oolkit 'cc#pational and 1nvironmental Health &nit

http)wwwwhointocc#pationalOhealth

( D 4ork"ook for designing. implementing and eval#ating a sharps in*#ry prevention programme ,200=-) http)wwwcdcgovsharpssafety
http://www.ijoeh.com/http://www.epic.tvu.ac.uk/epicphase/1.htmlhttp://www.icna.co.uk/http://www.icna.co.uk/http://www.needlestickforum.net/http://www.needlestickforum.net/http://www.pasa.nhs.uk/medicalconsumables/sharps/http://www.who.int/occupational_healthhttp://www.cdc.gov/sharpssafety/http://www.cdc.gov/sharpssafety/http://www.who.int/occupational_healthhttp://www.pasa.nhs.uk/medicalconsumables/sharps/http://www.needlestickforum.net/http://www.icna.co.uk/http://www.epic.tvu.ac.uk/epicphase/1.htmlhttp://www.ijoeh.com/

207 handling sharps

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