Needlestick and sharps account for 400,000 injuries to NHS staff each year.
The major blood-borne pathogens of concern associated with needlestick injury are:
- hepatitis B virus (HBV)
- hepatitis C virus (HCV)
- human immunodeficiency virus (HIV).
However, other infectious agents also have the potential for transmission through needlestick injury. These include:
- human T lymphotrophic retroviruses (HTLV I & II)
- hepatitis D virus (HDV or delta agent, which is activated in the presence of HBV)
- hepatitis G virus (GB virus or GBV-C)
- cytomegalovirus (CMV)
- Epstein Barr Virus (EBV)
- parvovirus B19
- transfusion-transmitted virus (TTV)
- West Nile Virus (WNV)
- malarial parasites
- prion agents such as those associated with transmissible spongiform encephalopathies (TSE).
Employer responsibilities
Employers are responsible for assessing risk and preventing exposure to biological hazards, or reducing the risks of exposure as far as possible. They should do the following:
- formal risk assessment
- risk management, including work design and safer working practices
- effective and regular training
- provide medical devices incorporating safety-engineered protection mechanisms.
With 40,000 reported incidents each year (and at least as many unreported), needlesticks and sharps injuries are a significant issue affecting NHS staff health, safety and welfare. They should be managed as part of a trust's integrated risk management policy.
The legal position
The Health and Safety at Work etc Act 1974 places a legal duty on employers to provide for the health and safety of their employees. NHS trusts have been subject to the full requirements of this legislation since 1991.
These duties were extended under the Management of Health and Safety at Work Regulations 1999, which require employers to:
- assess risks to the health and safety of their employees
- arrange for implementing a comprehensive system of safety management.
By failing to prevent needlestick injuries, trusts can be found to be in breach of health and safety regulations, and many have settled such cases, resulting in substantial legal expenses and compensation payments.
There are additionally three EU Council Directives relevant to the health and safety of workers (EU Council Directive 89/391/EEC, EU Council Directive 89/655/EEC and EU Council Directive 2000/54/EC). In 2006, the European Parliament approved a report 2006/2015 (INI) on recommendations to protecting European healthcare workers from blood-borne infections due to needlestick injuries. The European Commission should now bring forward a legislative proposal to respond to the recommendations in the report. The Control of Substances Hazardous to Health Regulations 2002 (as amended) specifically include micro-organisms in the definition of substances that are hazardous to health. The law requires employers to make a suitable and sufficient assessment of the risks to the health of workers exposed to such substances, with a view to preventing or adequately controlling the risks. This includes the proper use of protective equipment and regular monitoring of exposure.
Under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR), exposures to hepatitis B or C, or HIV, are reportable to the HSE as a dangerous occurrence ('accidental release of a biological agent likely to cause severe human illness') using form F2508, rather than as an injury (unless the exposure results in three or more days absence from work). Reports can be made online at www.riddor.gov.uk
Under the Health Act (2006), the Government has published a new and specific Code of Practice for the prevention and control of healthcare-associated infection, which requires NHS bodies to implement policies that encompass 'the provision of medical devices incorporating sharps protection mechanisms.'
It places a new statutory duty on NHS healthcare organisations to make arrangements to put the provisions of the Code into practice, backed up by action if there are significant failings in relation to the Code.
In a legal ruling against the Scottish Ambulance Service in 2004, three appeal judges ruled that cost grounds alone cannot be a reason not to purchase safer sharps devices, as this breached European health and safety laws.
