Avoiding Needlestick Injuries

By Luke Rutterford / 04 Apr 2018

Clinic waste technical manager Luke Rutterford explains how to implement best practice to avoid injury from sharps and needlesticks.

Needlestick and sharps injuries are one of the most efficient methods for spreading bloodborne pathogens between patients and healthcare providers, and therefore can pose a substantial risk to health.1 Because of the kinds of treatments conducted in medical aesthetic clinics, there is a risk of needlestick and sharps injuries occurring, so it is crucial that practitioners and other clinic staff are aware of the safe segregation, storage, disposal and management of sharps’ waste. This will ensure the hazards associated with handling these items are significantly reduced, and that there is compliance with the Hazardous Waste Regulations2 (or Special Waste Regulations in Scotland).3 Needlestick and sharps injuries can result in the spread of hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV), while other types of infections can also occur.4 A European directive was made available in 2010 with the aim to create safer working environments by preventing injuries caused by medical sharps. In the UK, The Health and Safety (Sharp Instruments in Healthcare) Regulations 20135 was launched to meet the requirements of the EU Directive 2010/32 and to specifically address the gaps in existing UK legislation at that time.

Instruments of concern

Items that are commonly found around the aesthetic clinic classed as ‘sharps’ include syringes, hypodermic needles, scalpels, razors and razor blades, phials, pipettes, microneedling devices, test tubes and glass (whether broken or intact). Some of the most common scenarios where needlestick injuries occur in the healthcare sectors around the world include when recapping or detaching the needle after use on a patient, while taking a blood test or during IV cannulation.6

The risk of needlestick or sharps injury is highest among workers in health and social care environments, including aesthetic clinics, as these professionals directly handle sharps on a daily basis, multiple times a day. It is crucial that all team members that facilitate any type of treatment with needles or other sharp items are fully aware of and trained on this subject, and that this training is regularly updated and reinforced.

What are the risks? 

As mentioned, the main risks from a sharps injury are the potential exposure to infections, such as bloodborne viruses (BBV). This can occur when a sharp that is contaminated with blood or another bodily fluid from a patient pierces the skin of another person. Of the BBVs that cause the most concern is HBV, which affects the liver, causing inflammation called hepatitis.7 Infections of HBV can either be acute or chronic, the latter being more serious. Individuals can recover from acute infections without medical intervention and many people do not even display any symptoms; they often don’t realise that they have it. Chronic infections remain with the person for life and can affect the liver in the long-term, causing cirrhosis, if treatment such as an anti-viral drug is not administered. HCV is also an infection of the liver that can be acute or chronic and again, many people infected might mistake symptoms as another illness, such as the flu.8 HIV is a lentivirus that causes acquired immunodeficiency syndrome (AIDS) and can be passed on through infected blood and other bodily fluids. It weakens the immune system, which can allow life-threatening infections and cancers to attack the body.9 The rate of diffusion of infection after an infected needlestick injury varies depending upon the bloodborne pathogen. Factors that may increase the risk of contracting an infection, and that influence possible management of its development, include:10

  • Percutaneous injury, rather than mucous membrane or broken skin exposure
  • Injury with a device used to penetrate a patient’s artery or vein
  • Blood exposure rather than exposure to blood-stained fluid, diluted blood (for example in a local anaesthetic solution) or other bodily fluid
  • Injury from a hollow bore rather than solid bore needle
  • Injury from a wide gauge rather than narrow gauge needle
  • Visible blood on the device
  • No protective equipment used (such as gloves, double gloves and eye protection)
  • First aid measures not implemented (not washing wounds or dealing with them in the correct manner)
  • Hepatitis B e-antigen (HBeAg) detectable in source patient blood
  • Exposed person not, or inadequately, immunised against hepatitis B
  • Source patient co-infected with more than one BBV
  • High viral load of HIV in source patient11
  • Deep rather than superficial injury12

Safe segregation, storage and disposal

The segregation, storage and disposal of sharps is determined by the type of contamination. This contamination establishes the correct colour of waste bin required for the waste that is being disposed. The Safe Management of Healthcare Waste Regulations18 set out guidelines on the safe and legal disposal of sharps waste using a colour-coded scheme. Sharps containers provide safe storage and disposal of sharps waste and come colour coded to ensure that the waste is segregated appropriately according to legislation:

An orange lid – sharps not containing or contaminated with medicines, such as sharps used for blood samples and acupuncture

A yellow lid – items contaminated with or containing medicines or anaesthetics

A purple lid – for the disposal of sharps and medicines with cytotoxic or cyostatic contents or contamination

A blue lid – for the disposal of out-of-date drugs, used drug denaturing kits and discarded items from use in the handling of pharmaceuticals such as bottles or boxes with residues, gloves, masks, connecting tubes, syringe bodies and drug vials

Sharps bins should be sourced from a reputable supplier to ensure that they are impact and puncture resistant, as well as being leakage proof, to ensure complete protection of healthcare workers, patients and waste disposal employees. Once sharps containers are full – i.e. they are full to the recommended fill line and no more needles can be easily and safely placed in the container – they should be securely closed and stored in a separate area away from patients. Waste collection should be organised according to the individual clinic’s needs, as it’s important to limit the amount of time full sharps containers and other waste streams are stored on the premises. 


Prevention

The Health and Safety (Sharps Instruments in Healthcare) Regulations 2013 outline requirements for hospitals and the healthcare sector in general, including cosmetic, medical and dental establishments. The regulations target both employers and employees, showing how important it is for every single person involved in healthcare to take responsibility for their part in needle and sharps safety. They have a duty of care to their colleagues and patients.5

The recent additions taken from the European Directive and included in the 2013 UK Regulation are:

  • Providing sharps disposal equipment as close as possible to the assessed areas where sharps are being used or found
  • Prevent the recapping of needles
  • Use of personal protection equipment (PPE)
  • Making information available and raising awareness of risks, good practice, recording of incidents/accidents and support on offer. This information may be presented as safe operating systems, safety guides, posters or sections on a dedicated website that covers the potential risks from injuries involving sharps, relevant legal duties of the employer, good practice injury prevention and the pros and cons of vaccination.
  • Training on the correct use of safer sharps and disposal procedures13

It is acknowledged that the single most important way to help to prevent needlestick injuries is to avoid recapping and re-sheathing.5,14,15 The term ‘safer sharps’ is now commonly used and this refers to medical sharps that incorporate features or mechanisms to prevent or minimise the risk of an injury.5 

It is also advised to keep a rigid, puncture-proof waste container close to hand for used needles, helping to avoid the temptation of recapping. It is equally important to use proper protective clothing, such as gloves, facemasks and goggles to avoid any inadvertent transmission of blood or other bodily fluids. Every healthcare worker at risk from accidental exposure to blood should be trained in infection control and vaccinated against HBV (unfortunately there are not yet any preventive vaccines available for HCV or HIV).

Action

Action after exposure to potentially contaminated material through a needlestick or sharps injury should be swift and follow the below protocol: 15,16

  • If skin is punctured, free bleeding should be gently encouraged, ideally holding it under running water to prevent infection of other areas of the hand/skin
  • The wound should be washed with soap or disinfecting handwash and water, but not scrubbed or sucked
  • If there is any possibility of HCV, HBV or HIV exposure, urgent medical advice should be sought for the relative indications for anti-retroviral post-exposure prophylaxis.17 This is the medication administered in emergency situations where HIV transmission is possible and must be started within 72 hours of potential exposure. It’s available from healthcare providers on prescription or from emergency health services.
  • Notification to the employer should be made as soon as is practically possible, with them making an official recording of the incident. Or if you are a sole practitioner/employer then you should record the incident.

When the employer is notified, this should initiate an investigation into the event so that any immediate action can be taken, but also so lessons can be learnt for the future; for example, perhaps a change in policy or protocol or the acquisition of a new safety device is required.

Conclusion

Through minimising sharps usage, remaining abreast of new regulations and adopting safety devices to prevent injuries, aesthetic clinics can help keep their employees, patients and other members of the public safe. 

References
  1. Science Direct, Needlestick Injury, (2008) <http://www.sciencedirect.com/topics/medicine-and-dentistry/needlestick-injury>
  2. The Hazardous Waste (England and Wales) (Amendment) Regulations 2005. http://www.legislation. gov.uk/uksi/2005/894/contents/made [Accessed November 2017]
  3. The Special Waste Regulations 1996. http://www.legislation.gov.uk/uksi/1996/972/contents/made [Accessed November 2017]
  4. Science Direct, Needlestick Injury, (2008) <http://www.sciencedirect.com/topics/medicine-and-dentistry/needlestick-injury>
  5. Health and Safety Executive. Health and Safety (Sharp Instruments in Healthcare) regulations 2013. http://www.hse.gov.uk/pubns/hsis7.htm [Accessed November 2017]
  6. Goel V, Kumar D, Lingaiah R, Singh S. Occurrence of needlestick and injuries among health-care workers of a tertiary care teaching hospital in north India. J Lab Physicians. 2017 Jan-Mar; 9(1): 20–25. doi: 10.4103/0974-2727.187917
  7. NHS Choices. Health A-Z. Hepatitis B. https://www.nhs.uk/conditions/hepatitis-b/ [Accessed November 2017]
  8. NHS Choices. Health A-Z. Hepatitis C https://www.nhs.uk/conditions/hepatitis-c/ [Accessed November 2017]
  9. NHS Choices. Health A-Z. HIV and AIDS. https://www.nhs.uk/conditions/hiv-and-aids/symptoms/ [Accessed November 2017]
  10. NHS Employers Needlestick Injury document: http://www.nhsemployers.org/~/media/Employers/ Documents/Retain%20and%20improve/Needlestick20injury.pdf [Accessed November 2017]
  11. Cardo DM, Culver DH, Ciesielski CA, Srivastava PU, Marcus R et al. „A case-control study of HIV seroconversion in healthcare workers after percutaneous exposure‟ (1997). N Engl J Med. 337: 1485-1490
  12. Cardo DM, Culver DH, Ciesielski CA, Srivastava PU, Marcus R et al. „A case-control study of HIV seroconversion in healthcare workers after percutaneous exposure‟ (1997). N Engl J Med. 337: 1485-1490
  13. Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 Guidance for employers and employees. http://www.hse.gov.uk/pubns/hsis7.pdf [Accessed November 2017]
  14. Royal College of Nursing. Sharps Safety RCN guidance to support the implementation of The Health and Safety (Sharp Instruments in healthcare regulations) 2013. https://www.gla.ac.uk/media/ media_511552_en.pdf [Accessed February 2018]
  15. Council Directive 2010/32/EU. Official Journal of the European Union. http://eur-lex.europa.eu/ LexUriServ/LexUriServ.do?uri=OJ:L:2010:134:0066:0072:EN:PDF [Accessed February 2018]
  16. Health and Safety Executive. Sharps injuries. What to do if you receive a sharps injury. http://www. hse.gov.uk/healthservices/needlesticks/ [Accessed February 2018]
  17. NHS Employers Needlestick Injury, (2017) http://www.nhsemployers.org/~/media/Employers/ Documents/Retain%20and%20improve/Needlestick20injury.pdf [Accessed November 2017]
  18. Department of Health. Environment and sustainability health technical memorandum 07-01: safe management of healthcare waste. https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/167976/HTM_07-01_Final.pdf [Accessed November 2017]. 

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