Key points
Sharps are responsible for a significant number of injuries to colleagues each year. The safe use and disposal of sharps will reduce the risk of injury and the acquisition of blood-borne viruses (BBVs) to both colleagues and patients. Factors associated with an increased risk of occupationally acquired BBVs include:
- deep injury
- visible blood on the device which caused the injury
- injury with a needle which had been placed in the source patient’s artery or vein
- injury with a hollow bore needle
- advanced progression of human immunodeficiency virus (HIV) related illness in the source patient
The term “sharps” includes items such as needles, scalpels, razor blades, broken glass and any other sharp items that may cause a penetrating injury, laceration or puncture to the skin.
It is recommended that healthcare colleagues who handle sharps or are exposed to blood or body fluids are offered hepatitis b vaccination.
Legislation
The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 requires employers to take specific risk control measures to avoid the unnecessary use of sharps.
Where risks are identified, the sharps in health care regulations require the employer to take specific risk control measures:
- where the employer has identified a risk, steps must be taken to avoid the unnecessary use of sharps
- where it is not reasonably practicable to avoid the use of medical sharps, the sharps regulations require employers to:
- use safe sharps (incorporating protection mechanisms) where it is reasonably practicable to do so
- prevent the recapping of needles
- place secure containers and instructions for the safe disposal of medical sharps close to the work area
Under regulation 8 there is also a duty of employees to notify their employer of a sharps injury as soon as practicable after the event.
Safer sharps
A range of syringes and needles are available with a shield or cover that slides or pivots to cover the needle after use and the following factors should also be considered:
- the device must not compromise patient care
- the device must perform reliably
- the safety mechanism must be an integral part of the safety device, not a separate accessory
- it should be easy to use and require little change of technique
- activation of the device must be convenient and allow care given to maintain appropriate control over the procedure
- the safety mechanism must be deployed before disposal
- the device must not create other safety hazards or sources of blood exposures
- single handed or automatic activation is preferred
- activation must manifest itself by means of an audible, tactile or visual sign to the health professional and is not reversible when activated
Drawing up medication and fluids
Filter straws and blunt filter needles are the accepted practice for the Trust to ensure that practices are as safe as possible and comply with the legislation.
A straw (a sterile long, thin plastic tube) or blunt needle (a needle-like construct with a blunt end and wide bore) must be used to draw up medication and fluids.
A medical straw is best for large volumes of liquid and the blunt needle for smaller amounts in ampoules.
As a standard safety measure, blunt needles used for aspirating from ‘break neck’ glass ampoules should have a filter built in, if not a filter straw should be used. Some injections (for example, depot) cannot be drawn up using a blunt filter needle. On these occasions a blunt needle without a filter must be used as indicated in the manufacturer’s instructions.
Some medications are only supplied as prefilled multi dose pen devices for patient self-administration. Where the patient is unable to self-administer and there is no alternative solution colleagues should use the device to administer according to prescriber’s instructions. Where it is necessary to remove the needle to allow for multi dose administration, a suitable needle removal device must be used carefully following manufacturer’s instructions.
Sharps containers
Assembly:
- ensure the colour of the lid and the label match, for example, yellow label, yellow lid
- ensure the sharps container is correctly assembled according to manufacturer’s instructions
- once assembled and prior to putting into use, attempt to pull the lid and container apart to ensure it has been assembled correctly
- colleagues must ensure traceability of sharps containers in case of adverse incident by labelling the sharps container at the time of assembly with:
- point of origin
- date
- name of person assembling the container (print name not signature)
Location:
- must be stored out of reach of patients, the public and others who may be at risk
- must be in a safe and secure position in the clinical area so they cannot be tipped over. Use either a tray or a wall or trolley bracket to secure
- should not be stored on the floor or above shoulder level
should be placed on a secure, stable surface, at or just above waist height
Safe use:
- always ensure that the correct sharps container is used for the segregation and disposal of waste in accordance with the Trust’s Waste Policy
- never overfill a sharps container and leave a sharp protruding out of the container
- damaged sharps containers should be placed in a larger container which should then be locked
- under no circumstances must the contents of one container be decanted into another container
- always use safe sharp systems where available
- when not in use the temporary closure mechanism must be deployed
- the person using the sharp must dispose of it into a sharps container immediately after use and at the point of use. Sharps must not be left for someone else to clear away or handed to someone else for disposal
Disposal:
- sharps containers must be disposed of when the manufactures fill line is reached
- ensure sharps container lid is securely locked prior to disposal, following manufacturer’s guidelines
- ensure the sharps container is labelled at the time of disposal with:
- date of locking
- name of person locking the container name of person assembling the container (print name not signature)
- sharps containers awaiting final disposal must be stored securely in a locked area
Transporting sharps
Colleagues who travel in the community and carry sharps (used or unused) in the course of their work must follow a safe system of working:
- the transportation of sharps and sharps containers must be undertaken in a responsible and safe manner
- it is best practice to use a red transport box with a green label (UN3291) to carry sharps containers and to carry the trust’s transport document
- sharps containers must be kept out of sight in a locked vehicle
- check the car at the end of each journey to ensure no sharps have been dropped or spilled in the vehicle
- lease or pool vehicles must be checked before handing them back by the driver
Where larger sharps containers are required that are too big to put into a transport box the following control measures must be used:
- the lid must be securely attached to the container
- the temporary closure must be in place
- the sharps container must be secured in the boot and not able to roll around
- the parcel shelf must be in place
Patient’s sharps disposal from own home
Where required colleagues must provide education to patients on the safe use and disposal of sharps, for example, colleagues involved with the needle exchange scheme within the drugs and alcohol service.
Sharps containers must not be disposed of in the household domestic waste stream.
It is the responsibility of the integrated care boards (ICBs) to organise collection and disposal of sharps waste from patients’ homes if the waste is not generated by healthcare providers.
Doncaster
Office hours:
- Monday to Friday from 8am to 6pm
- Saturday from 8am to 12 noon
- Telephone: 01302 736000
Out of office hours:
- Telephone: 01302 737296
Rotherham
- 8am to 8pm:
- if found on highways telephone: 01709 336003
- if found on private land telephone: 01709 526137
- Telephone: 01709 823172 (out of hours)
North Lincolnshire
Office Hours:
- Monday to Thursday from 8:30am to 5pm
- Friday from 8:30am to 4:30 pm
- Telephone: 01724 297843
Out of office hours, phone is diverted:
- Telephone: 01724 297843
Sharps found in public areas
Only pick up discarded sharps if you have been trained to do so. If found on trust owned sites estates can be contacted for support as they have equipment required to deal with this safely including anti-stab gloves, litter pickers and sharps containers.
If the sharps are found in a public place or non-trust owned sites, either accessible or inaccessible then report it to the relevant council for the locality:
- Doncaster telephone: 01302 736000.
- Rotherham telephone: 01709 382121
- North Lincolnshire telephone: 01724 297000
The incident must be recorded on the Ulyses IR1 system.
Contamination injury
Safe systems of work must be adhered to and refer to sharps risk assessment for list of control measures. Please also check with your line manager to determine if there is a service specific risk assessment in your area.
However, there may be occasions when despite all precautions being adhered to colleagues may receive a contamination injury. If this happens the quick guide to contamination injury management procedure must be followed.
Source testing
The source (from whom the contamination occurs) if known, must be informed of the incident and a history obtained which should include details of whether they are known to have a BBV or belong to a high-risk group (for example, people who inject drugs, people who change their sexual partner frequently). The responsible clinician or emergency department should be informed of the results to aid the risk assessment process in determining the need for treatment.
It is recommended that the source be tested for hepatitis b, hepatitis c and HIV with informed consent given. If the source is unable to consent or refuses to give a history or have blood taken the incident will be assessed as unknown source. This must be recorded on SystmOne.
If the source is a patient, the colleague who has sustained the injury should not be involved in the pre-test discussion or the taking of blood samples.
When an incident occurs in which a colleague may have exposed a patient to their blood or another patient’s blood, this should be reported immediately to the responsible clinician for an assessment of the risks involved and to the line manager.
The 24 hour hotline 0330 6600365 can be contacted for further advice and will arrange an appointment for the colleague to have blood taken for source testing if required.
If the incident occurs in the community setting the patient sustaining the injury (recipient) should be advised to go to the local emergency department for assessment.
Pre and post blood test counselling is an important part in the management of colleagues and patients who have suffered a contamination injury that may have exposed them to a BBV. Individuals may need referring to a specialist service for counselling via the trust or their general practitioner.
Page last reviewed: April 24, 2024
Next review due: April 24, 2025