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A sharps injury occurs when a sharp object such as a needle, scalpel or razor blade accidentally penetrates the skin. This could be in the form of a cut, a stab or a graze.
Most often people encounter sharps in the workplace. Sharps injuries occur by accident as sometimes workers might not realise that there is a hazard present. Although a sharps injury can sometimes be an unfortunate mishap, it is more often down to the misuse of equipment or a lack of training.
Some behaviours in the workplace might increase the risk of a sharps injury happening, such as:
- Mishandling objects.
- Rushing/feeling pressured.
- Not fully concentrating.
- Using no or incorrect PPE.
- Failure to provide a sharps box.
- Poor housekeeping.
- Lack of training.
- Using the wrong equipment.
Sharps injuries could be from needles, scalpels, razor blades or other sharp objects. They are a serious injury because of the risk of transmission of blood-borne pathogens. This can happen if the sharp has been contaminated by blood or body fluid from an infected person.
The blood-borne viruses that are most concerning in relation to sharps injuries are:
The number of sharps injuries at work each year is high, but transmission rates of infection are relatively low. In 2019, the Hospital Times magazine estimated that more than 9 out of 10 surgeons will receive a needlestick injury during their career. The chances of infection after a sharps injury from an infected object vary depending on factors such as the person’s immune system and how quickly they seek medical attention.
Prophylaxis drugs are available and can be given, which are a type of medicine that fights infection. These drugs can have unpleasant side effects.
Who might get a sharps injury in the workplace?
Sharps injuries at work will most likely be encountered in high-risk workplaces. These are usually medical facilities, such as:
- Operating theatres.
- Hospital wards.
- GP surgeries.
- Phlebotomy clinics.
- Nursing homes.
However, it is possible to come across sharps, in particular discarded needles, in many different types of workplace.
Needles are often associated with drug use, such as heroin or steroids. However, this is not always the case – some people have to inject themselves on a regular basis using sharp needles to manage medical conditions such as diabetes.
Those who work within health and social care are most at risk from exposure to sharps.
Other jobs where there might be an expected risk of a sharps injury will include:
- Hotel housekeepers.
- Gym employees.
- Cleaners (especially those of public toilets).
- Grounds people/gardeners (especially those who work in public parks).
- Waste disposal workers.
In these types of job, the highest risk activity for a sharps injury will often be the handling of rubbish or discarded items. The HSE reports sharps injuries as among the most common causes for injuries in the waste sector.
Steps employers should take to protect employees that may encounter sharps during their work time:
- Risk assessment – Complete a risk assessment. This needs to be proportionate to the level of risk workers are likely to face, so in a high-risk environment the risk assessment will need to be more detailed.
- Hazards – Identify potential hazards and who is at risk from them.
- COSSH – Put control measures in place which should be in line with the Control of Substances Hazardous to Health (COSHH) 2002.
- Prevention and control – Highlight ways to prevent the risk of exposure to sharps, or where this is not possible, control the risk of exposure to sharps.
It is very important that staff who may encounter sharps have had training on how to deal with them. The higher the level of risk, the more in depth the training is required to be and the more controls will need to be in place.
In a hotel housekeeping team, for example, it may be sufficient to provide sharps training as part of more general health and safety training. Although cleaners and housekeepers may encounter needles or razors discarded by hotel guests, these would most likely only be occasional instances.
The controls that might be put in place in a hotel include:
- Hygiene bags to be provided in rooms, clearly labelled for guests to use to dispose of hazardous items, before placing them into the rubbish bin.
- A dedicated, yellow sharps box to be kept in a specific area that workers can access to dispose of relevant items they find.
- PPE such as gloves to be provided and worn as standard during cleaning.
- Staff to be trained on how to safely remove and dispose of rubbish.
- In-person training, as well as posters displayed, on how to deal with sharps injuries and who their on-site first aider is.
A similar approach would work in other areas, such as gyms, where there is anticipation of finding sharps in bins or changing rooms, but the instances of handling them will usually be minimal.
How to deal with a sharps injury
What to do if you get a sharps injury:
- Hold the injured area under running water, try to get the wound to bleed a little if possible.
- Wash the affected area with soap and water (but do not scrub).
- Pat the wound dry and cover with an appropriate dressing (bandage, gauze, plaster).
- Seek urgent medical assistance as soon as possible.
- Report the injury to your employer.
How to reduce the risk of a sharps injury
Health and safety law is applicable to the risk of injuries from sharps, as it is for other workplace risks.
When managers or health and safety trainers are designing training around sharps, relevant legislation to keep in mind includes:
- Health and Safety at Work etc. Act 1984.
- Control of Substances Hazardous to Health (COSSH) Regulations 2002.
- Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR).
- Management of Health and Safety Regulations 1999.
- Health and Safety (Sharp Instruments in Health Care) 2013.
In certain workplaces, there is an expectation for some instances of sharps injury to occur. This is especially true in high pressured, fast paced environments where there is repetitive or prolonged exposure to hazardous objects.
In clinical environments, needles and scalpels are essential tools that provide necessary medical care to patients. However, if an alternative to a sharp can be used effectively for some activities (such as the drawing up of medication or fluids), the non-sharp alternative (such as a medical straw or blunt needle) should be opted for.
Wherever possible, however, it is important that managers and employees work together to reduce the risks of sharps injuries occurring.
To reduce the risk of sharps injuries, all workplaces should:
- Provide adequate training on how to use equipment.
- Demonstrate how to safely dispose of sharps, contaminated items and waste.
- Promote good housekeeping and a sanitary environment.
- Ensure all staff understand health and safety protocol, how to deal with sharps injuries and how to report them.
- Ensure relevant sharps boxes are available for safe disposal, they are fit for purpose and never overfilled.
In high-risk areas, additionally, training should cover what to do in an emergency and what prophylaxis treatments are available.
What is the purpose of a sharps injury log?
A sharps injury log is designed to keep track of the kind of objects that are causing injuries, whether these need to be replaced, and to assess changes that need to be made to improve health and safety protocols within the workplace that will decrease the risk of exposure to blood-borne viruses.
A basic sharps injury log should include:
- The date and time the sharps injury or exposure occurred.
- The activity that led to the injury or exposure.
- The type of device that was being used (including make and model).
- Information such as the department the injury occurred in, the job title of the person etc.
They are not designed to contain sensitive personal or confidential information.
Are all sharps injuries preventable?
Although it is inevitable that some sharps injuries will happen, the instances of these occurrences can be minimised by:
- Providing adequate training and ensuring that all workers are fully trained on how to use medical instruments, for example needles, and how to perform procedures.
- Making sure that needles with safety features are used properly.
- Ensuring all staff have access to a sharps box that is visible, fit for purpose and emptied regularly.
- Creating a calm environment where adequate staffing levels are maintained, as many sharps injuries occur when healthcare workers are stressed or rushing.
- Ensuring that regular training is given on how to prevent and manage hazards at work.
- Ensuring a thorough risk assessment is completed by management and updated if any changes occur in the workplace.
Between 2012 and 2017, the NHS received 1,833 incident claims for needlestick injuries. The cost of paying out for the successful claims was over 4 million pounds.
In addition to this shocking amount of money are the hidden costs (both financial and human) of sharps injuries:
- Time and cost for resources to investigate incidents.
- Staff shortage due to sickness resulting from sharps incidents.
- The unpleasant and debilitating side effects antiviral drugs can cause.
- The stress and anxiety caused to workers and their loved ones whilst awaiting results after exposure to blood-borne viruses.
The fact remains that many needlestick and other sharps injuries are preventable. By being compliant with health and safety advice and infection-control protocols, using correct PPE and disposing of sharps correctly, employees can help to promote a safer working environment.
It is also vital that primary users dispose of their sharps correctly so as not to harm other staff, as the majority of claims to the NHS come from ancillary workers (such as cleaners, porters and maintenance staff).
Management in turn must ensure they are keeping up to date with legislation and best practice and that they review data on incidents from sharps injuries regularly.
What workplaces can do to help prevent sharps injuries:
- Make sure training on disposal of sharps is up to date.
- Ensure all bank workers, agency staff or new employees have had a thorough induction and filled out health and safety paperwork.
- Review whether conventional sharps or ‘safer sharps’ (those with additional safety features) are being used and whether this should change.
- Review data from the injury log – is a specific instrument causing issues and could an alternative be ordered?
- Avoid recapping needles (this is one of the most common causes of needlestick injury).
How to manage and report a sharps injury
You should always report a work-related sharps injury to your line manager or supervisor and seek medical attention as soon as possible.
Your workplace will have their own protocol to follow, which should have been outlined to all staff during their training and induction. There will most likely be an incident report to complete, once relevant medical treatment has been sought. If your company has an occupation health team, they will need to be involved.
Some types of sharps injury must also be reported to the HSE under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR).
This is necessary when:
- An employee is injured by a sharp that is known to have been exposed to contaminated blood or body fluid, such as HIV, Hepatitis B or C.
- The injury is deep, severe or causes issues for more than a seven-day period.
- The employee develops a disease that can be directly related back to the sharps injury.
Other types of sharps injury, where the object was not contaminated or the source of the injury is unknown, are not required to be reported to the HSE. It is important that injuries are always reported within the workplace and any relevant procedure is followed and the sharps injury log is updated accordingly.
Following the correct procedure for reporting sharps injuries within the workplace protects all staff, assists with data collection and can inform necessary changes within the business that will reduce the risk of a similar incident occurring.
By using appropriate equipment and with the correct training, the risk of complications from sharps injuries can be effectively managed within the workplace. Maintaining compliance with infection control and health and safety protocol is also vital, as well as an effort from the top-down to continually assess processes around risk management and deliver effective training in the use of – and disposal of – sharps within the workplace.