Sharps Injury Prevention and Blood Borne Virus Exposure - SHARPS

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					   SHARPS INJURY PREVENTION & BLOOD BORNE VIRUS
            EXPOSURE PREVENTION POLICY




LEAD DIRECTOR:          Stephanie Dawe, Chief Operating Officer & Director of
                        Infection Prevention and Control

POLICY APPROVED BY:     Executive Management Team

DATE POLICY APPROVED:   October 2009

IMPLEMENTATION DATE:    October 2009

REVIEW DATE:            November 2011


                                                                       Policy No IC003:
                                                                            Page 1 of 14
                          Document Control Sheet
Policy Title
                                                     Blood Borne Virus
                                                Exposure Prevention Policy


Purpose of Policy               The purpose of this document is to highlight the
                                risks from blood and body fluid exposure and to
                                provide Healthcare Workers (HCW) with evidence
                                based guidelines to minimise these risks. Although
                                HCW’S are most at risk, patients can also be put at
                                risk of infection from blood and body fluid
                                contaminated equipment.


Lead Director                  Stephanie Dawe, Chief Operating Officer & Director
                                      of Infection Prevention and Control

Lead
                                                       Phil Cohen
                                                Infection Control Nurse
Version (state if final
 or draft)                                               Final
                                                       Version 2

Date
                                                       April 2007

Circulated to
                                    Operational Directors, Corporate and Local
                                    Integrated Governance Groups Executive
                                               Management Team
 If draft                    [only complete remaining boxes]
Draft Number


Comments to




By




                                                                             Policy No IC003:
                                                                                  Page 2 of 14
Table of Contents                                                            Page


        Assurance Statement ……………………………………………………..                             4
1.0     Introduction …………………………………………………………………                                 4
2.0     Aims and Objectives……………………………………………………….                              4
3.0     Duties and Responsibilities ……………………………………………….                        4
4.0     Implementation Process …………………………………………………...                          5
4.1     Education and Training…………………………………………………….                            6
5.0     Monitoring Procedure ………………………………………………………                            5-6
6.0     High Risk Body Fluids ……………………………………………………                             6
7.0     Causes of Blood and Body Fluid Exposure…………………………….                    6
8.0     Definition of a Sharps Injury………………………………………………                       6-7
9.0     Practice recommendations……………………………………………….                            7
9.1     Gloves…………………………………………………………………                                        7
9.2     Aprons and Gowns…………………………………………………………                                 7
9.3     Management of specimens………………………………………………..                            7
9.4     Safe Sharps Practice……………………………………………………….                             8
9.4.1         Before Use………………………………………………………….                               8
9.4.2         During Use………………………………………………………….                               8
9.4.3         After Use…………………………………………………………….                               8
10.0    Equality Statement………………………………………………………..                              9
11.0    References Bibliography ………………………………………………….                          10
        Appendix 1- Safe Use and Disposal of Sharps Observational Audit       11
                    Tool
        Appendix 2- Personal Protective Equipment Observational Audit Tool    13




                                                                              Policy No IC003:
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        BLOOD BORNE VIRUS EXPOSURE & SHARPS INJURY PREVENTION POLICY

                                        Assurance Statement

The purpose of the policy is to ensure that all staff involved in clinical care are aware of the correct
procedures to follow for prevention of sharp injuries to minimise the risk of blood borne virus.
Implementation of the policy will demonstrate compliance with the ‘Hygiene Code’ (DH 2006).

1.0     Introduction

        Blood, body fluid and tissue should be regarded as potentially infectious. All healthcare
        staff should observe standard infection control precautions at all times to protect
        themselves, their patients and others from the risk of exposure to blood and body fluid and
        potential blood borne viruses at all times.

2.0     Aims and Objectives

        The purpose of this document is to highlight the risks from blood and body fluid exposure
        and to provide Healthcare Workers (HCW) with evidence based guidelines to minimise
        these risks. Although HCW’S are most at risk, patients can also be put at risk of infection
        from blood and body fluid contaminated equipment.

3.0     Duties and Responsibilities

        Risk Management
        Healthcare managers have a responsibility to provide a safe working environment for
        employees, contractors, members of the public, patients and visitors (HSWA and
        Environmental Protection Act 1990). A multi-faceted risk management strategy should be
        put in place to prevent and manage blood and body fluid exposures including:
             Sharps injury prevention
             Assessment of exposure/injuries
             Provision of safe equipment.
             Provision of Occupational Health Services
             Training of the risks associated with handling sharps and body fluids.
             Safe working procedures.
             Incident reporting systems.

3. 1.   Legal Requirements in the UK to Prevent to Prevent and Manage Blood and Body
                                         Fluid Exposure

         Regulation Name            Main Requirements                    Application
         The Health Act – 2006      An NHS organisation has a            Specific duty to adhere to
         Code of Practice for the   general duty to protect patients,    protocols for prevention and
         Prevention and Control     staff and others from HCAI by        management of occupational
         of Healthcare              having appropriate systems in        exposure to blood-borne viruses,
         Associated Infections      place.                               including prevention of sharps
         (DH 2006)                                                       injuries
         The management of          Employer must undertake suitable     Specific, detailed risk
         Health and Safety at       and sufficient risk assessments of   assessment of sharps handling
         work Regulations, 1999     all significant hazards in the       and disposal.
                                    workplace.

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        The Control of             Employer must undertake suitable       COSHH assessment of blood
        Substances Hazardous       and sufficient risk assessments of     and body fluids.
        to Health (COSHH)          all hazardous substances.
        Regulations, 1994
        The Personal Protective    Employer must assess the risks to      Provision of suitable and safe
        Equipment at Work          the employees in order to select       equipment.
        Regulations, 1992          and provide suitable protective
                                   clothing.
        The provision and use of   Employer must provide work             Provision of safety devices and
        Work Equipment             equipment that is suitable for the     other quality products and
        Regulations, 1998          intended job, which must be            sharps boxes etc
                                   maintained for safe usage.
        First Aid Regulations,     Employer must provide adequate         Provision of appropriate first aid
        1981                       first aid facilities,                  treatment post sharps injury.
        Reporting of Injuries,     Employer must report all injury        The HSE must be notified if any
        Diseases and dangerous     accidents that results in serious      staff member contracts a blood
        Occurrences                injury      and/or    occupationally   borne virus following a sharps
        Regulations (RIDDOR)       acquired disease, to the Health        injury.
        1995                       and Safety Executive.

3.2.   Staff Responsibilities

       Although the ultimate responsibility for the Health and Safety of staff rests with the chief
       executive, employees have a duty under the Health and Safety at work Act (1974) to
       comply with all safety procedures and policies to ensure that their actions will not harm the
       health and safety of themselves and others through careless disposal of blood and body
       fluids and contaminated sharps.

       The trust has formal arrangements in place with two local Occupational Health Services
       patients where relevant from hepatitis B virus. All HCW’S must be covered by pre-
       employment immunisation against HBV.

 4.0   Implementation Process

       The infection control group and the Integrated Committee are responsible for the
       implementation of this policy. The Director of Infection Prevention oversees the policy.

       Operational managers are responsible for ensuring that all staff are aware of the policy,
       and ensure that staff attend Trust training programmes which includes safe disposal of
       sharps.

       The policy should be read in conjunction with the trust Hand Hygiene and Standard
       Infection Control Precautions policies.

4.1.   Education and Training

       Infection control nurse will provide educational sessions at induction for new staff and
       during mandatory training updates for all Trust staff groups to highlight the risks of
       acquision of blood borne viruses from contaminated sharps injuries.

5.0    Monitoring Procedure


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      The policy and its implementation will be monitored through the Infection Control Group
      and the Integrated Governance Committee and groups.

      The Infection Control Nurse will audit compliance with this policy as part of the annual audit
      programme. Results will be reported to the Infection Control Group and Integrated
      Governance Committee. Reports will be sent to Clinical Managers.

      Infection Control Link Nurses have been trained to carry out sharps injury prevention and
      the appropriate use of personal protective equipment audits in their clinical areas.

6.0   High Risk Body Fluids

      Body Fluids that should be handled with the same precautions as blood
          Cerebrospinal fluid
          Peritoneal fluid
          Pleural fluid
          Synovial fluid
          Amniotic fluid
          Semen
          Vaginal secretions
          Breast milk
          All body fluids that contain blood, including saliva in dentistry
          Unfixed organs and tissues

7.0   Causes of Blood and Body Fluid Exposure

      Most exposures result from injuries involving the needle and syringe. The main risks of
      infection are from Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human Immune
      Viruses (HIV 1) and (HIV 2). There is evidence that HCW’s are most at risk of exposure to
      blood borne viruses (BBV’s) from contaminated sharps injuries. Injuries among nurses
      account for almost half of all injuries (HPA 2006).
        www.hpa.org.uk/publications/2006/eye_needle/pdf/eye_needle.pdf.

      The Health Protection Agency (HPA) seven year surveillance report highlighted that there
      was an increase of 67% in the number of HCW’s infected with Hepatitis C, from blood and
      body fluid contaminated sharps from source patients who are injecting drug users between
      July 2003 and June 2004 in the United Kingdom (UK).
      Injuries are most likely to occur if:
            Needles are re-sheathed after use.
            Not disposed of immediately after use.
            Risks also increase if sharps bins are not available for disposal at the point of use,
               or if bins are overfilled or not assembled safely.

      Most sharps injuries/NSI can be prevented and the main causes of injuries are due to
      users failing to follow safe procedures and policy for handling and disposing of needles and
      syringes (Castella et al 2003).

8.0   Definition of a Sharps Injury



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      A sharps or needle stick injury (NSI) can be defined as an injury from a needle or any other
      device that has been contaminated with blood or other body fluid and penetrates the skin
      percutaneously. The types that are associated with significant risks are:
      Percutaneously injuries from needles, instruments including razors, bone fragments and
      human bites that break the skin.
          Skin abrasions, cuts, eczema or any other condition non-intact skin condition,
             which is exposed to blood or body fluid.
          Mucous membranes, including eyes and mouth, exposure from blood splashes.

      Report any blood or body fluid exposures within one hour to A&E or Occupational Health
      (See Post Blood or Body Fluid Exposure Management Policy).

9.0   Practice Recommendations
9.1   Gloves:
      Cover any wounds, lesions or any breaks in the skin with waterproof dressings. Apply
      gloves to protect eczema or psoriasis, prior to carrying out any procedure where there is
      likely to be contact with blood or body fluid. Gloves are not an alternative to hand washing;
      always wash your hands before and after any patient contact and on removal of gloves
      (See Hand Hygiene Policy).

      Gloves do not need to be worn for contact with intact skin for routine procedures e.g. while
      checking blood pressure. Gloves must be worn when performing high risk tasks e.g. when
      taking blood. Gloves will not protect against a needle stick injury but the wiping of the blood
      through the glove can substantially reduce the volume of blood inoculated in the event of
      the needle stick injury (See personal Protective Equipment Policy).

9.2   Aprons and Gowns
      Wear protective clothing e.g. aprons or gowns where appropriate, for all clinical procedures
      where there is likely to be contact with blood or body fluid.

      Masks should be worn for any procedure where there is a risk of body fluid splashes or
      excretions into mucous membranes and for respiratory protection. Always carry out an
      assessment of the risk associated with the procedure in order to select the appropriate
      protection. Masks should be worn for protection against tuberculosis (TB) for prolonged
      close contact; use FFP3 masks for multi drug resistant TB (MDR-TB) in line with the TB
      and isolation precautions policy.

9.3   Management of Specimens
      A specimen is any body substance taken from a person for analysis, such as blood, urine
      or faeces. All specimens have a potential infection risk and must be packaged and
      handled appropriately. Specimens from patients who are known to have a BBV should
      have this information identified on the request form and on the specimen container. All
      specimens should be:
           Collected in the correct container.
           Securely fastened lids on containers
           individually placed into the correct plastic specimen bag
           Pins, staples or paper clips must not be used
           Specimens should be clearly labelled with details
           Clinical details must be correct
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              Request form must be separate to compartment for specimen
              Specimens should be transported in the community in rigid containers and not in mail
               envelopes
              Reach the laboratory as soon as possible
              Spillage must be dealt with immediately (See Decontamination Policy)

9.4     Safe Sharps Practice
9.4.1   Before Use:
            Always assemble sharps bins correctly, ensuring that the lid is securely snapped
              into position.
            Use rigid BS/UN approved Sharps bins.
            All products must be CE marked (MDA 2002)
            Bins must be available in a variety of sizes e.g. 1 litre bins for use Community CPN
              use and for use at patient bedside, and large bins for disposal of prescription only
              medicines.
            Bins must be available on drug trolleys, anaesthetic machines and in ECT suites
              and at all other locations where sharps are used.
            Used or in-use bins must never be placed on the floor.
            Always place the bin on a level surface, or wall mounted at waist height. Brackets
              are available from the manufacturers for wall or trolley mounting.
            Bins must be taken to where they are being used in a well fitting tray for disposal at
              the point of use.
            Close the temporary closure mechanism between uses.
            Never move an open sharps bin.
            Do not over fill the sharps bin or fill beyond the fill line.
            Identify your ward or community clinic by signing the label on assembling the bin.
            Always carry sharps bins by the handle and away from the body.

9.4.2   During Use
            Safety devices supplied by the Trust must be used at all times e.g. safer needles
              supplied with respiridone injections.
            Use intravenous devices with a safety feature whenever possible.
            Single use retractable lancets should be used for all capillary sampling.
            Practitioners must be competent in procedures using sharps.
            Wear appropriate personal protective equipment.
            Assemble devices with care.
            Do not disassemble devices.
            Never pass sharps from hand to hand or rely on others to dispose of your sharps.
            Do not re-sheath needles.
            Be vigilant during emergency procedures and get assistance with patients who are
              confused or potentially aggressive.
            The user is responsible for disposal of sharps.

        Never carry exposed used sharps in open cardboard trays through patient areas,
        always transport used sharps in sharps bins with a compatible trays.

9.4.3   After Use
             Dispose of sharps immediately after use at the bedside or in the patient’s home.
             Needles and syringes must be disposed of as a single unit.
                                                                                      Policy No IC003:
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             Do not leave full sharps boxes for disposal by other staff.
             Shut, lock and label bin when full for disposal.
             Never use tape to seal sharps bins.
             Label bin using the NELMHT unique ID tag to identify the source, such as Hospital
              or Community Clinic.
             Never dispose of sharps bins in clinical waste bags.
             CPN’S doing domiciliary visits should only carry the community size sharps bins
               with compatible trays.
             Community psychiatric nurses must return sealed sharps boxes to the community
              clinic for disposal.
             Always place a damaged or broken sharps bin into a larger sharps box for safe
              disposal.
             Never decant contents of community sharps bins into larger bins.
             Full sharps bins must be stored in a secure locked disposal hold away from the
              public while awaiting collection.
             Used sharps bins must not be stored in clean treatment areas and must never be
              mixed with sterile items in cupboards.

       Remember it is your duty to protect yourself and others from injury!

10.0    Equality Statement

       The Trust is committed in having in place a sustainable people driven service with care
       system which are best of class. The Trust values embracing diversity and will make every
       effort to ensure that the needs of different groups of people, including people from different
       race, religion or belief systems, age, gender, disability and sexual orientation, are met
       effectively and sufficiently, as appropriate.




                                                                                       Policy No IC003:
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11.0 References:
Health Protection Agency. (2006) Eye of the Needle. HPA. 14. Accessed 13.03.07
www.hpa.org.uk/publications/2006/eye_needle/pdf/eye_needle.pdf.

UK Health Departments Guidance for Clinical Health Care Workers: Protection Against Infection
with Blood-borne Viruses. Recommendations of the Expert Advisory Group on AIDS and the
Advisory Group on Hepatitis. 1998.

Infection Control Nurses Association. Protective Clothing. Principles and Guidance. Lance
Publishing Ltd. 2002.

Immunisation against Infectious Disease. 2006, HMSO, UK Health Departments             ISBN 01
322528-8

The management of staff health and welfare issues for NHS staff. Department of Health (1998).

Protecting health care workers and patients from hepatitis B: recommendations of the Advisory
Group on epatitis. Department of Health, HSG(93)40 1993. Addendum was issued under cover
of EL(96)77, 1996.

Protection against blood-borne infections in the workplace: HIV and hepatitis (ACDP) 1995,
HMSO, ISBNn 321953 9

Medical Devices Agency (2002) The Medical Devices Regulations Stationary Instrument 2002
Number 618, The Stationary Office.

Health and Safety Executive (1999a). Management of Health and Safety at Work Regulations –
Approved code of practice. Sudbury, HSE.

Health and Safety Executive (1999b). The Control of Substances Hazardous to Health
Regulations. Sudbury, HSE.

Health and Safety Commission (1992). Personal Protective Equipment Regulations 1992 –
Approved code of practice. Sudbury, HSE

Health and Safety Executive (1998). The Provision and Use of Work Equipment Regulations.
Sudbury, HSE.

Health and Safety Executive (1996) A guide to the Reporting of Incidents, Diseases and
Dangerous Occurrences Regulations 1995. Sudbury, HSE

Cardo D M, (1997) A case – control study of HIV seroconversion in healthcare workers after
percutaneous exposure. New England Journal of Medicine. 337: 1485-90.

Pratt R, Pellowe C, Loveday H P, Robinson N, Smith G W and the epic guideline development
team (2001). The epic Project: Guidelines for preventing Hospital-acquired Infections, Journal of
Hospital Infection; 47 (Supplement) S1-S82.

Castella A. Vallino A. Argentero P. Zotti M (2003) Preventability of percutaneous injuries in
healthcare workers: A year-long survey in Italy. Journal of Hospital Infection. 55:290-294.
                                                                                    Policy No IC003:
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SAFE USE AND DISPOSAL OF SHARPS OBSERVATIONAL AUDIT TOOL
Please carry out this audit on a monthly basis. Carry out observations 5 times. Send results to
your Lead nurse and forward a copy to the NELMHT Infection Control nurse. Retain a copy
in your clinical environment.

Safe disposal of sharps, expected standard:
Staff should always dispose of sharps safely to prevent infection risks to patients, staff and
members of the public in line with the trust sharps injury prevention policy.
Compliance target = 100%

Key:         Yes = Sharps disposed of safely
              No = Not performed safely.
Observers Name & Role:        Date:                         Time:         Location:
 Sharps disposal observations                        Doctors        Nurses      Others
                                         Yes   No

 Bins have not been filled above the
 fill line

 Bins are free from protruding sharps

 All bins have been assembled
 correctly
 All sharps bins are labelled and
 signed & dated on first and final
 closure
 Sharps bins are stored separately
 from general & clinical waste in a
 locked area, away from the public
 and out of reach of children
 Bins are stored appropriately off the
 floor

 Once full the bin opening is locked

 Needles and syringes are discarded
 into a sharps bin as one unit
 Sharps are disposed of at point of
 use
 Sharps trays with integral sharps
 bins are primed ready for use in
 emergency situations.
 Needles are never re-sheathed after
 use
 Staff are aware of the policy and
 procedure to follow in the event of a
 sharps injury
 Sharps trays are visibly clean

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                                        INFECTION CONTROL

                   SHARPS AUDIT OBSERVATIONS – FEEDBACK FORM


DATE……………….                 TIME....................... LOCATION.............

OBSERVERS NAME..............


NUMBER OF OBSERVATIONS CARRIED OUT:


RESULTS SCORE:


                          Number of yes scores divided by the total number of
                            observations multiplied by 100 = % Compliance




SPECIFIC FEEDBACK……………….




FEEDBACK GIVEN TO.............................




FURTHER ACTION REQUIRED…………..




                                                                                Policy No IC003:
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        PERSONAL PROTECTIVE EQUIPMENT (PPE) OBSERVATIONAL AUDIT TOOL

Please carry out this observational audit on a bi-monthly basis. Observe practice 5 times. Forward
a copy to the Lead Nurse, to the NELMHT Infection Control Nurse and retain a copy in your clinical
environment.
Standard: Appropriate protective equipment should be worn to protect both the patient and the
member of staff. Aprons should be worn for direct patient care, gloves and aprons for exposure to
all body fluids and cleaning. Gloves and aprons are single use only items and should be worn and
disposed of appropriately. Goggles and masks should be worn only if needed.

For every opportunity observed please record: YES for the correct use of PPE or NO for
incorrect use of PPE. Compliance target =100%

Observers Name:                              Date:           Time:          Location:

                                             Yes     No                         Support
 PPE observations                                         Nurses     Doctors
                                                                                Workers
 Gloves are worn for invasive procedures
 e.g. phlebotomy & injections
 Sterile gloves are worn for contact with
 sterile sites

 Contact with mucous membranes

 All activities that have been assessed as
 carrying a risk of exposure to body
 fluids

 Gloves are worn as a single use item

 Gloves are applied immediately before
 an episode of patient contact and
 removed immediately afterwards
 Hand hygiene is performed following
 removal of gloves
 Disposable plastic aprons are worn
 when there is a risk that clothing may
 become exposed to body fluids
 Aprons are colour coded for different
 procedures e.g. food and clinical care
 Aprons are worn as a single use item
 Face masks are worn if there is a risk of
 body fluid splashing on to the face
 Respiratory protective equipment e.g.
 particulate filtration masks are used for
 open pulmonary tuberculosis




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                                        INFECTION CONTROL

    PERSONAL PROTECTIVE EQUIPMENT OBSERVATIONS – FEEDBACK FORM


DATE……………….                 TIME....................... LOCATION.............

OBSERVERS NAMES..............


NUMBER OF OBSERVATIONS CARRIED OUT………….


SCORE:


                          Number of yes scores divided by the total number of
                            observations multiplied by 100 = % Compliance




SPECIFIC FEEDBACK…………………




FEEDBACK GIVEN TO.............................




FURTHER ACTION REQUIRED……………..




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