Policies and Procedures
SAFE USE & DISPOSAL OF SHARPS
Date Approved by Clinical Policy Group 21/01/2010
Version
Issue Date
Review Date
V3
February 2010
January 2012
Procedure /Policy number Procedure /Policy type Equality & Diversity Impact Assessed:
Lead Person Infection Prevention and Control Team IC0007.V3 Infection Control Policy 19/11/2009
Contents
Page No
1
Introduction
3
2
Purpose
3
3
Relevant Legislation and Policies
3
4
Scope
4
5
Definition
4
6
General for safe handling and disposal
4
7
Colour coding of sharps boxes
5
8 8.1 8.2 8.3 8.4 8.5 8.6 8.7
Special circumstances Operative procedures Cardiac arrest pack Venepuncture Vacuated blood collection system Blood cultures Waste from medical physics HSDU/Sterile procedure packs
6 6 6 6 6 7 7 7
9
Internal collection from wards/departments
7
10
External collection
8
11 11.1 11.2
Inoculation injury and follow up Immediate first aid Incident reporting
8 8 8
12
Responsibilities
9
13
Audit
9
14
Bibliography
10
Appendices 1 2 3
Waste flow chart Glossary Signature Sheet
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1.
INTRODUCTION
1.1
Accidental injury with sharps is recognised as an occupational hazard in the healthcare setting.
1.2
Accidental inoculation with infected blood presents a real risk to the Health Care Worker (HCW), even if the actual volume of blood transfused during the needle stick injury is small.
1.3
Sharps injuries constitute a major route for the HCW to acquire occupational infection and it is for this reason that sharps injuries have assumed such importance.
1.4
All blood and body fluids must be treated as potentially infectious.
2
PURPOSE
2.1
The policy provides suitable guidance and a framework to ensure the management and safe use and disposal of sharps.
2.2
It is important that the management of sharps includes the following components: (a) (b) (c) (d) (e)
3
Free access by all relevant staff within the Trust to this policy and strict adherence to the standards set out. The ongoing training programme for staff. Provision of sharps boxes which conform to BS 732 19900 and U.N. 3291. The issue of protective clothing, as appropriate. Regular statistical review of sharps injuries/causes.
RELEVANT LEGISLATION AND POLICIES The Environmental Protection Act 1990
3.1
The Act imposes a very strict duty of care on all those who generate, store or dispose of any form of waste to: (a) (b) (c) (d)
Store it securely. Prevent its escape. Only hand it on to those who are authorised to receive it. In the case of “Hazardous” waste (which includes clinical waste) to inform the receiver as to the precise nature of the waste either in writing, or by means of suitable labelling.
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3.2
The Act also governs the correct disposal route so as to minimise environmental pollution.
3.3
It is the personal responsibility of the individual using a sharp to dispose of it safely. Sharps should not be left for disposal by others. Where the specific clinical procedure prevents the user from doing this, the user still retains overall responsibility for the safe system of disposal of the sharp. This policy should be read in conjunction with the Trust “Hand Hygiene”, “Standard Principles for Preventing Healthcare Associated Infection”, “Health and Safety” and “Waste Management” policies, and “Prevention and Management of Blood-borne Viruses and Post-Exposure Prophylaxis Guidance”. This policy takes account of the “Hygiene Code” (and its proposed update) under the “Health and Social Care” Act (2008).
4
SCOPE
4.1
This policy applies to all staff working within the Trust.
4.2
Staff must ensure that patients, visitors, volunteers and contractors are advised and encouraged to adhere to the practice in this policy.
5
DEFINITION
5.1
A sharp may be any item which can puncture/cut the skin and may or may not be contaminated with blood or body fluid, e.g. hypodermic needle, blades, cannulae, razors, instruments, glass ampoules, suture needles, bone splinters or pathology slides.
5.2
Sharps injuries therefore include wounds which may be cut, punctured or pierced and may be caused by a variety of items.
6
GENERAL PRINCIPLES FOR SAFE HANDLING AND DISPOSAL
6.1
Ensure that sharps boxes are correctly assembled and marked to identify ward/department of origin.
6.2
Use a tray/sharps box at the point of use.
6.3
Do NOT leave sharps for other members of staff to dispose of.
6.4
Do NOT dispose of sharps into anything other than an approved container.
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6.5
Boxes must only be filled to the manufacturer's fill line.
6.6
Never re-sheath any needle by hand.
6.7
Needles and syringes should not be dismantled following use, but disposed of as a single unit.
6.8
On no account should needles be removed, bent or distorted in any way.
6.9
Ensure that needles are not protruding from the box.
6.10
When disposing of sharps do not insert hands/fingers into the box.
6.11
Care must be taken not to contaminate the outside of the sharps box.
6.12
Sharps boxes should be wall or trolley mounted using brackets whenever possible.
6.13
In public areas, special care must be taken when deciding on the placement of sharps boxes.
6.14
All syringes, regardless of their use, (e.g. syringes used to feed infants, or oral administration of medicine), must always be disposed of into a sharps box. The only exception to this is the purple enteral feeding syringes.
7
COLOUR CODING OF SHARPS BOXES
7.1
Orange lidded sharps boxes; Are to be used for sharps which do not contain prescription only medicines e.g. sharps used for blood sampling.
7.2
Yellow lidded sharps boxes; Are to be used for sharps and other equipment used for prescription only medicines
7.3
Purple lidded sharps boxes; Are to be used for cytotoxic and cytostatic drugs and equipment contaminated with these drugs e.g. needles, syringes, giving sets, gloves
7.4
Unused cytotoxic drugs should be returned to pharmacy.
7.5
Colour-blind staff who have difficulty differentiating between the different coloured lids should inform the ward or departmental manager and seek help from Occupational Health.
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8
SPECIAL CIRCUMSTANCES
8.1
Operative Procedures
8.1.1
i.e. in:- Theatres, X-ray, Diagnostic Centre, Maternity, Accident & Emergency Dept.
8.1.2
A foam adhesive occlusive pad e.g. 'Discard-pad', should be used for the safe disposal of all blades and needles used during the procedure.
8.1.3
Each item remains visible until final check/count is completed.
8.1.4
The clinician remains responsible for ensuring that suitable arrangements exist for the disposal of sharps used in the operative procedure but the task may be delegated to an appropriate person, e.g. scrub nurse/midwife.
8.2
Cardiac Arrest Pack The nurse in charge of the ward must ensure that there are no needles, broken ampoules etc. left in the used pack before returning it to Pharmacy.
8.3 8.3.1
Venepuncture Taking blood is an invasive procedure with a potential for the HCW to be exposed to blood, therefore gloves should be worn in the following instances:(a) (b) (c) (d) (e)
When the individual taking blood is inexperienced. Where there are cuts and abrasions on the hands of the health care worker taking the blood. When the patient is either known / suspected to belong to a high risk group. When the patient is restless or uncooperative. When a risk assessment indicates that the HCW is at risk of exposure to blood or body fluids.
8.3.2
Refer to the Glove Usage Chart
8.4
Vacuated Blood Collection System The needle and holder must be disposed of as a single unit.
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8.5
Blood cultures
8.5.1
The blood culture vacuate collection system must be used.
8.5.2
This system can be subsequently used for routine venous blood sampling.
8.5.3
The safety hub must be engaged prior to removal from the vein.
8.5.4
The unit must be disposed of into an orange lidded sharps box.
8.6
Waste from Medical Physics
8.6.1
Used sharps boxes which may contain radioactive material will be stored securely within the Medical Physics Dept. until only a low level of radioactivity remains.
8.6.2
Boxes will be collected separately.
8.7
H.S.D.U. / Sterile Procedure Packs
8.7.1
Generally, sterile single use items are used, and this is the preferred option.
8.7.2
When non-disposable equipment is used ensure all sharps are safely disposed of at the point of use and not accidentally returned to HSDU.
8.7.3
The "Return to HSDU" bags and the rigid containers provided should be used.
9
INTERNAL COLLECTION FROM WARDS & DEPARTMENTS
9.1
Within wards and departments, it is a nursing staff responsibility to ensure that full boxes are correctly sealed and that the ward/department is clearly marked on the box.
9.2
Sealed boxes will be kept in a secure designated area separate from other clinical waste and public access until collection.
9.3
The appropriate PPE must be worn by the waste management porters when handling used sharps boxes.
9.4
The porters will not remove sharps boxes which have not been correctly labelled, sealed and made safe, and will report this and any other irregularity to the ward manager or nurse in charge deputy.
9.5
Summaries of all incidents are received by the Risk Management sub-group.
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10
EXTERNAL COLLECTION The Trust will ensure that a satisfactory collection system is operational and sharps boxes will be collected from all Trust premises by our waste contractor. The waste contractor will then take the sharps away to be incinerated.
11
INOCULATION INJURY AND FOLLOW UP
11.1
Immediate First Aid
11.1.1
Should be performed at the scene of incident if possible.
11.1.2
(a) (b) (c) (d)
11.1.3
The health care worker should attend:(a)
(b)
Make the wound bleed. Wash thoroughly under lukewarm running water. Cover with an appropriate dressing. Report as soon as possible to line manager
Occupational Health Department during "working hours" 8 am 4pm Monday to Friday. If necessary the H.C.W. may be referred to the Emergency Department for treatment if the injury is sufficiently severe. Emergency Department, if the injury occurs outside Occupational Health working hours.
11.1.4
The procedures to be followed are detailed fully in the “Prevention & Management of Blood-borne Viruses & Post Exposure Prophylaxis” policy.
11.2
Incident Reporting
11.2.1
All incidents involving sharps (including near misses) must be reported whether or not actual injury is sustained. The Incident Report Form must be completed and returned to the Risk Manager. The supervisor/line manager must be informed of all incidents.
11.2.2
Any sharps injury where the needle and syringe is known to contain blood or bodily fluids which have been contaminated with a blood borne virus is reportable to the Health & Safety Executive as a dangerous occurrence under RIDDOR. For assistance with this process contact the Health, Safety and Environmental Officer.
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12
RESPONSIBILITIES
12.1
Staff must attend the Trust induction programme to ensure they receive training on the safe use and disposal of sharps and the innoculation injury procedure.
12.2
It is the ward managers’ responsibility to ensure that nursing staff adopt safe practice when using or disposing of sharps.
12.3
It is the responsibility of the user to dispose of all sharps safely. This duty may not be delegated except during an operative procedure where this may be delegated to the “scrub” nurse, but the responsibility still lies with the user.
13
AUDIT Compliance with this policy will be audited annually by the ward/ department based infection control leader.
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14
BIBLIOGRAPHY
Environmental Protection Act 1990. London: HMSO. The Health and Social Care Act 2008, London: Department of Health South Tyneside NHS Foundation Trust (2005) Health and Safety Policy. South Tyneside NHS Foundation Trust (2007) Prevention and Management of Blood-borne Viruses and Post-Exposure Prophylaxis Guidance. South Tyneside NHS Foundation Trust (2009) Standard Principles for preventing Healthcare Associated infection South Tyneside NHS Foundation Trust (2009) Waste Management Policy
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Appendix 1
Waste Flow Chart No
Has the waste contained a chemical?
No
Is the waste offensive waste?
Yes
No
Yes
No
Is the waste Pharmaceutical waste? Yes
Yes
Has the waste contained cytotoxic or cytostatic medicines?
Chemical waste Alcohol gel containers, aerosols, or container that has contained a chemical substance
Is the waste infectious clinical waste?
Tiger Stripe bag Incontinence pads, nappies, plaster casts, uncontaminated PPE, etc
Yes
Purple lidded sharps box
Yes
Has the waste contained cytotoxic or cytostatic medicines? No
No Yes
Has the waste contained POMs?
Is it a blade, needle or syringe?
No
Yes
Yellow lidded sharps box
No
Yes
Orange/red lidded sharps bin
Does it contain a sharp?
Pharmaceutical waste (blue lidded bin)
No
Does the waste contain glass? No
Municipal waste
Yes
Has the glass contained POMs?
Yes
No
Orange glass bin or stout cardboard box
Does it contain human tissue?
Key:
Yes
Yellow anatomical bin
POM’s - prescription only medicines. Cytotoxic drugs – cancer treatment
No
Cytostatic drugs – anti-virals, immunosuppressants, hormonal, etc
Orange Clinical Waste bag
Municipal waste – what used to be called domestic waste
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Appendix 2
Glossary BBV
Blood-borne Viruses
BS
British Standard
Dept.
Department
HCW
Healthcare Worker
HMSO
Her Majesty’s Sorting Office
HSDU
Hospital Sterilisation and Disinfection Unit
PEP
Post-Exposure Prophylaxis
PPE
Personal Protective Equipment
RIDDOR
Reporting of Injuries, Disease and Dangerous Occurrences Regulations 1995
UN
United Nations
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Appendix 3
Signature Sheet
The Safe Use & Disposal of Sharps This sheet should be used to record the names of staff members who have read and understood the above policy document.
Name (please print)
Job Title
Policy Number IC0007.V3 Policy Title Safe Use and Disposal of Sharps
Date
Signature
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