What are sharps and what risks do they pose?
“Sharps” are medical objects or instruments (such as hypodermic needles, suture needles, winged steel (also known as “butterfly”) needles, scalpels and other blades, IV catheter stylets, and phlebotomy needles) necessary for the exercise of specific healthcare activities, which are able to cut, prick or rupture the skin or otherwise cause injury or infection.
A sharps injury (sometimes called a percutaneous injury) is an incident which causes a sharp to penetrate the skin, giving rise to the risk of infection with any bloodborne pathogens that may be present on the sharp. Nurses and other healthcare professionals are regularly exposed to serious infections such as the hepatitis B virus (HBV), the hepatitis C virus (HCV), and the human immunodeficiency virus (HIV), as a result of needlestick and sharps injuries.
Some of the more common instances of where sharps injuries occur are:
- manipulating a needle in a patient.
- disposal of sharps after use.
- collision with workers or sharps during clean-up.
- accessing IV lines.
- recapping needles.
While the risk of contracting HIV from a sharps injury is relatively low, the risk of infection with HBV and HCV among unimmunized nurses and healthcare workers is very high. There is no immunization for HIV or HCV, and no recommended post-exposure prophylaxis (PEP) for HCV. The only solution is therefore to prevent infection by preventing exposure.
Sharps injuries are a major source of HCV infection among healthcare workers, causing approximately 39% of the HCV infections globally that occur in this group every year. Often, symptoms of HCV do not emerge for up to twenty or thirty years after viral transmission occurs, meaning that infection may go undiagnosed for decades. As many as 85% of those infected with HCV develop chronic liver infection and are at risk of developing cirrhosis and hepatocarcinoma or liver cancer.
What measures should my employer be taking to reduce the risk of sharps injuries?
The European Union (Prevention of Sharps Injuries in the Healthcare Sector) Regulations 2014 (“the Sharps Regulations”) deal specifically with the risks posed to nurses and healthcare workers by the use of sharps in the course of carrying out their everyday duties and set out the measures which employers must adopt in order to minimize the risk of sharps injuries.
The Sharps Regulations place duties on both employers and employees to:
- assess the risks of sharps injuries.
- select appropriate controls to minimize the identified risks.
- implement these controls through safe working procedures and the provision of information and training.
- have in place arrangements for accident reporting, follow-up and the care of any injured employee.
In work environments where appropriate sharps safety policies have been implemented, a marked decrease in needlestick and sharps injuries has been observed. This may be attributed to the elimination of needle recapping and the use of safer needle devices, sharps collection boxes, gloves and personal protective gear, and universal precautions.
Examples of some of the practices that can be easily implemented and which have proven to be extremely effective in reducing the risks of sharps injuries include:
- eliminating needle recapping and avoiding unnecessary injections.
- safely managing sharps waste by collecting contaminated materials immediately after their use, without recapping any needles used, and placing them in specially designed watertight and puncture-proof sharps containers.
- using safer sharps devices such as autodisposable syringes, needle-free devices, and retractable or sheathed needles.
- providing appropriate personal protective equipment, such as gloves, gowns and masks.
- training and informing nurses and healthcare workers on the risks of transmission of bloodborne pathogens and on safe practices to combat transmission.
Not surprisingly, no matter how good a sharps injury prevention policy is on paper, numerous studies have shown that the provision of adequate resources is the real key to minimizing injury, with a clear relationship between the heightened prevalence of sharps injuries and understaffing having been demonstrated. In certain studies, nurses from units with low staffing and poor organizational climates reported twice as many sharps injuries than nurses on well-staffed units. Accordingly, even where your employer’s policy ostensibly complies fully with the obligations laid down by the Sharps Regulations, your employer may nevertheless be liable to compensate you for a sharps injury which was caused due to understaffing or any other want of resources in the workplace.
Should I receive vaccinations to prevent infection?
The Safety, Health and Welfare at Work (Biological Agents) Regulations 2013 provide that a risk assessment should be performed to establish if vaccinations are required for employees in a particular work setting. This assessment should occur before commencing employment.
The general rules set out in the 2013 Regulations are enhanced and given more specific focus by the Sharps Regulations. The Sharps Regulations require that a healthcare employer is obliged to carry out a risk assessment in respect of each employee’s work activities. Where the risk assessment indicates that there is a risk of exposure to a biological agent for which an effective vaccine exists, the employer must offer the vaccine (free of charge) to the employee at risk.
Currently a vaccine is available for protection against HAV and HBV, but not for HCV or HIV. The Immunisation Guidelines for Ireland issued by the National Immunisation Advisory Committee of the Royal College of Physicians of Ireland provide that healthcare workers who have direct patient contact should be immunized against HAV and HBV. As certain vaccinations will provide protection for only a limited period, care should be taken to ensure that the protection remains by receiving further vaccinations as required.
While immunisation is obviously a very effective healthcare intervention for those pathogens for which it is available, the fact that an employer offers free vaccination does not in any way reduce the ongoing obligation to have in place good infection control practices and standard precautions.
What should I do if I’ve suffered a sharp-related injury?
If you suffer an injury from a sharp which may be contaminated, the immediate steps to be taken to minimize the risk of infection are:
- encourage the wound to gently bleed, ideally holding it under running water.
- Wash the wound using running water and plenty of soap.
- do not scrub the wound whilst you are washing it.
- do not suck the wound.
- after bleeding and washing the wound, dry it and cover it with a waterproof plaster or dressing.
- seek urgent medical advice to ensure that all additional medical treatment that is required is received as soon as possible.
Once you’re sure that you’ve received all appropriate medical treatment as soon as possible you should be sure to complete an incident report form. Clearly describing how the accident occurred will be invaluable in working out what can be done prevent similar incidents from happening again in the future. By identifying where and how injuries occur in specific settings, interventions can be easily recognized and prioritized.
What additional precautionary measures should be taken if I believe I’ve suffered a sharps injury?
Post exposure prophylaxis (PEP) considerably reduces the risk of HIV infection among healthcare workers who have been injured with contaminated sharps, with some studies suggesting that it can be successful in preventing infections in up to 80% of cases in which it is employed.
However, for PEP to be effective, it should be started immediately or in any case no later than two hours after the event giving rise to the suspected exposure. It should then continue for a month to be most effective. PEP rapidly loses its effectiveness if its initial administration is delayed, with some reports indicating that if delayed by more than 72 hours, it is not effective at all.
As taking PEP will result in certain symptoms and side effects, if you have been placed on a course of this medication you should also be provided with additional support from your employer to manage these resulting issues.
Even where it turns out that a sharps injury has thankfully not resulted in any infection, the psychological impact of the fear of having contracted a deadly virus can obviously be very damaging. For this reason, appropriate counselling services should be provided to you to ensure that you are able to cope with the ordeal mentally and that you do not suffer any psychiatric injury which could be avoided by provision of the appropriate support mechanisms.