Council Directive 2010/32/EUImplementing the Framework Agreement on prevention from sharp injuries in the hospital and healthcare sector concluded by HOSPEEM and EPSU

Kim Sunley

Senior Employment Relations Adviser

RCN

Why be concerned about sharps injuries?u Moral case

– 17 Hepatitis C cases– 5 HIV cases– and countless hidden cases....

u Costs– Blood tests, counselling, treatment,

litigation, staff time....£500, 000 per annum– one incident £330 to £11, 000 per annum – Criminal cases & personal injury cases

u Preventable

Definition of sharp

u objects or instruments necessary for the exercise of specific healthcare activities, which are able to cut prick cause injury and or infection.

Who does the directive cover?

u Workers in the hospital and healthcare sector

u Private and publicu Students & temporary staffu Sub contractors

Underlying Principles

u Well trained and adequately resourced workforceu Exposure preventionu Responsibilities for employers and individualsu Role of safety representatives and consultationu Never assume there is not a risk u Apply hierarchy of general principles u Promote a no blame culture to promote incident

reporting and focus on systemic failures

Key requirements

u Risk assessment u Elimination, prevention and protectionu Information and awareness raising u Trainingu Reportingu Response and Follow-up

Risk Assessment

u Assess who is at risk from injury and exposure and how?– Highest risk from hollow bore needles– High risk procedures blood collection, IV

cannulation and percutaneously placed syringes

– Still a risk from lancets, scalpels, suture needles etc.

Type of exposure by occupation, 2000-2009

0 20 40 60 80 100

Ancillary

Professions allied to medicine

Dentists/dental nurses

Doctors

Midwives

Nurses & healthcare assistants

Occ

upat

ion

Proportion of reports

Mucocutaneous Bite/scratch PCE unknown needle/sharp Other sharp Solid needle Hollowbore needle

n=1701

n=92

n=1595

n=151

n=300

n=69

Provisional data to end 2009Source: Health Protection Agency

Elimination, Prevention and Protectionu Eliminate the unnecessary use of

sharps by implementing changes in practice or equipment

u Where exposure cannot be eliminated provide medical device incorporating safety- engineered protection mechanisms

u Ban on recappingu Safe disposal “as close as possible” to

areas where sharps being used

Source: Prof Dr A Wittman, University of Heidelberg, Germany in EU Bio-safety network toolkit (2010)

Elimination, Prevention and Protectionu Safe systems of work u Use of personal protective equipment

e.g. Glovesu Where available provide protective

vaccination i.e. Hepatitis Bu Health monitoring

ILO/WHO Hierarchy of Controls

• Elimination or substitution (e.g. eliminate unnecessary injections, needle free systems)

• Engineering Controls (e.g. safer needle devices, sharps containers)

• Administrative (policies and training programmes)

• Work Practices (Universal Precautions, no recapping)

• Personal Protective Equipment (gloves, masks, gowns, etc)

MOST EFFECTIVE

LEAST EFFECTIVE ILO/WHO (2005) Guidelines on health services and HIV/AIDS

Primary Care Trusts and Hospital Trusts and any other relevant healthcare settings, should be encouraged to adopt safety devices in place of the conventional devices, in order to prevent needlestick injuries in HCWs. (HPA eye of needle 2008)

A review of seven studies of safer needle devices demonstrated a reduction in injuries from 23-100 per cent with an average of 71 per cent. (WHO/ILO 2005)

When educational programmes were implemented alongside a safer sharps device, lower rates of sharps injuries were sustained for longer (HSL Systematic Review of the efficacy of sharps safety devices 2012)

A word on safety engineered devices…u The device must not compromise patient careu The device must perform reliablyu The safety mechanism must be an integral part of the safety

device, not a separate accessoryu Easy to use and require little change of techniqueu Activation of the device must be convenient and allow care give

to maintain appropriate control over the procedureu The device must not create other safety hazards or sources of

blood exposuresu Single handed or automatic activation is preferredu Activation must manifest itself by means of an audible, tactile or

visual sign to the health professionalu Not reversible when activated

Source: NHS Employers/POSHH/SNN (2010) Implementation advice on sharps agreement

Key requirements (contd.)

u Information and awareness raising u Trainingu Reportingu Response and Follow-up

Next stepsu Must be transposed in UK law by 11th

May 2013u HSE consultation out – closes 8th

November u HSL research published on efficacy of

safety engineered devicesu HSE audits u EU level worku RCN workshops & publicationu Development of resources

HSE Consultation – The Health and Safety (Sharp Instruments) Regulations 2013

u Application of duties u Use and disposalu Information and

trainingu Reporting of injuriesu Arrangements in the

event of injury

Resources/Further information

u www.hse.gov.uku http://www.europeanbiosa

fetynetwork.euu http://www.tdict.org/evalu

ation2.htmlu www.saferneedles.org.uk