What is the risk?
The main risk from a needlestick injury is exposure to blood-borne viruses (BBV) such as Hepatitis B (HBV), Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) (Of these three viruses a vaccination exists only for Hepatitis B – no vaccination exists for Hepatitis C and HIV)
Although there is a risk through sharps & needlesticks but also there other ways to be infected from infected blood or body fluids can be through the eyes, inside of the mouth and nose – you will need to consider this in your risk assessment.
The prevalence of blood-borne viruses is generally low and the risk of infection from needlestick injuries remains low and the inoculation should be a last resort as you will need to put other suitable controls in place first. These controls should include :
- the provision of suitable tools to avoid hand contact with discarded needles or syringes (e.g. pliers, trowel, dustpan etc.)
- puncture resistant gloves
- puncture-proof ‘sharps bins’ to enable the safe collection and disposal of needles
- waterproof dressings (e.g. plasters) to enable wounds to be covered
- hand washing facilities
- training in the safe handling and disposal of needles for staff likely to work in areas where discarded needles may be found or use needles and emergency vaccinations
- Suitable footwear with sole protection
Staff working in areas where discarded needles may foreseeably be found, or in roles that involve entering voids, caretaking, decluttering, picking up waste or fly tipping etc, should wear suitable footwear with a fully closed toe and steel mid soles to minimise the risk of a needlestick or cut injury to the foot. Where identified as necessary by a work activity risk assessment, suitable needle resistant safety gloves, footwear and any other relevant PPE must be provided.
Managers of employees identified as being at significant risk of sustaining a needlestick injury that may cause infection while at work should inform their employees of the risks and benefits of immunisation against Hepatitis B to enable them to make an informed decision on whether to be vaccinated. Employees have the right to decline immunisation, although they should be encouraged to take advantage of the vaccine where risk assessment deems this appropriate.
Where this is the case it should be documented in their personnel record. Employees wishing to be vaccinated may be charged by their GP for the vaccination. Workers at significant risk of needlestick injury will normally be required to attend an Occupational Health appointment for this vaccine.
What happens if staff use needles to self medicate?
Where staff members use needles to self medicate they may need to be given their own sharps box via their GP. A specific risk assessment needs to be in place completed by the line manager identifying any risks and necessary controls. This must be reviewed on at least an annual basis or sooner if deemed appropriate.
Advise your staff on controls for the Risk Assessment
- Do not put your unprotected hands anywhere you cannot see.
- If you cannot see what you are going to touch, wear appropriate protective gloves (puncture resistant gloves)
- Always be aware that there could be needles or other sharps present
- Cover any cuts or abrasions with waterproof plasters
- Under no circumstances should any worker be expected to touch a discarded needle with their bare hands there are specialist kits available through stores which should be on each van or at least easily to hand
- Where needles are found there must be a procedure for safe disposal – there is a sharps box available in stores to dispose of these safely
- Staff should ensure that all exposed skin cuts and abrasions are washed with soap and water and covered with a suitable dressing (e.g. adhesive plaster or bandage)
What should employees do if they find a discarded hypodermic needle?
Under no circumstances should an employee attempt to pick up a discarded
hypodermic needle or syringe by hand – a suitable tool to avoid direct contact such as pliers, a trowel or dustpan etc. should be used. No discarded needles should be passed between persons. Consider within your risk assessments and safe systems that there may be needlesticks or sharps hidden in waste, behind bath panels or hidden in crevices in properties or outside. Remind staff never to place unprotected hands where they cannot see.
Where no suitable tool is readily available the needle should be left in the location found, although suitable efforts should be taken to minimise the risk to others. This may include pushing the needle with a suitable implement (e.g. a brush) into a corner, covering the needle with a stone, displaying a suitable sign (or handwritten note), closing the room or area off (e.g. locking the door to the room where a discarded needle is located) and reporting the location of the needle(s) to the appropriate manager.
Due to the risk of the needle piercing through the shoe discarded syringes and needles should not be kicked or pushed by foot. Arrangements should be made for the safe collection and disposal of the needle(s) as soon as possible in line with local refuse and cleansing arrangements.
Needles must never re-sheathed but be disposed of directly into an appropriate ‘sharps’ container for incineration.
What is a suitable ‘sharps’ container for discarded needles and syringes?
‘Sharps’ containers must be constructed to British Standard 7320:1990/UN3291, and have a suitable and secure lid that minimises the risk of needles falling out should the container be tipped over. They are typically made of rigid yellow plastic, and are designed for incineration when full. They should display a biohazard warning sign.
The lid should be closed securely and correctly when not in use. Sharps containers must never be filled above the mark on the container stating ‘Do Not Fill Above The Line.’ Needles should never be pushed down or forced into the container to attempt to fit more needles in, as this could cause the needle to break and cause a needlestick injury.
Full containers should be collected for incineration as soon as the ‘fill to’ line is approached or reached and replaced with an empty container to ensure overfilling is avoided.
Sharps boxes should be available to staff at all times when working in locations where discarded needles may foreseeably be found. Sharps boxes should be kept within vehicles where necessary. They must be assembled correctly, and signed and dated by the person responsible for them. This also applies when closing the box for final disposal. PBH may be called to deal with any concerns or larger issues of discarded needles etc.
Where no approved sharps container is readily available, discarded needles may be placed inside a used drinks can or a glass jar with a secure lid as a temporary measure for transport to a location with an approved sharps container (you must have approval to transport). Care must be taken to keep the container secure during transport to avoid breakage or the content falling out.
What to do after a needlestick injury has occurred?
It is normally recommended that if a needlestick injury occurs the bleeding should be encouraged and the wound washed in warm running water with soap. Following this, immediate medical treatment should be sought.
Employees should take immediate action to minimise the risk of infection by:
- Encouraging the wound to bleed, but not scrubbed or sucked
- Washing or splashing the wound with soap and clean water
- Applying a sterile adhesive dressing (plaster) to prevent further infection
- If exposure occurs to the eyes or mouth, rinse with copious amounts of water where possible.
- Blood-contaminated surfaces must be adequately cleaned to minimise the risk to others
- Employees should also seek medical advice from the nearest hospital accident and emergency department, their GP or NHS Direct (Tel. 0845 46 47) and may be offered treatment such as a booster immunisation against the tetanus bacteria
- Employees should notify their line manager or supervisor as soon as possible following any needlestick injury. Managers/supervisors should contact Occupational Health by telephone for advice on what to do next and to arrange for the employee to undergo suitable health surveillance (if necessary) at the earliest opportunity
- To protect the employee, a full history of the source of infection is essential to enable a full accident investigation and review of activity risk assessments to be undertaken to help minimise the risk of recurrence.
- Needles must not be picked up due to the risk of causing further injury or infection
An Accident / Incident Report Form should be completed and submitted to the Health and Safety Team for all needlestick injuries, near misses or concerns
Further advice can be found here on the NHS website
What should I do if I injure myself with a used needle? – NHS (www.nhs.uk)
Checklist for Line Managers
- Are there any workers in particular who might be at risk of needlestick injuries?
- Are there any specific tasks which are more at risk?
- If so is there a risk assessment in place for both staff and/or the tasks?
- Is there anyone in your team who may need to use needles for self medication?
- Is the risk of needlestick injury addressed in a risk assessment?
- Is there a policy on needlestick injury, and has a safe system of work been developed? Has your team been made aware?
Do your processes include:
- How to deal with needles found or reported
- The use of personal protective equipment
- Safe disposal
- First aid (including access to warm water
- Post-exposure/emergency arrangements
- Incident reporting arrangements
- Has training been provided?
- Has the issue been discussed at any team meetings /1:2:1s
Employees concerned about their health following a diagnosed or suspected infection may seek free emotional support, advice and counselling from :
- ‘Employee Assistance Programme Information and Counselling Service’ 24 hours a day
- Contact details for local clinics are available from NHS Direct – Tel. 0845 46 47 or nhsdirect.wales.nhs.uk
- Where a doctor diagnoses an employee as having been infected with hepatitis B, hepatitis C or HIV, and the source of infection can be attributed to a known needlestick injury, then the infection must be reported to the HSE as a RIDDOR-reportable disease in line with the Corporate Accident / Incident Reporting and Investigation Procedure. Managers should obtain advice regarding this matter from the Health and Safety or HR Teams
Detailed information regarding the risks associated with needlestick injuries and appropriate measures to minimise the risk may be found in the HSE publication, ‘Protection Against Blood-Borne Infections In The Workplace: HIV and Hepatitis,’ available to view online at: https://www.hse.gov.uk/biosafety/