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At the sharp end - protecting your health

Graham Mobbs
BA PGDip DipM MSc
Director
MEDILINK (North West) Limited
Central Manchester Healthcare NHS Trust
7th Floor
St Mary's Hospital Hathersage Road
Manchester
M13 OJH
T:0161 276 5782
F:0161 276 5766
E:gmobbs@central.cmht.nwest.nhs.uk

Professionals within the healthcare sector use a range of equipment with sharp edges, points and needles. "Sharps" incidents are common and one of the most dangerous hazards facing professionals in the healthcare industry - over 20 bloodborne pathogens can be transmitted from sharps injuries, including hepatitis C and HIV. UNISON has reported six NHS employees who have contracted HIV from a needlestick injury, two of whom have died.(1)
In the UK, nurses, doctors, midwives and domestic staff are most at risk of injury. Five primary activities are associated with the majority of injuries:

  • Administering injections.
  • Taking blood.
  • Needle disposal.
  • Recapping needles.
  • Handling rubbish and dirty linen.

The financial costs
Apart from the human cost, sharps injuries lead to significant financial costs to the NHS. In 1998 a junior doctor was awarded nearly £500,000 in an out-of-court settlement for suffering a sharps injury. The Daily Telegraph reported that the doctor developed a needlestick phobia that left her afraid to leave the house, and claimed that she was offered neither proper training about the injury nor counselling. According to Jon Richards (National Officer, UNISON), compensation for injuries are on the increase - at the start of the UNISON needlestick campaign a basic award for a black bag injury to a porter was around £1,000; this has now gone up to the £3,000-5,000 mark. In addition to payment of damages, there are a number of other direct costs, including:

  • Loss of employee time.
  • Cost of tying up staff to investigate the injury.
  • Expense of laboratory tests.
  • Long-term cost of treatment for infected ­professionals.
  • Cost of replacing staff.

Today's healthcare professionals do not have to accept the risks of a potential life-threatening injury while carrying out their everyday duties; there are now new safer medical devices to avoid and stop sharps injuries.

Safer devices
Manufacturers have developed new innovative
CE-marked devices, including:

  • Retractable needles.
  • Safety syringe shields.
  • Needleless systems.
  • Safer sharp management systems.
  • Post-use technologies for easy and safe disposal of sharps.
  • Safer, easy-to-use lancets.

The introduction of safer devices has been shown to reduce sharps injuries. There was an 84% decrease in intravenous (IV) device-related injuries after the introduction of safety IV catheters in three American hospitals.(2) A 1997 sponsored report from the Centres for Disease Control and Prevention in America found that needlestick injuries dropped by 76% when safer needles were used to draw blood.(3)
The main reason given for not introducing safer devices is cost. On a one-to-one basis safer devices are more expensive than current devices, but when the wider costs of sharps injuries are taken into account new safer devices not only protect healthcare professionals but are also more cost-effective.
 
Support for implementing devices
UNISON is running a nationwide campaign to reduce sharps injuries. This calls for a number of measures, including government legislation, for the introduction of safer devices. It calls upon the Department of Health and the NHS Executive to alert employees about the use of safer devices and to promote the improvement in manufacturing to reduce their costs. For more information, see "Further reading".
MEDILINK (North West) Limited has been ­working with safer device manufacturers for the introduction and evaluation of new safety devices for the reduction of sharps injuries. A result of this has been the creation of a sharps safety information pack detailing equipment and products to reduce sharps injuries. The packs are available free of charge to healthcare professionals from MEDILINK (North West) Limited.
There are currently ongoing trials at a number of NHS trusts, and MEDILINK is linking together companies and NHS trusts for the evaluation and implementation of new safer devices. MEDILINK supports the evaluation and trials by facilitating meetings and ­organising regional sharps injury safety days.
 
Regional sharps injury seminars
Leeds Hilton Hotel (April 2000) and Harlow Playhouse (September 2000) have hosted regional sharps injury days. Uniquely at these events, there was the opportunity to view a wide range of medical devices aimed at reducing the potential hazard from sharps injuries. These events saw presentations from experts on sharps injuries, including:

  • Dr David Morgan, Head of Science, British Medical Association.
  • Julian Topping, NHS Executive.
  • Dee May, Infection Control Adviser to the RCN.
  • Jon Richards, National Officer, UNISON.

There will be another safety day on 20 September 2001 aimed at safety for healthcare professionals. Sharps injuries will be one of the three main topics, the others being violence against healthcare professionals and patient handling and lifting. For information on events in your region contact MEDILINK.

What can you do?
Safety for healthcare professionals is everyone's responsibility. You can make a difference by working to introduce safer devices, by:

  • Always reporting a sharps injury.
  • Working with your employer to evaluate new safer devices.
  • Assessing and highlighting the high-risk areas where sharps incidents occur and appraise which device(s) will reduce incidents.
  • Supporting the implementation of those devices that reduce the incidence of sharps injuries.

Conclusion
The vast majority of sharps injuries are avoidable. Healthcare professionals can protect themselves by becoming and being aware of the dangers, by following safer systems for the use and disposal of hazardous devices, and by insisting on the assessment and use of safer devices.
Finance is the big issue affecting the introduction of safer devices. However, when the wider financial consequences of sharps injuries are taken into account, the price of safer devices is cheaper than the current devices used. More importantly, these devices are safer for healthcare professionals, protecting the lives of those people whose job it is to care for others.

References

  1. Richards J. Safer needles. London: ASI International; 2000.
  2. Jagger J, Bentley MB. Injuries from vascular access devices: high risk and preventable.J Intraven Nurs 1997;20(6):33-9.
  3. US Center for Disease Control. MMWR [Morbidity and Mortality Weekly Report] 17 January 1997.

Resources
UNISON Health Group
1 Mabledon Place London WC1H 9AJ
T: 0800 597 97 50

UNISON 'Needle Safety at Work'
W:www.unison.org.uk/campaigns/index

British Medical Association
BMA House Tavistock Square London WC1H 9JP
T:020 7383 6132
F:020 7383 6399

Lynda Arnold's Healthcare Workers Safety Site.
Lynda was stuck by the catheter needle she used to start an IV when the patient made a sudden move. Within 6 months she tested positive for HIV
W:www.bizsafe.com/healthcaresafety

Dorset Health Authority site
"Needlestick injury - what you need to know"
W:www.dorset.swestnhs.uk

Fact Sheet from the American Nurses Association
W:www.nursingworld.org/readroom/fsneedle.htm

Further reading
British Medical Association. Bloodborne viruses. Infection & control. A guide for health care professionals.
CD-ROM. London: BMA.

Jeanes A. Zero-Stik-Safety syringe: an automatic safety syringe. Br J Nurs 1999;8(8):530-1, 534-5.

UNISON. Needle safety at work. Evaluating safer needles. A UNISON guide. (An article based on this guide appears in Health and Safety Organiser, Issue 6, December l999.) For an email version contact: Healthandsafety@unison.co.uk

UNISON. Needle safety at work. Safer needles - questions and answers. A UNISON guide. Freephone 0800 5979750.