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'Myths' could leave nurses in danger of sharps injuries

Nurses will remain at risk of unnecessary sharps injuries because half of trusts are unlikely to switch to safer needles, despite new European legislation.

Myths around the cost of safer devices will hinder their introduction in many cases, according to documents seen by Nursing Times.

European ministers ruled last week that risk assessments should be done in all areas where sharps are used and safety devices, such as retractable needles, introduced where a risk of injury is found.

A similar law was adopted in the US almost a decade ago and led to hospitals universally adopting safety syringes and needleless devices. An NHS trial of safety-only needles at University Hospitals Birmingham Foundation Trust led to a 70 per cent reduction in needlestick injuries over four years.

Campaigners now hope the EU law – which must be adopted by the UK within three years – will have a similar effect across the NHS.

Latest figures from NHS Supply Chain suggest that just 9 per cent of syringes and needles used in the NHS have safety devices to prevent nurse injuries.

But calculations made in 2008 by the Health and Safety Executive, seen by Nursing Times, show the agency expects only a 40 to 50 per cent of trusts to switch to safety devises over ten years.

The HSE calculate that will lead to only half of the estimated total 63,750 preventable needle stick injuries a year being prevented. That would be the equivalent of a 38 per cent reduction in injuries, compared with 70 per cent in the Birmingham study.

It says the lack of urgency is down to a “perception” that safety devices are very expensive, which would in turn influence those undertaking risk assessments to decide that costs outweigh the benefits of switching.

That perception is not borne out by the HSEs’ calculation however, which estimate that in 2008 the average extra cost of a safety device was just 5p more than a standard device. According to HSE figures, that would entail an extra cost to the NHS of just £6.2m a year if all NHS trusts switched to safety devices.

South London and the Maudsley foundation trust deputy nurse director Jane Sayer told Nursing Times her trust had decided four years ago to use only retractable safety needles.

She said: “They were more expensive, but it’s a risk issue so the decision was very clear: we were going to use retractables.”

But Royal Devon and Exeter foundation trust senior infection prevention and control nurse Judy Potter said the trust “hardly use” retractable needles because “they are not as sharp, [so] the patients find them much more uncomfortable”.

The directive sets out in EU law requirements for risk assessment, prevention and treatment of sharps injuries among healthcare workers.

Senior healthcare litigation solicitor at Hempsons Solicitors Miriam Farley told Nursing Times much of the directive was already implicit in UK law and regulation, but there was a perception EU law was needed to make NHS employers “take more action.”

She said the most significant change for the UK was the “immediate” ban on “re-capping” or re-sheathing of needles.

Although directors of nursing say this is already “a no-no”, re-sheathing accounts for up to 30 per cent of reported needle stick injuries a year.

The new law puts the onus on both employers and employees to completely eliminate re-sheathing. For directors of nursing that means ensuring adequate training, as well as providing sufficient sharps bins to remove the need for needles to be re-sheathed when being carried to a distant bin, she said.

But Ms Farley warned the law’s new “positive duty” on nurses to take responsibility for their own safety could act to limit potential claims against their employer, especially if they received an injury while re-sheathing.

Even if a nurse claimed he or she was “forced” to re-sheath a needle due to a lack of sharps bins, the courts may want to see evidence that the nurse had fulfilled their duty to alert the employer to the situation, Ms Farley said.

Readers' comments (4)

  • Why do we need new legislation to place the onus on both employers and employees over needle stick injuries. The 1974 Health and Safety at work act already states that employers have a duty to ensure the health and safety of employees, and employees have a duty to ensure their own health and safety.

    Under the 1974 Act a nurse who resheaths a needle when it is against their employer's policy would have little or no claim should they have a needlestick injury. If an employee's work practices are contrary to the policies of their employer then they do so at their own risk, the employer cannot be held accountable for the employee's stupidity or negligence.
    If there are insufficient sharps bins then the employee has a legal duty, under the 1974 H&SAW Act, to inform the employer that this has happened; the employer then has to ensure that sufficient safety equipment is in place.
    Therefore there is nothing new in this legislation that is not already part of UK law.

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  • From the US:
    1. We have 10 years of experience with our law (Needlestick Safety and Prevention Act 2000). We learned that the adoption rates of safety-engineered needles did not reach an adequate level to have a detectable impact on overall injury rates until we had an enforceable law requiring them. Adoption rates must exceed 50% for safety devices to have a significant impact in reducing overall needlestick rates. It took an enforceable law to motivate hospitals to achieve this level of adoption. If it's tied to hospital accreditation this usually gets results.
    2. Unfortunately, when nurses and administrators discuss "safety needles" they are usually referring to syringes. For the ultimate outcome of reducing the transmission of bloodborne pathogens it is important to focus on high risk devices/procedures - which clearly are blood drawing devices and vascular access devices. If you spend your money first on safety injection equipment (syringes) you will be targeting less than 3% of occupational transmission risk. If you focus on phlebotomy and IV catheter equipment you will be targeting more than 75% of transmission risk.
    3. It is a misnomer to refer to safety-engineered needles as "retractables." There are many different designs to achieve safety and retracting designs are only one. This is important because "retractables" (as well as any other type of safety feature) is limited to specific procedures. If you limit safety devices to one type of design you will not be able to address the full spectrum of risk.
    4. We have a lot of experience in the US with the adoption of safety-engineered sharps - glad to help out and reduce the "learning curve" for our European colleagues.
    Janine Jagger, Univ of Virginia

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  • With regards to recapping:

    If safety-engineered needles and sharps were universally adopted in the U.K., recapping would be a non-issue. In the U.S., in 1988, recapping accounted for 33% of injuries [Jagger et al, NEJM, 1988]; as of 1995 it was down to 6.8% (EPINet surveillance data, UVa); and in 2007, after widespread implementation of safety devices following passage of the Needlestick Safety & Prevention Act, it was 3%.

    That said, the figure quoted -- "re-sheathing accounts for up to 30% of reported needlestick injuries a year" -- is extraordinarily high, even for developing countries, and is probably not accurate. For example, in data from Brazil, 15% of SIs were due to recapping; in Mexican data, 8%.

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  • If the EU has brought out new laws for the safe disposal of sharps the UK has to adopt them.

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