22/05/2019
“Sharps” are an essential tool in healthcare provision. Common examples include needles for venepuncture, intravenous cannulae to provide fluid resuscitation and drug administration, as well as sutures in the operating theatre and emergency department. Clearly appropriate use and disposal is paramount, not only to protect the patient but also the user and indeed any other person who comes into contact with that environment from harm.
Every year several thousand needle stick injuries occur, many of which go unreported. While one may view these as part of the course, or indeed an occupational hazard, it must be remembered that there is a small but real chance of the transmission of blood borne viruses, importantly hepatitis B, C and HIV. These can be life changing, as well as preventing you from performing exposure prone procedures (EPPs).Thankfully; there are many small steps that if followed, should reduce your chance of such injuries.
Although it sounds like common sense, always pay full attention when performing procedures. Mistakes are often made when your concentration lapses. Universal precautions include latex gloves. While these do protect against exposure to bodily fluids, they will not prevent a needle stick injury. Always keep sharps directly visible at all times. This includes not placing a needle or suture on a surface above shoulder or eye level where you have to reach upwards to get it.
Never recap a needle; simply place it in a sharps bin tip first. When at the bedside, take a sharps bin with you to reduce the distance the needle needs to be transported after use. There should be no need to bend or snap a needle so that it fits in the disposal container. If a sharps bin is more than ¾ full make sure it is closed and sealed and use a fresh bin. Do not put your fingers inside a sharps bin. You cannot see them and the needles in the container may have come from high risk patients.
As part of your requirements for continuing professional development (CPD), it is vital that you attend updates on infection control and are appropriately immunised against hepatitis B.
Many new devices have been developed for venepuncture which may be safer than the traditional needle and syringe method. One of these is a needle with a hinged plastic device that can be flipped over the needle tip after use. Try to familiarise yourself with these.
If you are unlucky enough to sustain a sharps injury, it is important not to panic. First steps include squeezing the puncture site under warm running water to make it bleed. Wash the wound thoroughly with soap. There is no need to scrub it. Never suck a wound. Afterwards dry it and apply a plaster. Depending on the time of injury, your next step should be to contact occupational health or A+ E if it occurs out of hours. Bloods will be taken from you to check for hepatitis B, C and HIV. The patient from whom you sustained a needle stick injury will also need to consent to these bloods being taken from them, if they are able to.
The actual risks of blood borne infection remain low following a needle stick injury. However if the situation in which you obtained the injury is high risk, or if the risk cannot be quantified e.g. needle stick from a sharp incorrectly disposed of, you may be offered post exposure prophylaxis.
The time between getting an injury and hopefully getting the all clear can be a very testing period, but it is important that you practice safe sex and do not donate blood during this time. Psychological help is available for anyone affected by a needle stick injury.
“(Needle stick injuries) can be life changing, as well as preventing you from performing exposure prone procedures (EPPs)”
“Many new devices have been developed, especially for venepuncture, which may be safer than the traditional needle and syringe method…. try to familiarise yourself with these”.
References
http://www.hse.gov.uk/healthservices/needlesticks/resources.htm
http://www.newcastle-hospitals.org.uk/Needlestickinjuriesandbloodbornevirus201508.pdf
https://www.nhsemployers.org/~/media/Employers/Documents/Retain%20and%20improve/Needlestick20injury.pdf
https://www.nhs.uk/common-health-questions/accidents-first-aid-and-treatments/what-should-i-do-if-i-injure-myself-with-a-used-needle/
Dr. Zak Uddin
Mb ChB, MRCS, DRCOG, MRCGP
Consulting General Practitioner
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