Needlestick injuries can be prevented

• Needlestick injuries can be prevented ( )
  Document Type: Guidance Note
  Keycode: web only
  Industry: Community Services Health and Aged Care Sector Local Government 
  Category: Infectious Diseases 
  Division Author: Public Sector & Community Services
  Publication Date: 13 June 2006
  Date First Published: 25 February 2003
  Summary: This guidance note outlines how to control the risks associated with needle stick injuries in health care.

Introduction
Many health care workers face a daily risk of acquiring serious blood borne infections from needlestick injuries. In Victoria, reports from 9 metropolitan hospitals in the 2001/2002 financial year showed a combined figure of 797 reported needlestick injuries. That is, potentially 797 health care workers were exposed to blood-borne viral infection from Hepatitis B, Hepatitis C and HIV. Anecdotal information considers that this exposure figure is under reported. The use of intravenous cannulae is generally regarded as representing the highest risk of transmission of blood-borne disease to health care workers. The transmission rate for Hepatitis C is 3% to 10% following a percutaneous injury, with development of chronic Hepatitis in more than 50% of infected adults (Gerberding 1995).

Relatively new intravenous systems are available such as safety cannulae and needleless IV systems, and these can significantly reduce the risk of needlestick injuries. WorkSafe Victoria believes there is sufficient evidence that these systems are likely to be practicable in many health care workplaces where intravenous systems are used.


The cost of needlestick injuries
The cost for infected individuals is devastating in terms of health effects. The waiting period for results of blood tests following an exposure can be psychologically traumatic. In addition, these injuries can generate expensive WorkCover payments through premium increases and potential common law claims.

The severity of the hazard or risk and the state of knowledge associated with needlestick injury is well documented. The costs of these systems are financially viable when compared to the savings associated with:
1. the monetary savings outlaid on several hundred thousand needles which will no longer be required, and
2. potential claims associated with health care workers contracting an infectious disease.


A systematic approach to preventing needlestick injuries
The National Occupational Health and Safety Commission, (NOHSC) in its National Code of Practice for Health Care Workers and Other People at Risk of the Transmission of Human Immunodeficiency Virus and Hepatitis B in the Workplace [NOHSC:2010(1993)], outlines a systematic approach in the development of a program for the prevention of the transmission of HIV and Hepatitis B.

WorkSafe Victoria suggests health care employers adopt the following needlestick injury prevention program which is based on that one formulated by NOHSC.

The suggested program assumes that the employer has identified that a needlestick injury hazard does exist in the workplace; consequently, a hazard identification phase is not included.

1. Risk Assessment

• Discuss with Health and Safety Representatives and other employees the nature and extent of the risk of injury. Use this step to encourage staff to contribute ideas on possible risk control solutions.
• Number of employees exposed to the risk.
• Number of actual needlestick injuries.
• Frequency of cannulation and access to IV systems.
• How are employees exposed to risks?
• ·Does the workplace layout and practices contribute to the risk?
• Potential health effects of each risk.
• Assessment of knowledge and training of employees, including casual and agency staff.
• Adequacy of existing control methods and need for more or better control measures.

2. Implementation of risk control methods

• Elimination
  WorkSafe Victoria recommends that employers aim to eliminate the risk of needlestick injury. A good option is the use of needleless IV systems. This is currently regarded as the most effective way to control risk as it is a method that acts directly on the source of the risk.
• Substitution and engineering controls
  WorkSafe would consider the self-blunting or retractable so-called “safety” cannulae as a combined substitution and engineering risk control. These are regarded as “higher order” controls because they act directly on the source of the risk.
• Safe work practices and information and training
  Although there is evidence that these risk control methods can reduce the total number of needlestick injuries they should be regarded as supplementary to higher order controls because they do nothing to remove the source of the risk.
• Personal protective equipment
  Apart from the use of disposable gloves and safety glasses to protect against contact with contaminated blood products there is no known, effective personal protective equipment which stops the risk of needlestick injuries.

3. Monitoring and evaluation

National Health and Medical Research Council (NHMRC)
The 1996 NHMRC Infection Control Guidelines addresses the handling and disposal of sharps, it recognises that “sharps” represent the major cause of incidents involving potential exposure to blood borne diseases. It suggests the use of needless IV systems to control the risk.

Developments in the USA
In the USA The Needlestick Safety and Prevention Act (HR 5178) became effective on April 18th 2001. The provisions of this legislation expanded the definition of engineering controls to include devices with engineered sharps injury protection. In the report to Congress on 24/1/2000 the findings to support this legislation included the numerous workers who are occupationally exposed to blood borne pathogens who have contracted serious viruses and diseases. The report went on to cite examples of engineering controls which included sharps with engineered injury protection and needleless IV systems.

Use of safety cannulae and needless IV systems at the Austin & Repatriation Medical Centre
The Austin & Repatriation Medical Centre in Melbourne recently won a WorkSafe Victoria Award for the introduction of a “No Needlestick Program”. They trialled several safety cannulae and selected a safety cannula that automatically blunts itself. Such systems greatly reduce the potential for a needlestick injury with the used cannula. (Other effective safety cannulae are available which retract the used needle into a protective sheath.)

In addition, the Centre has also introduced a needleless IV system which reduced the number of needles used within the Centre by 550,000 per annum, assisting with the business case proposal; the needleless IV system eliminates the use of needles to gain access to an IV line. The removal of such a vast number of needles from the workplace significantly reduces the risk of injury exposure to workers within and outside medical establishments who are required to deal with medical waste.

Legal responsibilities
The Occupational Health and Safety Act 2004 requires employers to provide and maintain so far as is reasonably practicable a workplace that is safe and without risks to health.

The term practicable is defined in the Occupational Health and Safety Act as having regard to:
(a) the likelihood of the hazard or risk concerned eventuating;
(b) the degree of harm that would result if the hazard or risk eventuated;
(c) what the person concerned knows, or ought reasonably to know, about the hazard or risk and any ways of eliminating or reducing the hazard or risk;
(d) the availability and suitability of ways to eliminate or reduce the hazard or risk; and
(e) the cost of eliminating or reducing the hazard or risk.

See also

Needlestick injury risk when handling refuse bags

Acts and Regulations

Acts and regulations are available from Information Victoria on 1300 366 356 or order online at www.bookshop.vic.gov.au.

View the legislation at Victorian Law Today at www.legislation.vic.gov.au.

Standards Australia

Copies of standards can be obtained by contacting Standards Australia on 1300 654 646 or by visiting the web site at www.standards.com.au.