Get on the right side of the sharps practice law
A Nursing Times special event gathered together senior nurses to consider what action they needed to take to protect themselves and their staff from needlestick injuries as the EU Directive becomes law in May 2013
Attendees at the Nursing Times/Becton Dickinson event on 2 May, Covent Garden, London
- Kerry Bloodworth, assistant director of nursing, Nottingham University Hospitals Trust
- Peter Carter, chief executive and general secretary, Royal College of Nursing
- Julie Cotterell, marketing manager, Becton Dickinson
- Cynthia Davis, deputy director of nursing, Croydon Health Services Trust
- Steve Hams, deputy chief nurse, East Kent Hospitals Trust
- Jane Hentley, director of nursing, East Sussex Healthcare Trust
- Fergus Keegan, deputy director of nursing, Kingston Hospital Trust
- Jenni Middleton, editor, Nursing Times
- Liz Morgan, chief nurse and director of education, Great Ormond Street Hospital Foundation Trust
- Mandy Rayani, assistant director of nursing, Cardiff and Vale University Local Health Board
- Cormac Smyth, marketing manager, Becton Dickinson
- Peter Walsh, director of nursing practice, Central & North West London Foundation Trust
A hospital trust was fined £20,000 in 2010 after a healthcare worker contracted hepatitis C following a needlestick injury (NSI). The trust was found guilty of breaching the Health and Safety at Work Act and the Control of Substances Hazardous to Health. Those penalties could get tougher in the next 12 months as the EU Directive 2010/32/EU on sharps injuries becomes law in May 2013.
Tougher policing of sharps practice and penalties for those not adhering to the law could be in order from this date.
The directive is one that the Royal College of Nursing has been campaigning for ten years, and according to its general secretary and chief executive Peter Carter, it’s one that is long overdue.
At an event organised by Nursing Times and sponsored by medical devices manufacturer Becton Dickinson, he told the group of nursing directors and deputy chief nurses that he felt proud this law was coming onto the statute books.
“In a 2008 survey, we found that 45% of nurses said that at some stage of their careers they had suffered a needlestick injury,” he said. “Thankfully only a very miniscule amount of those had contracted a life-threatening condition, such as HIV or hepatitis C, but those people are suffering months of anxiety and distress.”
But, according to many industry professionals, good practice around sharps is still not being taken seriously enough and preventable injuries continue to occur.
Many nurses at the event believe needlestick injuries went under-reported in their organisations and that the problem could be far higher than the statistics indicate.
Mandy Rayani, assistant director of nursing at Cardiff and Vale University Local Health Board, recalls working ten years ago with a colleague who had suffered a needlestick injury and remembers only too well the months of stress it caused while she awaited the results. She says since then, organisations have worked hard to increase awareness and support staff who have injuries, and staff realise the importance of reporting injuries.
Cynthia Davis, deputy director of nursing, Croydon Health Services Trust, had a similar experience with a colleague she worked with, and also agreed that having a needlestick injury, even if the risk of contracting a serious condition was small, could be hugely debilitating for staff. “They don’t know who to tell,” she says. “There has to be a culture where they can report these things and get support.”
“There was a belief that NSI at some time in your career is to be expected,” says Fergus Keegan, deputy director of nursing, Kingston Hospital Trust. “That shouldn’t be the case.”
Taking the lead
When asked if apathy was to blame for the lack of action, all delegates said they recognised the importance of eliminating NSI, but just felt bombarded with so much to comply with. And, against a background of having to make cuts, it was hard to push it up the agenda. They knew it was serious but it was one of many serious things they have to take care of. Most delegates agreed that it was “a case of how you prioritise your priorities”.
“Unless it’s mandated that you can’t, say, become a foundation trust unless you do this, it won’t get done in many hospitals,” says Jane Hentley, director of nursing East Sussex Healthcare Trust.
All the delegates believed it had to be led from the top down, while nursing still made its presence felt in any decisions or changes to practice that were made.
When asked, all the attendees agreed nurse directors and managers have a moral obligation to ensure that staff were safe.
That was certainly the view of Peter Walsh, Central and North West London Trust director of nursing practice, who because he believed it was a moral responsibility to take care of his staff, had taken a lead on this and implemented safety measures ahead of the directive. He provided evidence that taking a strong lead and changing culture pays dividends. Introducing a sharps policy and providing needle-protected products brought about zero incidences of NSI at his trust. He says even extremely experienced nurses in his trust have had needlestick injuries and stressed the importance of training for all.
The group acknowledged investment is often required when implementing new devices to reduce needlestick injuries. They also agreed that good business cases that look at the true cost benefit are key to successful introduction of safety products. Factors such as the cost of testing, counselling and staff absence need to be factored in to get a true picture of the financial impact. Steve Hams, deputy chief nurse, East Kent Hospitals Trust, said his trust had used this approach successfully.
He was not alone in believing training is vital for changing the culture and attitudes to needlestick injuries. For all delegates, training was essential. “We make sure that nurses are able to collect blood and take blood, but we don’t learn how to protect ourselves,” was the common view.
“It’s great to get hands-on training, and our trust ran such drop-in sessions for our staff,” says Mr Hams, who believes his trust is ahead of the directive becoming law, having set up a policy and training framework. He also commented on the role of industry in working with the trust to provide training and product support.
Ms Davis agreed that such training is useful and believed that competency assessment should be an essential part of the practical training.
Kerry Bloodworth, assistant director of nursing of Nottingham University Hospitals Trust, believes that practical skills need to be taught in person but she also welcomes the idea of backing these up with e-learning scenarios. “I think we need training that increases knowledge and raises awareness. Some three-minute videos or apps would be useful – you’ve got to make the training appeal and work for a lot of people, especially as taking time out for classroom teaching costs so much.”
Involving all the staff
Everyone agreed that this is an issue that isn’t restricted to nursing staff.
“The integrated approach works best,” says Ms Hentley. “Porters and domestics can easily be harmed (by unprotected needles) and you don’t want people working hard in practice and then someone who is less careful letting their colleagues down.”
Mr Keegan agrees. “The issue is about getting it right across the whole organisation. Some people have different preferences in different areas and it’s important to coordinate it centrally. We should look at more standards and standardisation.”
He also raised the issue that with a transient workforce, it would be easier if staff could prove they had been trained properly in this area and had a passport they could take to any trust to prove that they had met certain competencies.
“I think we should almost name and shame people,” says Ms Hentley. “That is how we get the message out there.”
The right products and buying
Nurses and other healthcare professionals should have a closer working relationship with suppliers, according to Mr Carter. He says healthcare workers have an almost “schizophrenic” relationship with suppliers and tended to “keep them at arm’s length”, which meant they missed out.
The senior nurses in the room agreed with this view that there was huge benefit to someone with clinical experience being in charge of the buying.
“We have a clinical procurement matron,” says Ms Bloodworth, “It helps to have someone in this role who knows what they are buying and what is out there.”
According to Mr Walsh one of the most troublesome products for nurses is diabetic pens. “Even some very experienced nurses have jabbed themselves with those. Some work is needed in that area.”
At his trust, they have moved to all retractable needles, but he identifies that people get comfortable with equipment they have always used.
All delegates agreed that staff get used to using the same devices and can be reluctant to change products or practice even if it provides better personal protection.
Some nurses admitted that they have staff who resheath needles and who were unclear why this was bad practice.
It was felt by the nurses that medical devices manufacturers had a duty to discontinue supply of products that were unsafe, as Mr Keegan said: “You haven’t been able to buy a new car without seatbelts since the seatbelt law came in.”
What does the EU directive on sharps mean for you?
By 11 May 2013, you must comply with the main requirements of the directive, which are:
- Trusts and organisations must carry out assessments of the risk of exposure to blood-borne infections from sharps injuries, and work out ways to eliminate those risks
- Where exposure cannot be eliminated, risks of NSI should be prevented through: implementing safe procedures for using and disposing of sharp medical instruments and contaminated waste; eliminating unnecessary use of sharps by changing practice and providing devices with safety-engineered protection features; providing sharps bins and other disposal sites as close as possible to areas where sharps are used and banning the practice of recapping
- Implement safe systems of work by: developing an overall prevention policy that looks at work habits such as staffing numbers and working hours; use of technology, working conditions (lighting and space) and psycho-social factors. Train staff appropriately and undertake health monitoring
- Use of personal protective equipment, such as gloves
- Ensuring at-risk staff and students are vaccinated appropriately for hepatitis B, for example
- Raise awareness of risks and good practice through information
- Record incidence/accidents and offer support
If you are not sure if you will be compliant in May 2013, please contact Becton Dickinson at:
The Danby Building
Edmund Halley Road
Oxford Science Park, Oxford
Tel: 01865 781 666
Fax: 01865 781 627
E-mail: firstname.lastname@example.org or see BD’s safety website, www.bd.com/europe/safety
Go to http://www.rcn.org.uk/__data/assets/pdf_file/0008/418490/ 004135.pdf for a copy of the directive
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