Infection Control Manual - Chapter 22- Sharps Management Policy-Version 10(Clinical) Page

DOCUMENT NUMBER / STHK0051
APPROVING COMMITTEE / Patient Safety Council
DATE APPROVED / 12 November 2014
DATE IMPLEMENTED / 1 December 2014
NEXT REVIEW DATE / 1 December 2017
ACCOUNTABLE DIRECTOR / Sue Redfern, Director of Nursing, Midwifery & Governance
POLICY AUTHOR / Karen Allen, Director of Infection Prevention & Control
TARGET AUDIENCE / All clinical staff
KEY WORDS / Sharps, needlestick, inoculation.

Important Note:

The Intranet version of this document is the only version that is maintained. Any printed copies should therefore be viewed as “uncontrolled” and, as such, may not necessarily contain the latest updates and amendments.

Infection Control Manual - Chapter 22- Sharps Management Policy-Version 10(clinical) Page 1 of 23

Issue Date: 1st December 2014 Policy Reference number: STHK0051

St Helens & Knowsley Teaching Hospitals NHS Trust

Document Version History

Date / Version / Summary of key changes / Author
Designation
1989 / 1 / Service Manager Infection Prevention & Control (IP&C)
1991 / 2 / Service Manager IP&C
November 1997 / 3 / Service Manager IP&C
August 2000 / 4 / Service Manager IP&C
August 2003 / 5 / Service Manager IP&C
1 December 2004 / 6 / Service Manager IP&C
1 December 2006 / 7 / Service Manager IP&C
1 December 2008 / 8 / Service Manager IP&C
1 December 2011 / 9 / Format changed.
Page 9, 4.1.5 & Page 10, 4.2.3: All donors are to be tested for Hepatitis BsAg, HCV Ab and HIV Ab (with consent).
Contact details updated. References updated.
Appendix 1: Chart amended. / Service Manager IP&C
1 December 2014 / 10 / Format changed.
Section on risk assessment expanded (6.1).
Audit tool amended: bags & boxes must be filled no more than ¾ full.
Datix information added.
High risk donor section expanded.
References updated.
Appendix 2 (Scoop technique) deleted. / DIPC
1 December 2017 / Review
Date / Lead Nurse, Infection Prevention & Control

CONTENTS

Item No. / Subject / Page No.
1. / Scope / 4
2. / Introduction / 4
3. / Statement of Intent / 5
4. / Definitions / 5
5. / Duties, Accountabilities and Responsibilities / 5
6.
6.1
6.2
6.3
6.4
6.5
6.6
6.7 / Process
Risk assessment
Safe usage of sharps and prevention of injury
Protective clothing Safe use of sharps boxes
Inoculation/needlestick injury or splash of blood/blood stained fluid into mucous membranes or non-intact skin
Further advice
Glossary / 6
6
7
8
8
9
12
12
7. / Training / 12
8. / Monitoring compliance / 12
8.1. / Key Performance Indicators of the Policy / 12
8.2. / Performance Management of the Policy / 13
9. / References and Bibliography / 13
10. / Related Policies and Procedures / 13
11. / Equality analysis / 14
12. / Appendices
Appendix 1:Quick reference guidelines to be followed after a needlestick or sharps injury or splash of blood/blood-stained fluid into eyes, mucous membranes or non-intact skin. / 15
Appendix 2: Monitoring performance / 16
Appendix 3: Audit tool / 17

1. Scope

This policy applies to all clinical staff within St Helens and Knowsley Teaching Hospitals NHS Trust. It gives staff clear guidance on:

• Prevention of sharps/contamination incidents.
• The procedure staff should follow in the event of a sharps or contamination incident. These are classified as incidents where there is exposure toblood or other body fluids e.g.
• Percutaneous injuries such as needle stick injuries or sharps injuries
• Bites (blood drawn)
• Contamination of the mucous membrane e.g. mouth
• Contamination of the conjunctivae (eye)
• Minor cuts, abrasions and other open skin lesions which become contaminated.

2. Introduction

There are a number of laws that require employers to protect health care workers from sharps injuries. An additional European directive targeted at protecting health care workers was introduced in May 2010 and was transposed into UK regulations, The Health and Safety (Sharp Instruments in Healthcare) Regulations May 2013. These regulations build on the requirements of existing regulations including the Control of Substances Hazardous to Health Regulations 2002. The overarching law is the Health and Safety at Work etc. Act 1974. This places general responsibilities on employers to ensure, so far as reasonably practicable, the health, safety and welfare of employees. The act requires employers to provide a safe working environment in relation to sharps injuries, together with safe equipment, training, information and instructions on safe systems of work.

Blood borne infections e.g. Hepatitis B, Hepatitis C or Human Immunodeficiency Virus (HIV) infection may be contracted from incidents where there is exposure to blood or body fluids, as above.

Risks of transmission of blood borne viruses after sharps injury:

• Hepatitis B: 5% if donor is eAg negative

25% if donor is eAg positive (super-infectious)

• Hepatitis C:3%

• HIV:0.3%

The highest risk of transmission is via a hollow-bore needle stick injury, either during use or after use but before disposal. Re-sheathing needles carries a high risk of injury and must NOT be undertaken. Nurses and doctors are the health care workers most at high risk of injury.

The vast majority of sharps injuries are avoidable, and occur when sharps are handled or disposed of in an unsafe manner. Staff should follow this guidance in order to minimise the likelihood of sharps injuries occurring. Contamination incidents e.g. splashes of blood/body fluids to mouth/eyes/cuts can usually be avoided by judicious use of personal protective equipment (PPE).

3. Statement of Intent

The primary aim of this policy is to prevent sharps/contamination incidents from occurring. However, when they do occur, it is vital to ensure that the incident is reported, managed appropriately and in a timely fashion to prevent or reduce the risk of infection.

4. Definitions

Sharp

For the purpose of this document, a sharp is an object or instrument which is used for carrying out healthcare activities and which is able to cause injury by means of cutting or piercing the skin e.g.

• Needles (hypodermic, biopsy, spinal & suture),
• Stitch cutters
• Scissors
• Intravascular guide wires
• Razor blades
• Scalpel blades
• Cannulae
• Administration sets with exposed spikes
• Trochars
• Lancets
• Broken glass ampoules

Sharp tissues e.g. spicules of bones or teeth may also pose a risk of injury.Kitchen knives or utility knives are not included as these are not used to provide healthcare.

Safety device

Medical sharps that incorporate features or mechanisms to prevent or minimise the risk of accidental injury e.g. syringes and needles with a shield or cover that slides or pivots to cover the needle after use.

Percutaneous exposure

Needle or other sharp object contaminated with blood or body fluids causing injury, a bite causing visible bleeding, or other visible skin puncture.

Donor

The person from whom the blood or body fluid originates.

Victim

The person exposed to blood or body fluids that have the potential to be infected with a blood borne virus.

5. Duties Accountabilities and Responsibilities

For full details of infection control responsibilities see Infection Control Policy, Chapter 28B Infection Control Manual.

5.1. Staff

It is the responsibility of all clinical staff to:

• be aware of the current guidelines.
• put these guidelines into practice.
• bring to the attention of the Unit Manager or Infection Prevention and Control Team any problems in applying these guidelines

Breaches of this policy may lead to disciplinary action being taken against the individual.

5.2. Unit managers (person in charge of a ward or department) must ensure that

• The policy is readily accessible to all staff.
• The required facilities and equipment are available to enable compliance with the policies.
• All staff within their area of responsibility have received training in the appropriate procedures with respect to infection control.

5.3. Health, Work and Wellbeing

• Provide a comprehensive hepatitis B vaccination programme for all healthcare workers exposed to blood and other body fluids at work at pre-employment and following a sharps or contamination incident.
• Manage the care of staff in the event of a sharps injury or contamination incident.

6. Process

6.1. Risk assessment

The 5 stages of risks assessment are:

Step 1: Identify the hazards.

Step 2: Decide who might be harmedand how.

Step 3: Evaluate the risks and decide onprecautions.

Step 4: Record your findings and implementthem.

Step 5: Review your assessment and updateif necessary.

The Head of Department must review all exposure incidents to consider how recurrence might be prevented.

Risks may be addressed by:

6.1.1 Elimination

Review working practices regularly to, wherever possible, eliminate the use of unnecessary sharps.

6.1.2 Safety devices

All wards and departments should assess the risk of sharps injury in relation to their own practice. The use of CE-marked safety devices should be considered where necessary in conjunction with their suitability for the task being undertaken. However expectations of such devices must be realistic. Safer devices are not consistently protective and are often reliant on correct use.

6.1.3 Safe systems of work

Managers will ensure that safe systems of work are in place and that staff are adequately trained and adhere to the Trust’s policies and procedures for the management of sharps and waste.

6.1.4 Personal protective equipment (PPE)

Staff must use appropriate PPEe.g. gloves, eye protection, mask, apron for procedures where there is a risk of blood or body fluid exposure.

6.1.5 Vaccination

Staff should have appropriate hepatitis B vaccination where there is a risk of exposure to blood or body fluids. However, vaccines are not available for hepatitis C or HIV, therefore prevention of injury by safe use of sharps is key.

Hierarchy of controls applied to sharps injury prevention

6.2.Safe usage of sharps and prevention of injury

6.2.1Avoid use of sharps wherever possible.

6.2.2 Never re-sheath needles. This is the most common way of getting a needlestick injury.

6.2.3Always ensure that lighting is adequate in the work area.

6.2.4Sharps should not be used in recreational or patient rest areas or day rooms.

6.2.5Practise a safe handling technique, maintain concentration and do not be distracted during procedures involving the use of sharps.

6.2.6Enlist help from a colleague when handling uncooperative patients.

6.2.7The person using the sharps must dispose of them into sharps box immediately after use. Never leave them for someone else to clear away.

6.2.8Let falling objects fall, don’t attempt to catch sharps if they drop on thefloor.

6.2.9In operating theatres or specialised areas it is recommended that used suture needles and scalpel blades be kept for safety on the appropriate sterile adhesive pad (e.g. Discard-a-pad) during the surgical procedure, prior to counting before disposal into the recommended sharps container.

6.2.10Do not pass sharps from hand to hand – use a neutral zone.

6.2.11Scalpel blades should only be removed from handles promptly using forceps (never fingers).

6.2.12Sharps must never be affixed to patients notes, treatment record cards etc.

6.2.13Use blunt instruments when possible i.e. towel clips, blunt-tipped needles.

6.2.14Discard syringes and needles wherever possible as a single unit into a sharps container. Remove needles only when essential e.g. when transferring blood to a container. Remove needles and attach blind hubs to syringes containing arterial blood for blood gases.

6.2.15Used needles and syringes, intravenous lines and cannulae must be placed into sharps box immediately after use. Do not break or bend needles or cut lines into pieces.

6.3.Personal protective equipment

6.3.1Gloves cannot prevent percutaneous injury but they may reduce the risk of acquiring a bloodborne virus infection. Although punctured gloves allow blood to contaminate the hand, the wiping effect can reduce the volume of blood to which the worker’s hand is exposed and in turn the volume inoculated in the event of percutaneous injury.

6.3.2Gloves must be worn when performing venepuncture. Only experienced and competent venepuncturists should take blood from patients known to be infected with a blood borne virus.

6.3.3Use a closed blood collection system e.g. S-Monovette in preference to the use of needle and syringe for blood collection.

6.4.Safe usage of sharps boxes

6.4.1Sharps containers should be correctly assembled prior to use, to prevent spillage of the contents, only filled to ¾ of its capacity before being sealed prior to its disposal.

6.4.2Sharps bin sizes range from 22 litre down to 0.5 litre. Long bins are available for Operating Theatre andCritical Care Unit etc, for the disposal of long surgical instruments, chest drains, suture guns etc.

6.4.3The most appropriate size of container should be used e.g. 22 litre in operating theatres and wards with a heavy usage, in order to reduce the risk of external contamination of the box, prevent overfilling and to accept cannulae, wound drainage bottles etc. without risk of injury to user. Sharps boxes should be sealed and disposed of after being in use for 3 weeks.

6.4.4Boxes should be sited in positions in wards/departments convenient to users of sharps to encourage immediate disposal after use. Wherever possible take a sharps box to the bedside when undertaking procedures using sharps e.g. giving injections. Injection trays with sharps boxes are available on all wards and departments. Further supplies are available from Purchasing and Supplies Department. Where applicable, use a wall or trolley mounted bracket. Do not store sharps boxes on the floor. Site sharps boxes away from the public reach.

6.4.5Ensure that adequate spare boxes are available to reduce the temptation to overfill boxes.

6.4.6Don’t be tempted to overfill sharps box or to fiddle with or poke contents down using fingers or other implements.

6.4.7Seal box with lid, affix identification tag indicating ward/department and complete label on sharps box on assembly of box and on closure prior to collection by portering staff. Boxes are to remain in the ward/department in a safe area prior to collection.

6.4.8Sealed sharp boxes should be handled with care. Don’t throw, drop or invert them. Carry them only by the handle. Disposal must always be by incineration.

6.4.9Portering staff must wash their hands after handling used sharps boxes and should wear heavy duty gauntlets for transporting boxes.

6.4.10Sharps bins must conform to British Standard 7320. As sharps containers are transported off site for disposal they must be of a type approved under the requirements of The Carriage of Dangerous Goods and Use of Transportable Pressure Receptacles Regulations 1996.

6.5Inoculation/needlestick injury or splash of blood/blood stained fluid into eyes/mucous membranes/non-intact skin

See Appendix 1 for quick reference instruction chart (available from Infection Prevention & Control Nurse Specialists)

6.5.1ACTION TO BE TAKEN

The victim should:

6.5.1.1Perform immediate first aid

• Needlestick injury
• Encourage wound to bleed (without causing further damage). DO NOT suck the wound.
• Throroughly wash wound with soap and water. Do not scrub.
• Then dry puncture site and apply waterproof dressing.
• Eye contamination: Irrigate with eye wash. Remove contact lenses first.
• Mouth contamination: Rinse well with copious amounts of water. Do not swallow.

6.5.1.2 Note the identity of the donor

If the donor is an outpatient, make sure the donor does not leave before the incident has been reported or a sample of clotted blood has been taken).

6.5.1.3 The doctor (responsible for the care of the donor) should obtain blood from the donor for:

• Hepatitis BsAg
• HCV Ab
• HIV Ab only after counselling and consent. Oral or written consent should be recorded in the donor notes.

Sharps/needles must NOT be sent for testing.

6.5.1.4Report the incident to the Head of Department.

DATIX reporting

The incident must be completed using the DATIX system within 24 hours by the Ward/Departmental Manager.The online form is available at:

The Head of Department must review all exposure incidents to consider how recurrence might be prevented.

6.5.1.4 Report the incident to the Health, Work & Well Being Department. Out of hours report to Emergency Department instead but attend Health, Work & Well Being as soon as possible on the next working day.

RIDDOR reporting

If required, reports under RIDDOR can be made via Governance/Risk Departments Ext 1065/1258/1564. Any incident which involves the exposure of an employee to the body fluids of a known HBV, HCV or HIV positive patient is reportable under RIDDOR Regulations 1995. Cases of HBV, HCV or HIV which result from an occupational exposure are reportable as Diseases under RIDDOR Regulations 1995.

Health, Work and Wellbeing will inform the Health and Safety Department with written consent of the healthcare worker involved, of any cases requiring reporting under RIDOOR. RIDDOR reports are made by the Health and Safety Department.

6.5.2ACTION TO BE TAKEN BY HEALTH, WORK & WELL-BEING DEPARTMENT (EMERGENCY DEPARTMENT: OUT OF HOURS ONLY)

6.5.2.1 Assessment

Following appraisal and treatment of the injury (encourage wound to bleed and wash thorough with soap and water):

Complete a needlestick/sharps injury form noting name of victim, job title, Hepatitis B immunisation status, contact phone number, details of incident and name of patient that sharp was used on if available. Leave this form in the victim’s notes.

6.5.2.2 Take blood from victim for baseline storage

Send to laboratory with Microbiology request form.

6.5.2.3 Ensure that 5 mls of clotted blood has been taken from the donor by ward/department doctor. This must be done within 24 hours of the injury.

Donor tests:

• Hepatitis BsAg
• HCV Ab
• HIV Ab only after counselling and consent. Oral or written consent should be recorded in the donor notes.

6.5.2.4 Send specimens to Microbiology Laboratory.

Make sure that all request forms are labelled with reference to patient and donor (so that they can be matched).

6.5.2.5 Check hepatitis B vaccination status.

Were post-vaccine antibody levels satisfactory? Is the 5 year booster due? An accelerated course (0, 1, 2 and 12 months) of Hepatitis B vaccination is recommended for nursing/medical staff who have not already been vaccinated.

6.5.2.6Counsel victim.

Record in staff medical record card. The Trust provides support for those involved in or affected by an inoculation incident. This is provided by the Health, Work & Well-Being Department, also via referral to Clinical Psychologist in the Genito-urinary Medicine Clinic if required

6.5.2.7 Results

When donor result is available, contact victim andorganise further treatment if appropriate.

6.5.2.8 Further advice

The Microbiologist will advise on treatment and follow up where indicated.

6.5.2.9 High risk donor

Hepatitis BsAg positive

If victim is known responder to hepatitis B vaccine: