Nurses must assert their right to use safer sharps, according to the co-author of research showing many trusts are still failing to comply with regulations to reduce the risk of needlestick injuries.
The study, by analysts MindMetre Research, gathered information from more than 120 hospital trusts. It found “unacceptable” levels of compliance with sharps health and safety regulations two years after they came into force in the UK.
Nurses should insist trusts obey sharps safety rules
The regulations, which were introduced in 2013 on the back of EU legislation, expected trusts to ensure all sharps incorporate safety mechanisms where possible.
“Although progress has been made, the proportion of safer sharp devices is still nowhere near what would be reasonably expected in order to be fully compliant,” stated the report.
Paul Lindsell, managing director of MindMetre and co-author of the How Sharp Are We On Safety? report, told Nursing Times the level of improvement was simply not good enough.
Mr Lindsell said it was the responsibility of managers at all levels, including senior nurses and nursing team managers, to ensure safe practice. But he said it was also vital frontline nurses knew and understood their rights.
“There is definitely a lack of awareness on the shop floor, particularly among nursing staff, that this is their right,” he said in an exclusive interview with Nursing Times. “This is not ‘nice to have’, this is the law. Nursing staff at all levels have the right to be protected in the workplace.”
He called on nurses to raise concerns and challenge their organisations if asked to use non-safety sharps for no good reason.
“If their institution does not make a safety sharp available where reasonably practicable, then they should say ‘I’m sorry but you are asking me to do something that is against the law’,” he said.
The MindMetre study, based on a series of Freedom of Information requests, found trusts were buying more safety sharps than before.
“We are under-staffed in many areas of the health service so – for goodness sake – we should be protecting our people”
However, it revealed a worry proportion of devices purchased last year did not feature safety mechanisms that can help protect nurses and others from injury and blood-borne infections like hepatitis and HIV.
Data from 121 acute trusts shows more than one in five cannulas and nearly a third of blood collection needles bought in 2015 did not incorporate safety features. Meanwhile, more than half of injection needles – 56% – were not safety sharps.
This is despite official guidance from the Health and Safety Executive saying employers should replace traditional, unprotected sharps with safer sharps “where it is reasonably practicable to do so”.
Safety devices can be used for the vast majority of tasks, though there are a small handful of procedures where they cannot be used – mainly work with very young or premature babies.
“The whole reason EU-wide legislation was introduced to reduce needlestick injury and potential infection is that one case is one case too many,” said Mr Lindsell.
“It can ruin someone’s career and could ruin their life. We are under-staffed in many areas of the health service so – for goodness sake – we should be protecting our people,” he said.
However, Mr Lindsell said it was encouraging to see a significant increase in the use of safer sharps in recent years and it was clear the regulations had made a difference.
The proportion of cannulas fitted with safety mechanisms increased from 69% in 2013 to 79% in 2015.
“The bottom line is the employer is responsible for maintaining the health and safety and welfare of their worker”
In blood collection, the proportion went up from just 35% safety devices in 2013 to 68% in 2015, while the proportion of safety injections went from a quarter to 44%.
Mr Lindsell said organisations had tended to focus on cannulation, as it was recognised as a high risk procedure often carried out in tricky circumstances.
He suggested there had been less emphasis on blood collection because it was perceived to be fairly safe and generally carried out in a “highly controlled environment” by experienced phlebotomists. But he described this perception as “mistaken over-confidence”.
Meanwhile, poor compliance when it came to simple injections was “a real concern”.
“The real worry is the lack of recognition around injections, which are carried out in the most risky environment – accident and emergency,” he said.
“It may be an element of that is down to the dedication of A&E doctors and emergency nurses who are so focused on dealing with patients in a critical state, where seconds matter that they don’t consider their own safety,” he said. “But from a management point of view this is simply unacceptable.”
|Percentage of safety sharps devices puchased by NHS trusts|
|Source: MindMetre Research|
Mr Lindsell said the average figures masked wide variation in practice at individual trusts.
“What sits behind these numbers is a polarisation, so you get some trusts that were virtually 100% compliant across all areas and a rump of trusts whose compliance levels are surprisingly low,” he said.
Trusts who have failed to comply with sharps safety regulations have been issued with improvement notices by the HSE.
Mr Lindsell said failure to comply risked damaging an organisation’s reputation and might make it harder to recruit staff.
Robert Baughan, national officer for health and safety at Unison, he was “disappointed” but “not entirely surprised” by the findings, because “intelligence we’ve been receiving and research we’ve done in the past shows compliance has been patchy”.
Nurses should insist trusts obey sharps safety rules
“Europe was right to regulate because there were shortcomings in this area and the HSE were prompt in their compliance with it in terms of the regulations they produced,” he said. “There have been improvements, but this shows there is still much to be done in implementation.”
Mr Baughan said compliance was particularly patchy in community settings, especially GP practices. He added that there was a particular problem with flu vaccinations.
“The manufacturers are only producing pre-filled syringes, which are old-style conventional devices, so employers are saying there is no alternative,” he said. “Yet the manufacturers say the reason they are not producing new devices is because there isn’t the demand – it’s a bit of a Catch-22 situation.”
He said employers had a duty to ensure nurses and other staff were safe.
“The fact some trusts do have a high take-up rate puts pressure on those that aren’t compliant,” he said. “If it is reasonably practicable for 50% of trust to comply then it is reasonably practicable for the other 50% and there can be no excuses.
“The bottom line is the employer is responsible for maintaining the health and safety and welfare of their worker and so we’d expect them to comply with that duty and to comply with the sharps regulations.”