leanlinesschampions UNIT5 Promoting the prevention and control of infection Safe Use and Disposal of Sharps

Transcription

1 leanlinesschampions UNIT5 Promoting the Prevention & Control of Infection Cleanline l n Promo moting the preve vent tion and control ol of infection Cleanlin Promo moting the Cleanlines Promoting the preventio evention and control ol of infec ampio prevention and control of infec Promoting the prevention and control of infection n Safe Use and Disposal of Sharps

2 Contents Introduction 3 Learning Outcomes and Competencies 4 What are Sharps? 4 Sharps Injuries 5 Sharon Irvin s Story 5 Needlestick Injuries by Occupation 6 Needlestick Injury by Type of Procedure 6 Needlestick Injuries More Information 7 Preventing Sharps Injuries 7 What Causes Sharps Injuries? 7 Steps to Prevent Sharps Injuries 8 Key Points - Sharps 8 Key Points - Sharps Containers 8 Sharps in the Community 9 Activity 2 9 Management of Sharps Injuries 10 Ellen Dayton s Story 10 Minimising Risks from Sharps 11 The Risks from Blood-Borne Viruses 11 Activity 3 12 Sharps Injuries Procedure 12 Check Your Learning 13 Summary and Conclusion 14 References & Further Information 15 Glossary 15 Unit 5: Questions & Answers 15 2 NHS Education for Scotland Programme workbook for open and distance learning

3 UNIT5 leanlinesschampions Promoting the Prevention & Control of Infection Safe Use and Disposal of Sharps Introduction This unit addresses the safe use and disposal of sharps. Two case studies are included that demonstrate the seriousness with which this unit and its content should be viewed. Types of sharps containers Key Points Sharps can cause injury and are a major source of occupational transmission of bloodborne viruses, e.g. hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). In the healthcare setting where the use of sharps is an every-day occurrence, incidents can and do happen. It is for this reason that there are very clear policies and procedures laid down on the safe use and disposal of sharps. Unit 5 - Safe Use and Disposal of Sharps 3

4 Learning Outcomes and Competencies Learning Outcomes The outcomes for this unit are that on completion, you will be able to: 1 Explain the correct procedures for the safe handling and disposal of sharps 2 List the risks associated with the use and disposal of sharps 3 State the immediate actions to be taken in the event of a sharps injury Competencies The Core Competencies related to this unit are that on completion, you will be able to: A Demonstrate knowledge of safe use and disposal of sharps B Audit the safe use and disposal of sharps C Act as a role model in promoting best practice in the safe use and disposal of sharps D Demonstrate the actions you would take in the event of a sharps injury What are Sharps? Sharps are items that may cause laceration or puncture of the skin. Activity 1 Which of the following items are sharps? Tick as many as you think fit that description. Compare your answer with the correct answer at the end of the unit. Needles Scalpels Blood glucose lancets Broken glass Broken spectacles Used razor blades Disposable razors Spicules of bone or teeth 4 NHS Education for Scotland Programme workbook for open and distance learning

5 Sharps Injuries A sharps injury occurs when a needle or other sharp, which is potentially contaminated with blood or other body fluids, penetrates the skin. This can also include bites or scratches where the skin is broken. An injury caused by contaminated sharps is a significant occupational exposure. Sharps injury broken skin caused by bite An injury with non-contaminated sharps, e.g. an unused needle, is not classed as a significant occupational exposure. Sharon Irvin s Story Take a few minutes to read Sharon Irvin s experience of needlestick injury, reported in the San Francisco Chronicle in As a nurse working in the Infectious Disease Unit, Sharon Irvin, RN, is all too familiar with needlestick injuries. She knows firsthand how a clinician can accidentally get stuck with a needle during patient care. Even though she knows the proper procedures for handling such an incident, Irvin was so stunned when it happened to her six months ago that she wasn t sure what to do at first. Read what she has to say about her experience and how she dealt with it. I think I was in a state of confusion when it initially happened. I was giving an HIV patient a testosterone injection, and I accidentally pricked my middle finger with the needle. I didn t want to tell anyone at first. I ve been a nurse for 17 years, and nothing like this has ever happened to me before. After she composed herself, Sharon realised what she needed to do. She first told her supervisor and then called Occupational Health Services (OHS) to report the incident. According to June Carroll, RN, of OHS, Sharon s reaction is typical. I think most employees are stunned when it first happens, but Sharon did the right thing, she says. It is important that you know where your policies are and that you are familiar with them. Fortunately, in Sharon Irvin s case, she knew about the patient s condition and was relatively sure that she would not test positive for HIV. She took medications for two weeks and went back to OHS for check-ups after one month and three months, then again for a follow-up at six-months. I m fortunate that the incident didn t affect the way I do my job, says Sharon. It affects some employees emotionally, but I work with patients with infectious diseases every day. I think this actually has helped me take better care of my patients. I can assure them that I know what it feels like to take these medications. Unit 5 - Safe Use and Disposal of Sharps 5

6 Needlestick Injuries by Occupation Of all the groups of healthcare workers in the UK medical professionals (including dentists) had the highest number of reported needlestick injuries in However, potentially everyone in the healthcare setting can be affected by a sharps injury, including: Housekeepers Porters Allied health professionals Dentists/dental care professionals Domestic staff Medical staff Visitors. Most injuries in staff with no direct patient contact are due to inappropriately discarded needles. Needlestick Injury by Type of Procedure In all the sharps-related activities that take place in healthcare services, such as operating and assisting, handling clinical waste, injections, disposal of sharps and clearing the work area, the procedure most commonly associated with needlestick injury in NHSScotland in 2002 was venepuncture, or blood sampling. Although most injuries were related to venepuncture, you can see a significant number occurred during clearing the work area, disposal of sharps or handling of clinical waste. 6 NHS Education for Scotland Programme workbook for open and distance learning

7 Needlestick Injuries More Information Overfilled sharps container, not closed Studies have shown that injuries commonly occur when: Taking needles off syringes or other devices Re-sheathing needles Taking needles to a disposal point Not disposing of needles at all Over-filling sharps containers. The temporary closure facility should be utilised in between use. Preventing Sharps Injuries Key Points Sharps injuries are preventable. How individuals behave and deal with sharps can cause serious harm to themselves or others. In looking at the prevention and management of sharps injuries this unit should help raise your awareness of issues influencing compliance and non-compliance with safe practices. As a Cleanliness Champion such insights should help influence your role in the prevention and control of infection. What Causes Sharps Injuries? Most commonly they are caused by Thoughtlessness Poor practice Not following the proper procedure. Sharps often find their way to the laundry or Decontamination Unit and are even sometimes found on meal trays. This can result when staff are distracted from a task and, again, when procedures are not followed or policies upheld. Unit 5 - Safe Use and Disposal of Sharps 7

8 Stop and Think Given the serious or potentially fatal consequences of a sharps or needlestick injury, how do you think these can be prevented? Take a few moments to think about this. Steps to Prevent Sharps Injuries The following steps would prevent the majority of sharps injuries: Keep sharps handling to a minimum Used sharps should be disposed of immediately, at the point of use Used needles should not be recapped/re-sheathed Sharps containers should not be overfilled Use safety devices where available. Key Points - Sharps Do not re-sheathe, break or bend used needles. Do not carry used sharps. Do not pass sharps to another person hand to hand. Wear gloves when carrying out venepuncture and whenever contact with blood is likely. Get help with agitated or confused patients. Dispose of syringes and needles as one unit and do not disassemble (if unavoidable, use a specific removing/re-sheathing device). Dispose of sharps immediately at the point of use. Never leave sharps to be disposed of by someone else. Do not put sharps or containers in clinical waste bags. Key Points Sharps Containers Use approved, puncture-proof containers. Assemble containers correctly according to manufacturers instructions. Never try to retrieve articles or empty sharps containers. Use appropriate-sized containers - do not force things into containers. Keep sharps out of reach of children and vulnerable people. Close sharps containers, using the temporary closure mechanism, between uses. Locate containers at waist height and not on the floor or above eye level. Locate containers on flat surfaces or secured to a wall or trolley to prevent spillage. Seal or lock the container when it is three-quarters full and prior to disposal. Sharps are clinical waste and containers must be labelled with their source prior to disposal. Use the handle to carry containers and hold them away from your body. 8 NHS Education for Scotland Programme workbook for open and distance learning

9 Sharps in the Community When working in the community, risk assess whether sharps can be left in the patient s home and document this. Follow local guidance on the types of container to be used and whether they can be left in the car or carried by hand. For example, if sharps containers are being used by district nurses they must be safely secured when transported in the boot of the car. The temporary closure mechanism must be secured safely. Where patients are involved in administering their own injections, they should be encouraged to safely dispose of the sharps themselves, as far as possible. Activity 2 Consider the two scenarios which demonstrate a number of examples of poor practice in handling and disposing of sharps. For each scenario, you should be able to identify at least four examples of poor practice. Check your answers with those given at the end of this unit. Scenario 1 -Taking Blood from a Patient Scenario 2 Cleaning Up Contaminated Broken Glass Unit 5 - Safe Use and Disposal of Sharps 9

10 Management of Sharps Injuries We have looked at the safe handling and disposal of sharps, but unfortunately accidents still occur. In this section of the unit we will consider what to do if there is a sharps injury. Ellen Dayton s Story Before we discuss the management of sharps injuries, take time to read Ellen Dayton s story, reported in the San Francisco Chronicle in Ellen Dayton, a nurse practitioner, had just finished drawing blood from a young person addicted to cocaine and speed and infected with HIV. Holding the needle in her right hand, she reached across with her left, moving reflexively to catch three blood-collection tubes as they rolled toward a counter s edge. The needle, filled with infected blood, pierced the side of her left index finger. I felt scared and stressed and panicked. And at the same time, there was this other voice minimising things like No, it s not going to happen to me. I m not going to get HIV. Two months later, she tested positive for hepatitis C. Within 13 months she learned that she had HIV, the virus that causes AIDS. Today, she can no longer take care of the weak and the sick and the drug addicted, because she must take care of herself. Further Information The Complete Story You can find Ellen s full story in the San Francisco Chronicle - accessed 7 December NHS Education for Scotland Programme workbook for open and distance learning

11 Minimising Risks from Sharps The two stories in this unit are useful examples of sharps injuries and how they can so easily occur even with experienced practitioners. Key Points No one is exempt and accidents do happen. The aim is always to know and follow procedures to minimise the potential for accidents. The Risks from Bloodborne Viruses In acknowledging that sharps and needlestick injuries occur we need to be aware of the risk of transmitting bloodborne viruses, as the two case studies demonstrate. Here are some useful facts for you to consider: The risk of a sharps injury transmitting a bloodborne virus depends on the type of virus and type of injury. The risk is about 1 in 3 where a patient is infectious with hepatitis B about 1 in 30 with hepatitis C about 1 in 300 for HIV. Of the 2,296 injuries reported in the Health Protection Agency s 2008 survey in the UK, nearly half (48%) involved a source patient found to have the hepatitis C virus, and 22% involved an HIV positive patient. Key Points Hollow sharps, such as used needles, are more likely to transmit infection than solid sharps like scalpels as they contain more blood. Deep injuries are also of more concern. Occupational exposure to bloodborne viruses is a significant infection control and occupational health problem. Presently, viruses that cause concern are hepatitis viruses B and C and HIV. Further Information - Bloodborne Viruses You can find out more about bloodborne viruses (BBV) and occupational exposure on the HPA s website - accessed 7 December Unit 5 - Safe Use and Disposal of Sharps 11

12 Activity 3 What should you do if a significant occupational exposure due to a sharps injury occurs? In the event of a sharps injury occurring, it is very important that it is managed promptly and correctly. Should you experience a sharps injury, there are key steps that you should take, but in which order? Sort out these steps into what you think is the correct order for the steps to take should you experience a sharps injury (from 1-8). Write down your answers and compare them with the correct answers at the end of this unit. Report to Occupational Health or Accident and Emergency Department, according to your local policy. Stop what you are doing. Inform your manager immediately. Complete an accident/incident form. Near misses should also be clearly reported / documented. Encourage bleeding by squeezing under warm water but do not suck the injured site. Cover the site with a waterproof dressing. Ensure that the item that caused the injury is disposed of safely. Wash thoroughly with soap and water or antiseptic hand wash but do not scrub the injured site. Sharps Injuries Procedure Key Points As you have learned in this unit, should you experience a sharps injury, this is the correct order in which each step should be taken: 1 Stop what you are doing. 2 Encourage bleeding by squeezing under warm water but do not suck the injured site. 3 Wash thoroughly with soap and water or antiseptic hand wash but do not scrub the injured site. 4 Cover the site with a waterproof dressing. 5 Inform your manager immediately. 6 Complete an accident/incident form. Near misses should also be clearly reported / documented. 7 Ensure that the item that caused the injury is disposed of safely. 8 Report to Occupational Health or Accident and Emergency Department, according to your local policy. Make sure you know the correct steps you should take in event of a sharps injury. Urgency is important in these situations as prophylaxis for HIV or other treatments may be required and it is useful if these are commenced within one hour of the incident taking place. 12 NHS Education for Scotland Programme workbook for open and distance learning

13 Further Information - Management of Occupational Exposure Incidents You can find a useful summary of what to do in the event of a sharps injury or splashes of blood/ body fluids in the National Infection Prevention & Control Manual - Part 1 SICPs (Appendix 9 Management of occupational exposure incidents) - accessed January 2012 Occupational exposure incident Perform first aid to the exposed area immediately Is skin/tissue affected? No Are eyes/mouth affected? Yes Yes Encourage the area to bleed Do not suck the damaged skin or tissue Wash/irrigate with warm running water and non-antimicrobial soap Rinse/irrigate copiously with water Use eye/mouth washout kits if available If contact lenses are worn, remove then irrigate Report/document the incident as per local procedures and ensure that any corrective actions or interventions are undertaken Ensure that the item that caused the injury is disposed of safely Unit 5 - Safe Use and Disposal of Sharps 13

14 Check Your Learning Please answer these questions to check your learning for this unit. You can find the answers to the questions at the end of the unit. Question 1 What proportion of needlestick injuries occur after the procedure? Tick the correct answer. 0-25% 26-50% 51-75% % Question 2 What proportion of needlestick injuries from a patient with hepatitis B lead to infection? Tick the correct answer. 1 in 3 1 in 30 1 in 300 Question 3 Which of the following are occupational exposure incidents? Tick all that apply. Blood/body fluid contamination of the mouth Blood/body fluid contamination of the eyes Needlestick injury Blood/body fluid contamination of intact skin Question 4 What type of needlestick injury is most likely to transmit infection? Tick the correct answer. Surgical scalpel Blood sampling needle Injection needle Blood glucose lancet Question 5 Is this statement True or False? Sharps boxes should be handled as healthcare (including clinical) waste. True False Question 6 Is this statement True or False? Used needles should be removed from syringes before disposal. True False Question 7 Is this statement True or False? Sharps boxes should be closed temporarily between uses. True False Question 8 Is this statement True or False? Needlestick injuries should be scrubbed to encourage bleeding. True False 14 NHS Education for Scotland Programme workbook for open and distance learning

15 Summary and Conclusion Summary Key Points These are some key points for you to bear in mind: Avoid using sharps if possible Managers should risk-assess the use of sharps in their area Wear PPE appropriate for the task Handle sharps as little as possible Do not undertake procedures you are not competent to perform Take time when working with sharps, and seek assistance with confused or uncooperative patients It is the responsibility of every healthcare worker to safely dispose of the sharps they have used Carry out first aid and report sharps injuries immediately. In summary, the unit should have helped you to think about your role as a Cleanliness Champion in relation to the safe handling and disposal of sharps. This unit has considered: Bloodborne viruses What sharps are and what causes sharps injuries The safe handling and disposal of sharps How a sharps injury should be managed. Conclusion Sharps injury could result in severe or potentially fatal consequences. Compliance with policies and procedures is essential. Assessment Your next step is to complete the Folder of Evidence for Unit 5. Please remember that you could complete several Content Units in one session, before perhaps undertaking a block of Folder of Evidence activities. Unit 5 - Safe Use and Disposal of Sharps 15

16 References & Further Information The following web resources and articles are those referred to within this unit. They have been grouped together for your convenience. You can find the full list of web links for the Cleanliness Champions Programme on the NHS Education for Scotland HAI web site under Educational Programmes within the Cleanliness Champion section at: Health Protection Agency (2008) United Kingdom Surveillance of Significant Occupational Exposures to Bloodborne Viruses in Healthcare Workers. London, HPA. Health Protection Agency - Bloodborne Viruses (BBV) and Occupational Exposure - accessed 7 December Health Protection Scotland (2012) National Infection Prevention & Control Manual Part 1 SICPs. Glasgow, HPS - accessed January Holding R (1998) Nurse s life changed in a moment. San Francisco Chronicle 13 April, A-6. Glossary hepatitis B hepatitis C HIV A bloodborne virus which causes inflammation of the liver. A bloodborne virus which causes inflammation of the liver. Human Immunodeficiency virus - a bloodborne virus that can lead to AIDS. Unit 5: Questions & Answers Activity 1 Which of the following items are sharps? Correct answers: All of the items listed are considered to be sharps: Needles Scalpels Blood glucose lancets Broken glass Broken spectacles Used razor blades Disposable razors Spicules of bone or teeth. 16 NHS Education for Scotland Programme workbook for open and distance learning

17 Activity 2 Identifying examples of poor practice in handling and disposing of sharps Scenario 1 - Taking blood from a patient Correct answers: The four areas of poor practice identified in the photograph are: On the bedside table Blood glucose lancet, blood-stained testing strip and cotton wool ball left on bedside table. On the sink Sharps container is overfilled. Sharps are protruding from the container. There are non-sharp items in the container (syringe packet). There is blood-stained cotton wool left lying on the tray. The opening should be closed when not in use. On the floor The sharps box is on the floor and unsecured where it could be knocked over or pose a hazard to children. Any protruding sharps could injure the legs of staff using the sink. There are non-sharps items (paper towels) in the container. More difficult to see, the container is bloodsplattered and unlabelled. On the bed A used needle is being re-sheathed. There is also a used needle and syringe lying in the tray from a previous attempt at venepuncture, which could fly up if the patient moves as blood is taken. There is no sharps container available at the point of use. (Aseptic technique is not being followed.) Unit 5 - Safe Use and Disposal of Sharps 17

18 Scenario 2: Cleaning Up Contaminated Broken Glass Correct answers: The four areas of poor practice identified in the photograph are: On the floor Caution cone not placed to alert others to hazard. Healthcare worker should crouch over area, not kneel. PPE and tools Healthcare worker should be wearing heavy-duty gloves and a plastic apron. Broken glass should be removed with handbrush/ dustpan, scoop or cloth (in accordance with local policy), not by hand. Disposal Glass should be disposed of in accordance with local policy, e.g., into a sharps bin, a box clearly labelled broken glass or a heavy-duty paper sack. You may also be aware that bloodstained tissue should be disposed of as clinical waste. 18 NHS Education for Scotland Programme workbook for open and distance learning

19 Activity 3 What should you do if a significant occupational exposure due to a sharps injury occurs? Correct answers: The correct order is: 1 Stop what you are doing. 2 Encourage bleeding by squeezing under warm water but do not suck the injured site. 3 Wash thoroughly with soap and water or antiseptic hand wash but do not scrub the injured site. 4 Cover the site with a waterproof dressing. 5 Inform your manager immediately. 6 Complete an accident/incident form. Near misses should also be clearly reported / documented. 7 Ensure that the item that caused the injury is disposed of safely. 8 Report to Occupational Health or Accident and Emergency Department, according to your local policy. Check Your Learning Question 1 What proportion of needlestick injuries occur after the procedure? Correct answer: 51-75% of needlestick injuries occur after the procedure. Question 2 What proportion of needlestick injuries from a patient with hepatitis B lead to infection? Correct answer: 1 in 3 needlestick injuries from a patient with hepatitis B lead to infection. Question 3 Which of the following are occupational exposure incidents? Correct answer: Contamination of intact skin is not an occupational exposure incident as intact skin prevents the contamination reaching the bloodstream. All the others are occupational exposure incidents. Question 4 What type of needlestick injury is most likely to transmit infection? Correct answer: A blood sampling needle is most likely to transmit infection as there is likely to be a greater volume of blood. Question 5 Is this statement True or False? Sharps containers should be handled as healthcare (including clinical) waste. Correct answer: True - sharps boxes should be handled as healthcare (including clinical) waste. Question 6 Is this statement True or False? Used needles should be removed from syringes before disposal. Correct answer: False - needle and syringe should be disposed of as one unit. Unit 5 - Safe Use and Disposal of Sharps 19

20 Question 7 Is this statement True or False? Sharps containers should be closed temporarily between uses. Correct answer: True - sharps boxes should be closed temporarily between uses. Question 8 Is this statement True or False? Needlestick injuries should be scrubbed to encourage bleeding. Correct answer: False - needlestick injuries should be squeezed to encourage bleeding but not scrubbed as this may increase the amount of exposed skin. 20 NHS Education for Scotland Programme workbook for open and distance learning