[Nancy Kimmel ] [ Instructor] ] [Spring 2010]

1. THE SHARPS INJURY PREVENTION PROGRAM AT[IPHLEBOTOMY CAREER TRAINING] [Nancy Kimmel ][Instructor]] [Spring 2010]

2. Aims and objectives • To provide information about the sharps injury prevention program within [insert organisation] • To ensure healthcare workers are aware of the strategies utilised within the organisation to improve safety in relation to the use of sharps • To ensure healthcare workers are aware of the reporting and management processes within the organisation

3. Sharps Injury Prevention Programs • A sharps injury prevention program is a systematic approach that operates within an Occupational Health & Safety framework and is aimed at eliminating or minimising sharps injuries to healthcare workers in the NSW public health system • A sharps injuryis any injury (either clean or contaminated) that results in piercing of the skin by a needle, or other sharp object or device, as a result of a work related activity

4. Program development An effective sharps injury prevention program includes: • timely, appropriate consultation with healthcare workers • identification of foreseeable workplace hazards associated with the use of sharps • the risk assessment of sharp devices used in clinical areas • the risk assessment of sharp devices used in other work areas e.g. community settings, laundries, waste collection services • the implementation of appropriate control strategies • appropriate supervision of staff • appropriate education and training programs for staff

5. Current data • The number of sharps injuries reported within the organisation in the last year (or several years) [insert] • The number of sharps injuries reported within the NSW public health system in the last year (or several years) [insert] • The number of sharps injuries reported within the NSW public health system (peer group equivalent) in the last year (or several years) [insert] • Occupations, procedures, devices and settings involved with sharps injuries are [insert]

6. Discussion topics • Standard precautions • Safe handling and disposal of sharps • Routine use of sharps disposal containers • Reporting of sharps injuries / other blood or body fluid exposures • Safety-engineered sharps devices used throughout the organisation • How specific safety features operate • Product evaluation committees • Risks for acquisition of blood borne viruses • Occupational vaccination and screening • Other clinical practices • Post exposure management processes

7. Standard precautions Standard precautions: • Are a key element of infection control principles • Are designed to reduce the transmission of micro-organisms in health care facilities • Are based on the premise that all blood and body fluids are potentially infectious • Incorporate safe work practices, use of protective barriers (including personal protective equipment) and avoidance of sharps

8. Safe handling of sharps • Each healthcare worker is responsible for the management and disposal of the sharps that they use Minimum requirements are outlined in: • The healthcare worker registration regulations • The NSW Health Infection Control Policy

9. Sharps disposal containers • Sharps disposal containers must be placed near the ‘point of use’ of sharp devices to limit the distance between their use and disposal • Puncture resistant containers may be used to transport sharps for appropriate disposal in specific procedures or settings where sharps disposal containers are unavailable • The type of sharps disposal containers used in this organisation are [insert type]

10. Reporting sharps injuries • Clean and contaminated sharps injuries must be reported • Reporting of sharps injuries is essential for your safety and the safety of other workers • Reporting of all sharps injuries makes a significant contribution to the risk management process and to the process involved in purchasing decisions • Confidentiality of personal health information is supported by a legal and policy framework in place in NSW (NSW Health Privacy Manual - PD2005_593) • The organisation collates all reports using [insert database]

11. Post exposure management In the event that you experience a sharps injury or other exposure to blood or body fluids: • Make an initial verbal report to [insert person / designation] • Complete [insert form / database] • Present to [insert person / department] during business hours • Present to [insert person / department] ‘after hours’ • Further information [is / is not] available on the intranet

12. Blood borne virus acquisition • Needle stick injuries i.e. sharps injuries due to needle tips are of particular concern to healthcare workers • The most significant risk from a needle stick injury is transmission of a blood-borne virus (BBV), especially hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV) • Estimations of seroconversion rates following a NSI from an infectious source and in the presence of optimal circumstances are 1.6% - 40% for HBV, 1.8% - 10% for HCV and 0.1% - 0.3% for HIV

13. Safety-engineered sharps devices • Devices used in the delivery of patient care that have engineering features designed to prevent the device from causing a fluid splash or a sharps injury to those involved in their use or disposal • The safety mechanism of passive devices is integrated and remains in effect before, during and after use. Their activation is not dependent on any action by the user and cannot be bypassed or forgotten • The safety mechanisms of active devices require activation after use by the user in order to render them safe

14. Specific safety devices The following categories of safety-engineered sharps devices are used throughout the organisation: • syringes & injection equipment [YES / NO] • IV access insertion equipment [YES / NO] • IV delivery systems [YES / NO] • blood collection & phlebotomy [YES / NO] • lancets; suture needles [YES / NO] • surgical scalpels [YES / NO]

15. Other clinical practices • If a risk of violence or resistance exists during any procedure involving injection or venepuncture (or the patient is a small child) seek assistance and consider appropriate restraint of patient In this organisation: • specific teams of skilled staff to perform phlebotomy procedures [are / are not established] • specific IV cannulation teams [are / are not established]

16. Product evaluation committees • Such committees are convened for the purpose of review, trial, selection and evaluation of clinical consumables and equipment • Representation for the duration of the selection process is sought from HCWs responsible for direct patient care, in those clinical settings where devices under review are being considered for use • Evaluation of the device includes HCW safety, impact on patient care (quality and safety) and cost effectiveness

17. Occupational vaccination • Vaccination is available against hepatitis B and all relevant healthcare workers must be protected in accordance with PD2007_006 • Hepatitis B vaccination is provided free to relevant healthcare workers • Healthcare workers cannot perform exposure prone procedures unless protected • Other vaccines are available for healthcare workers as per PD2007_006 (see [insert department] for further information) • Vaccination is not available against hepatitis C or HIV

18. Questions Which of the following statements are true : • Sharps injuries are an acceptable hazard of a clinical occupation • I need only report sharps injuries that have involved a contaminated sharp object • Sharps injuries can only be avoided by the use of safety-engineered sharps devices • Sharps safety is the sole responsibility of the organisation’s management ?