1. The Management of Sharps in Primary Care
This presentation provides an introduction to the management of sharps waste in primary care.

2. What are “Sharps”?
Sharps are waste items that can cause injury and may pose a public health or infection risk
Examples include used needles, scalpel blades and stitch cutters
Sharps are classified as hazardous waste under the Controlled Waste Regulations 1992
A “sharp” is any waste item that can cause a penetrating skin injury and may pose a public health or infection risk. This includes needles, scalpel blades, stitch cutters and some glass, such as broken ampoules.

3. Why are Sharps Hazardous?
A scratch or skin puncture caused by an infected sharp may increase the possibility of infection with blood-borne diseases
The most common sharps injury is a so-called “needlestick” injury, where the person giving the procedure accidentally pricks themself with a used needle while disposing of it
Extreme care must be taken in the management and disposal of sharps waste.
The main danger associated with sharps waste is that of scratches to the skin or of actual puncturing of the skin. Staff most at risk are those carrying out the procedure that generates the potentially infected waste; for example, a member of staff carrying out an injection, or members of staff responsible for moving and disposing of waste.
To the victim of a scratch or skin puncture, the significance of even a minor injury is that the sharp may have been contaminated with blood or another hazardous substance, thus raising the possibility of infection with blood-borne diseases such as hepatitis B, hepatitis C and HIV.
The general public can be at direct risk to injuries from sharps waste as well as can healthcare staff. If these hazardous materials become mixed with standard waste, then people can come in contact with them and may be injured. In addition, if sharps waste is not disposed of properly and removed from the environment, particularly in the case of syringes, then it may be reused or misused.

4. Sharps and the Law
The Environmental Protection Act 1990 makes it the responsibility of an organisation to dispose of its clinical waste safely
The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, introduced in May 2013, apply to primary care settings where medical sharps are used
Sharps are defined under the Controlled Waste Regulations 1992 as clinical waste.
Under the Environmental Protection Act 1990, every producer of controlled waste is under a duty of care to ensure the safe handling and disposal of that waste.
As of 11 May 2013 all healthcare employers – including nursing homes and residential care homes where medical sharps are used – have a duty to comply with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 (the Sharps Regulations).
Where there is a breach of health and safety legislation, there may be prosecution by the Health and Safety Executive (HSE).

5. Sharps Policies
All healthcare organisations must have a policy which includes arrangements for the handling and disposal of sharps
Employers should focus on eliminating or reducing the risk of sharp injuries to acceptable levels
Staff have a legal duty to handle and dispose of sharps according to the policy
All healthcare organisations, including primary care employers, must ensure that they have a clearly written policy which includes arrangements for the handling and disposal of sharps. Managers must ensure that their employees understand their individual responsibilities under the policy and that the policy is up-to-date and regularly reviewed. The policy should include arrangements for preparation for use of sharps, their safe use and their disposal. The policy should also include procedures which should be followed in the event of a sharps injury that involves an employee, a patient or a visitor.
Under the Health and Safety at Work, etc Act 1974, all healthcare employees are responsible for their own safety and the safety of others and should take due care in the handling and disposing of sharps.
All staff should be made aware:
of the physical and infectious hazards involved in manipulating sharps, so that sharps are handled safely in all areas of operation
that it is the responsibility of the user to dispose of the sharp correctly and safely
that it is a potentially criminal offence to discard an item in such a way as could cause injury to others

6. Controlling Sharps Risks
Managers should perform suitable risk assessments covering the handling and disposal of sharps
Staff should be informed of the results
All reasonable steps should be taken to control risks through the use of safer handling procedures and effective training
Under the Management of Health and Safety at Work Regulations 1999, primary care employers are required to undertake an assessment of risks to identify:
people who are at risk from possible sharps injury
the nature and extent of the risk
methods for avoiding or controlling the risk.
Primary care employers should focus upon eliminating or reducing the risk of sharp injuries to acceptable levels through:
effective risk assessment
purchase of safer instruments or equipment
use of safer handling procedures and practices
implementation of effective policies
effective training.
An example of how new technologies can be used to help reduce the incidence of sharps injuries is that of syringe design.

7. The Sharps Regulations
The main provisions of the Sharps Regulations 2013 for reducing the risks involved in the use of medical sharps are that employers should:
Avoid the unnecessary use of sharps where possible
Where it is not reasonably practicable to avoid the use of medical sharps:
Use “safer sharps”
Prevent the recapping of needles
Place secure containers and instructions for safe disposal of medical sharps close
to the work area
The elimination or substitution of a risk or hazard is always the safest and most effective measure to take. Where a risk cannot be eliminated or substituted entirely – and it is unlikely that the use of needles and blades can ever be eliminated altogether from healthcare – then the next most effective measure is to introduce “engineering” or physical controls, eg safer needle devices and sharps containers.
Where it is not reasonably practicable to avoid the use of medical sharps, the Sharps Regulations 2013 require employers to substitute traditional, unprotected medical sharps with modern “safer” sharps wherever possible. Such equipment, based on new technologies, is becoming increasingly available. It is designed to prevent or minimise the risk of accidental injury, eg syringes and needles which are fitted with a shield or cover that covers the needle automatically after use.

8. Occupational Health Considerations
Primary care staff who are likely to handle and/or dispose of potentially contaminated sharps should be offered vaccination against Hepatitis B and their response to the vaccination recorded
All staff who are expected to handle sharps as part of their job should have the appropriate training and equipment
If an individual has a poor response or no response to a completed vaccine course, then counselling and appropriate medical advice may be required and a referral to an Occupational Health Service would be appropriate.

9. Handling Sharps
All sharps should be discarded directly into an appropriate sharps box immediately after use
Syringe needles should not be bent, broken or re-sheathed or prior to disposal
Syringe needles should not be detached from a syringe and should be disposed of as one unit
Handling should be kept to a minimum and sharps must not be passed from hand-to-hand
From the moment sharps waste is produced, it should be handled as little as possible.
Used syringes are the most common sharps waste in general practice. The most common injury involving a syringe is a so-called “needlestick” injury, where the person giving the procedure accidentally pricks themselves with the used needle while disposing of it. Other staff may also injure themselves with the needle if it is not disposed of properly.

10. Disposing of Sharps
Sharps must never be disposed of in ordinary waste bins or plastic bags
Misuse of sharps may be considered a disciplinary offence
The correct place to dispose of sharps is in a purpose- built sharps bin or box

11. Sharps Boxes
A sharps box or bin is a rigid plastic waste disposal box, usually yellow in colour, built specifically for the safe disposal of sharps waste
Sharps boxes should be purpose-built and comply with BS7320
They should be placed near to areas where sharps waste is generated
Sharps boxes should be puncture-resistant, leak-proof, suitable for incineration and designed with lids that can be closed in routine use and sealed securely when full
At this point in the session it would be useful to produce an example of a sharps box and to instruct the group in the correct way of using the box.
All practice staff who generate sharps waste through their day-to-day work should be appropriately trained in the safe use and disposal of sharps. This must include the safe use of sharps boxes or bins.
A sharps box or bin is a waste disposal box built specifically for the disposal of sharps waste. They are usually rigid yellow containers with a red lid which can be sealed (boxes designed for cytotoxic waste have a purple lid).
Staff should be trained to:
select sharps boxes of a design, specification and capacity suitable for the intended use, ie puncture resistant and suitable for incineration
assemble sharps boxes carefully where required, following the manufacturer's instructions carefully
locate sharps boxes safely and strategically
take the box to the task, if possible, rather than the sharps waste to the box
never allow a sharps box to fill beyond three quarters full
never place hands inside a sharps container that is in use
never attempt to retrieve anything from inside a sharps box
never attempt to compress or press down sharps to make extra room in a box
close sharps boxes securely and label them with the date and place of origin
position filled sharps boxes in a secure location, that precludes theft or injury to patients, visitors or other employees, prior to disposal
immediately report and take out of use any sharps box which has been broken or damaged — broken sharps boxes should be sealed within a larger sharps box.
Sharps containers must never be placed at floor level. They should always be placed out of the reach of children (who may find their bright colours attractive) and where unauthorised people cannot gain access to them when not in use. They should also be strategically sited where staff can easily access them and in such a position that minimises carrying or handling waste.

12. Disposing of Sharps Boxes
The Environmental Protection Act 1990 makes it the legal responsibility of an organisation to dispose of clinical waste safely
Under the regulations, such waste must be collected by a waste handler who is licensed with the Environment Agency
While awaiting collection full sharps boxes should be sealed and stored securely
Use this slide to introduce the actual arrangements in the organisational policy for the safe storage of full sharps boxes pending collection.
The Environmental Protection Act 1990 makes it the responsibility of an organisation to dispose of clinical waste safely; this includes sharps boxes, which are classified as clinical waste. Under the regulations, such waste must be disposed of by a waste handler who is licensed with the Environment Agency to deal with such waste. A list of such providers can be obtained from local authorities.
Licensed handlers arrange the destruction of sharps waste by incineration.

13. Sharps in Community Care
It is now relatively common for patients in the community to require to dispose of sharps in their own homes
If patients are treated in their home by a community nurse or a doctor, then any waste produced as a result is considered to be the healthcare professional's waste
If the waste is classified as clinical waste, as is the case with sharps, the healthcare professional can remove that waste and transport it in approved containers (ie rigid, leak proof, sealed, secured, etc) and take it back to his or her base for appropriate disposal. Alternatively, arrangements can be made for the collection of the waste from the patient's home with an appropriate waste contractor. Use this slide to describe the local arrangements in place.

14. Managing Sharps Injuries
Incidents in which staff are exposed to blood, such as in a “needlestick” accident, should be effectively managed and followed up
Staff should report any incident immediately
A full and accurate record of all accidents involving sharps or sharps waste should be made using the practice's reporting forms for adverse incidents

15. Dealing with Sharps Injuries
In the event of a needlestick injury involving a potentially infected needle, staff should:
encourage bleeding by squeezing
wash the wound with soap and water without scrubbing
cover the wound with waterproof dressing
inform the practice manager
complete an accident report form
seek further medical advice
Use this slide to describe the practice policy in dealing with sharps injuries.
The assessment and follow-up of such incidents should be undertaken by the local accident and emergency department, by an occupational health service, or by a GP. In drawing up a local policy, primary care employers should clarify and confirm who will be able to provide such a service.