The Health and Safety Executive (HSE) has this week issued new guidance on the use of instruments able to cut, prick, and cause injury and/or infection - sharps - in the health industry. This coincides with the planned implementation of the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 this May. The regulations implement Council Directive 2010/32 on the prevention of sharp injuries. Originally adopted on 8 March 2010, the Directive is designed to ensure healthcare workers are better protected from injuries caused by medical sharps.
Though the final version of the UK regulations is yet to arrive, the HSE last year issued a consultation paper and draft legislation to bring the Directive into effect in the UK. It builds on existing law and, while it will impose few brand new duties on UK employers it shows that safety issues relating to the use of sharps are higher up the agenda.
These developments make now a good time for employers to review their workplaces and existing practices to ensure that healthcare workers are adequately protected.
Aims of the Directive
It is estimated that around 100,000 injuries are caused by sharps in the UK each year. It is the second most common form of injury for healthcare workers after musculoskeletal injury. The risk of a fatal infection from an injury involving a sharp can be a huge source of stress for both victim and fellow workers.
The Directive aims to help better protect healthcare workers from injury caused by sharps by building on existing law and complementing the more general duties by requiring a greater focus on this issue.
Who will be covered by the new laws?
The scope of the Directive is very broad. The HSE has estimated it could affect 1.7 million healthcare workers.
It will cover all workers under the managerial authority and supervision of healthcare employers. It also covers some self employed workers such as agency staff and workers contracted to provide services for healthcare organisations, such as cleaners. Students and apprentices will be covered while under the supervision of a healthcare provider.
It applies across the NHS but also to independent healthcare providers. For example, it affects private hospitals or care homesif their primary purpose is to provide healthcare (as opposed to residential care).
The Directive only applies to employers whose main activity is the provision of healthcare. Organisations where healthcare is an ancillary service, such as a nurse working in a school, will not be subject to the Directive. They will, continue to be protected by existing health and safety duties.
We believe that compliance with the new legislation will reduce risk and represent best practice for every organisation facing a sharps risk.
What does the Directive mean for healthcare employers?
Existing health and safety legislation in the UK already goes a long way towards fulfilling the UK's obligations under the Directive. The focus of the new rules is therefore on clarifying existing duties and improving compliance with these duties, rather than creating extensive new obligations.
The Francis report into events at Mid Staffordshire NHS Foundation Trust contains recommendations into more effective enforcement of health and safety legislation in the healthcare sector, further stressing the importance of compliance.
The key features of the Directive are:
- Risk Assessment. It is already a requirement for employers to carry out risk assessments of the workplaces under their control, identifying anything that could cause harm. The Directive requires a review of risk assessment procedures to ensure that they are specific enough to cover sharps.
Elimination, prevention, protection. Based on the results of the risk assessment, employers must decide how best to eliminate, prevent and protect against the risks identified. It encourages greater sharing of information and awareness-raising of ways that workers can eliminate unnecessary use of sharps, minimising risk of injury. It also reinforces the requirement placed on employers to offer vaccinations and, if necessary, re-vaccinations.
The Directive requires employers to consider whether safer sharps are necessary. But, only those which are deemed to present a risk of injury will need to be replaced. The Directive also seeks to prevent 'recapping', which is the practice of replacing a cap onto a needle after it has been removed. For many employers, this will already be best practice.
- Training. Specific training on the correct use of sharps is obligatory under the Directive. Such training must cover reporting procedures, measures to be taken following an injury and induction processes for new and temporary staff.
- Reporting. Reports to the employer of all injuries involving sharps are mandatory. This is regardless of whether there is a risk of biological fluid being transferred. Employers must make a record of the sharps injury, including who was injured and when and where injury happened.
- Response and follow up. Employers must have in place policies dealing with what is to happen when a sharps injury occurs, [both in terms of the immediate aftermath and any subsequent follow up]. Workers must be aware of these policies and who to contact when an incident occurs.
According to the HSE, the main cost to employers complying with this Directive will be 'familiarisation' and ensuring all healthcare workers understand the importance of compliance. This should include familiarity with the risks, and what to do in the event that they or one of their colleagues suffers an injury from a sharp.
The UK Regulations will be passed under the Health and Safety at Work etc Act 1974. This means that breach will be a criminal offence and conviction will carry a potentially unlimited fine.