Needlestick safety: the regulations highlighted

In response to an EU directive adopted in 2010, requiring all European member states to implement national laws for needlestick injury prevention by May 2013, the Health and Safety Executive (HSE) in the UK is currently in the process of reviewing the development of national laws. The new law will seek to mandate the use of safety-engineered devices and other procedures to protect those at risk of infection from blood-borne pathogens incurred through needlestick or sharp object injury. The EU Commission for Employment has estimated that needlestick injuries are one of the most serious health and safety threats in European workplaces, and are the cause of approximately one million injuries each year. The US introduced legislation in 2000 to reduce sharpsrelated injuries. However, despite this, such injuries do still persist within the healthcare sector, with the risk of blood borne virus transmission, as well as infectious diseases caused by other viruses and bacteria. This issue, therefore remains a concern for healthcare employers and occupational health professionals. “Much of the drive for sharpsrelated legislation in the US can be traced back to the onset of the AIDS epidemic in the early 1980s,” said Dr Mary Foley, chairperson of Safe In Common (SIC), a US-based nonprofit organisation dedicated to protecting healthcare workers at risk of needlestick injury. Dr Foley was been active within the American Nurses Association since 1994, and was its president from 2000-2002. She has also played a key role in the adoption of several state initiatives to reduce injuries to healthcare workers, and worked at national level to secure passage of the Federal Needlestick Safety and Prevention Act in 2000. Shortly after the law was passed in the US, there was a noticeable shift towards patient safety issues from healthcare leaders and the focus and momentum being built around the issue of healthcare worker safety was largely lost. Dr Foley continued: “In the last few years a pattern has emerged where workers are telling us that they are still working with unsafe equipment and there are still a great deal of worker injuries due to the use of unsafe devices. It would, therefore, appear that in the US, although we passed a good law, we then lost a sense of purpose on the intent of this law. When healthcare workers are being regularly exposed to over 20 infectious diseases, this poses a serious problem.” Keen to pass on some of her experiences of introducing sharps-related legislation, Dr. Foley said: “During this current review period, it would be wise for the HSE to pay close attention to what has transpired in the US over the last decade since we began to mandate and enforce the use of safety products in healthcare facilities. “The majority of acute-care facilities in the US have now largely converted to the use of safety engineered medical devices and this has helped to reduce overall rates of reported needlestick injuries by around one-third. However, it is clear we still need to address a number of outstanding challenges regarding compliance, enforcement and the selection of the safest, simplest medical products.” The Occupational Safety and Health Administration (OSHA) estimates that 5.6 million workers in the US healthcare industry are at risk of occupational exposure to bloodborne pathogens via needlestick injuries and other sharpsrelated injuries and that each year 385,000 needlestick injuries and other sharpsrelated injuries are sustained by hospitalbased healthcare personnel. This equates to an average of around 1,000 sharps injuries occuring every day in US hospitals.1 However, hospital-based incidents are only the tip of the iceberg in the US. Including other non-acute healthcare facilities, it is estimated that between 600,000 and 800,000 healthcare personnel incur a needlestick injury each year in the US.2 Around 40% of injuries occur after the use of, and before disposal of, sharp devices, 41% of injuries occur during the use of sharp devices on patients, and 15% of injuries occur during or after disposal. The Centres for Disease Control & Prevention (CDC) notes that while nurses sustain approximately half of all needlestick injuries, physicians, housekeeping and maintenance staff, technicians, and administrators are also harmed.3 “The UK now has the opportunity to lead the way,” said Dr Foley. “In doing this it is vital to recognise that healthcare workers outside of the hospital environment are also exposed to needlestick hazards and this section of the workforce does need to be included in any new legislation that is introduced. It should also include paramedics, funeral workers, care home workers and cleaning staff. The whole system needs to addressed,” she said.

Evaluating efficacy

A systematic review to evaluate the efficacy of safer sharps devices, conducted by the HSE in 2012, concludes that there is sufficient published evidence to consider the use of ‘safer’ sharps devices to reduce the incidence of sharps injuries among healthcare workers in the UK. The review looks at studies that have examined the impact of ‘specific’ training related to the use of safer sharps devices, which found that, where educational programmes were implemented alongside a safer sharps device, lower rates of sharps injuries were sustained for longer. Training and worker attitudes were integral to the success of these safer sharp device interventions. However, the benefit attributable to education alone could not be isolated from the impact of the introduction of the safer sharps device, said the review authors. Evidence reviewed by the HSE also concluded that healthcare workers should be consulted about the acceptability of any new, safer, sharps devices before their introduction. This is also a view strongly supported by Dr Foley. She said: “It is important that any proposed safety products are tested and evaluated by frontline care workers. “One of the benefits of introducing safer needles observed in the US is that is has added to the overall ‘culture of safety’. There is evidence to show that when healthcare workers believe that they are working in a safe environment, they are able to provide better care because they feel safe. It is this kind of argument that supports better alignment of worker and patient safety issues.”