1. Council Directive 2010/32/EU Implementing the Framework Agreement on prevention from sharp injuries in the hospital and healthcare sector concluded by HOSPEEM and EPSU Kim Sunley Senior Employment Relations Adviser RCN

2. Why be concerned about sharps injuries? u Moral case –17 Hepatitis C cases –5 HIV cases –and countless hidden cases.... u Costs –Blood tests, counselling, treatment, litigation, staff time....£500, 000 per annum –one incident £330 to £11, 000 per annum –Criminal cases & personal injury cases u Preventable

5. Definition of sharp u objects or instruments necessary for the exercise of specific healthcare activities, which are able to cut prick cause injury and or infection.

6. Who does the directive cover? u Workers in the hospital and healthcare sector u Private and public u Students & temporary staff u Sub contractors

7. Underlying Principles u Well trained and adequately resourced workforce u Exposure prevention u Responsibilities for employers and individuals u Role of safety representatives and consultation u Never assume there is not a risk u Apply hierarchy of general principles u Promote a no blame culture to promote incident reporting and focus on systemic failures

8. Key requirements u Risk assessment u Elimination, prevention and protection u Information and awareness raising u Training u Reporting u Response and Follow-up

9. Risk Assessment u Assess who is at risk from injury and exposure and how? –Highest risk from hollow bore needles –High risk procedures blood collection, IV cannulation and percutaneously placed syringes –Still a risk from lancets, scalpels, suture needles etc.

10. Type of exposure by occupation, 2000-2009 Provisional data to end 2009 Source: Health Protection Agency

11. Elimination, Prevention and Protection u Eliminate the unnecessary use of sharps by implementing changes in practice or equipment u Where exposure cannot be eliminated provide medical device incorporating safety- engineered protection mechanisms u Ban on recapping u Safe disposal “as close as possible” to areas where sharps being used

12. Source: Prof Dr A Wittman, University of Heidelberg, Germany in EU Bio-safety network toolkit (2010)

13. Elimination, Prevention and Protection u Safe systems of work u Use of personal protective equipment e.g. Gloves u Where available provide protective vaccination i.e. Hepatitis B u Health monitoring

14. ILO/WHO Hierarchy of Controls Elimination or substitution (e.g. eliminate unnecessary injections, needle free systems) Engineering Controls (e.g. safer needle devices, sharps containers) Administrative (policies and training programmes) Work Practices (Universal Precautions, no recapping) Personal Protective Equipment (gloves, masks, gowns, etc) MOST EFFECTIVE LEAST EFFECTIVE ILO/WHO (2005) Guidelines on health services and HIV/AIDS

15.  Primary Care Trusts and Hospital Trusts and any other relevant healthcare settings, should be encouraged to adopt safety devices in place of the conventional devices, in order to prevent needlestick injuries in HCWs. (HPA eye of needle 2008)  A review of seven studies of safer needle devices demonstrated a reduction in injuries from 23-100 per cent with an average of 71 per cent. (WHO/ILO 2005)  When educational programmes were implemented alongside a safer sharps device, lower rates of sharps injuries were sustained for longer (HSL Systematic Review of the efficacy of sharps safety devices 2012)

16. A word on safety engineered devices … u The device must not compromise patient care u The device must perform reliably u The safety mechanism must be an integral part of the safety device, not a separate accessory u Easy to use and require little change of technique u Activation of the device must be convenient and allow care give to maintain appropriate control over the procedure u The device must not create other safety hazards or sources of blood exposures u Single handed or automatic activation is preferred u Activation must manifest itself by means of an audible, tactile or visual sign to the health professional u Not reversible when activated Source: NHS Employers/POSHH/SNN (2010) Implementation advice on sharps agreement

17. Key requirements (contd.) u Information and awareness raising u Training u Reporting u Response and Follow-up

18. Next steps u Must be transposed in UK law by 11th May 2013 u HSE consultation out – closes 8 th November u HSL research published on efficacy of safety engineered devices u HSE audits u EU level work u RCN workshops & publication u Development of resources

19. HSE Consultation – The Health and Safety (Sharp Instruments) Regulations 2013 u Application of duties u Use and disposal u Information and training u Reporting of injuries u Arrangements in the event of injury

20. Resources/Further information u www.hse.gov.uk www.hse.gov.uk u http://www.europeanbiosa fetynetwork.eu http://www.europeanbiosa fetynetwork.eu u http://www.tdict.org/evalu ation2.html http://www.tdict.org/evalu ation2.html u www.saferneedles.org.uk www.saferneedles.org.uk