The Mölnlycke O.R. blog
The Human Face of the EU Sharps Directive - part two
Often lost in the bureaucracy and layers of text that come with the implementation of directives are the personal experiences of healthcare workers who have been injured by needlestick and sharps. As someone who has experienced firsthand the kind of worry and stress that sharps injuries can cause, completely taking actual health consequences and costs out of the equation, I will provide real-life examples of people who sustained sharps injuries during their daily work framed in the context of reasons to comply with the directive. In doing so, I hope to make the EU Sharps Directive feel more than just necessary from a compliance standpoint but also a frontline safety defence.
Five reasons to comply with the EU Sharps Directive
This is a no-brainer. Compliance is mandatory. You are required by law to do it. Besides, anything you can do to create a safer workplace while following the rules is a win.
2. Avoid employee physical injury and subsequent psychological and occupational harm.
My first example of the aftermath of a sharps injury is quite important because it centres on an employee who did not even work with needles or sharps, and thus should never have sustained a ‘downstream injury’! This person was working as a cleaner, tasked with an end-of-session cleaning of the operating room. While mopping the floor, she squeezed water out of the mop with her hand and sustained a deep injury from a wide hollow-bore needle that had not been disposed of at the point of use.
Fortunately, the occupational health department was still open, and because the last surgical patient treated was known to be HIV positive, it was decided to start the woman on post-exposure prophylaxis until she could have an appointment with the sexual-health clinic for specialist advice. The following morning I arrived at work quite early, and the cleaning woman’s husband was already waiting in an extremely anxious state, refusing to let the woman bathe or kiss their young children because he was scared that she would pass HIV on to them. He was horrified by having to use a condom for the next six months (unprotected sex is not advised for those who have had a sharps injury).
In the end it was decided that it was highly unlikely that the needle had been used on the HIV patient as it wasn’t part of the kit for the surgery he had undergone. PEP was therefore stopped, but she still had to be followed up for six months to ensure she remained free of any other blood-borne virus. During that time, she received counselling and had a number of short periods off work with anxiety-related symptoms. While she did not ultimately contract a virus, this one incident had a huge impact on her life.
This should not have happened! Implementing the mandates of the EU Sharps Directive, i.e. the user of the sharp disposing of it at the point of use and the use of a ‘safety’ component where available, will help to ensure that events like this become a thing of the past!
3. Create a culture of safety, knowledge, education and reporting for all employees.
Can you imagine the stress, and the chain reaction of worry, that the aforementioned event created within the cleaning woman’s family? Healthcare workers are at least aware of the potential risks for sharps injuries – it should not be a concern for the cleaning staff (even though they too should be made aware of risks). Such mishaps shine a light on the need for education and awareness-building as well as clear handling and reporting procedures. Within the framework of the EU Sharps Directive, there are steps in place to ensure that the workplace culture is focussed on healthcare worker safety. Employers have a duty to ensure that all staff working in a healthcare environment have received training in the safe use and disposal of sharps. They must also know where to obtain further information and are made aware that reporting sharps injuries is essential and supported.
It is known, however, that there is a huge amount of underreporting, and out of the Health Protection Agency’s Eye of the Needle report 2008, only 22 percent of healthcare workers who were exposed to hepatitis C actually attended for the correct follow-up tests at the correct time, and of those who did, 20 were found to have contracted this virus.
For a healthcare practitioner working in an exposure-prone role (that is where, if they sustain a sharps injury, they could bleed into the patient’s body cavity), in the case of hepatitis C seroconversion, once they are infected, they have to come out of that role for potentially 12 months to undergo treatment. They then require follow-up for a further six months, requiring regular blood tests to check that they have a sustained viral response before they are allowed back to undertake surgery.
While I can understand healthcare workers’ reticence to report – it is really quite time consuming at the moment – many seem to forget that it is not just their practice they are compromising, but also they themselves may have contracted a potentially life threatening virus, which they could ultimately pass on to their family and in rare cases, to their patients.
4. Create ways to implement and enforce best practices, such as double gloving.
The next incident involves a surgeon from whom I received a phone call for advice. He was going to operate on a patient who was known to be infected with hepatitis C. He wanted to know what the chances of contracting the virus were, should he sustain a needlestick injury (following a percutaneous exposure the risk of transmission is 1 in 30). He did not routinely double glove, despite double-gloving practice significantly reducing risk. He decided not to change his practice but to operate as usual, wearing just one pair of gloves.
Later that day, I received a call from him, in a dreadful state, as he had sustained two needlestick injuries during the operation! He was terrified that if he had contracted the virus he would have to give up surgery. He came over to occupational health, and we tried to reassure him that he could continue to practice while going through the post-injury screening blood tests. (These are presently done at 6, 12 and 24 weeks.)
He required a lot of support leading up to the first blood test, which fortunately was negative, and he remained negative for the subsequent tests. Had the surgeon adopted double gloving (as an example) perhaps he could have avoided this injury and subsequent worry entirely.
The wiping effect of a glove is such that if a hollow-bore needle passes through a latex glove, the latex has a wiping effect of removing 90 percent of the innoculum off the sharp. If someone is double gloved, should the sharp also breach the inner glove, that wipes a further 90 percent of the 10 percent remaining, significantly reducing risk.
5. Create a proactively safer workplace.
The final incident I want to mention is a midwife. She was scrubbed for an emergency Caesarean section and sustained a needlestick injury when the surgeon accidentally stabbed her with a scalpel blade whilst returning it to her. The source patient had rarely been seen at the ante-natal clinic and there was no record of her status for hepatitis B, C or HIV. Initially the source patient refused to be screened, but then the midwife, who was extremely anxious and weepy, explained to us that she was undergoing IVF and was in the process of waiting to see if the latest treatment had been successful.
She was understandably confused: whilst she and her husband were desperate for her to have a positive pregnancy test; at the same time, if she were pregnant and the source patient was then found to have a BBV, there would be many discussions about treatment, etc.
Eventually, one of our infection control nurses obtained the patient’s consent. Sadly the patient was found to be infected with hepatitis C.
The midwife found out a short time later that the IVF had not been successful – we will never know whether the stress of her sharps injury was a contributory factor. What we do know is that while she had follow-up blood tests to see whether or not she had contracted hepatitis C, she and her husband had to delay any further IVF treatment for at least six months. I am pleased to say that the midwife remained hepatitis-C negative six months post-injury.
In this example, had the healthcare workers involved used safer sharps-handling practices (e.g. use of the ‘neutral zone’) and safety-engineered devices, perhaps this injury could have been avoided. Healthcare facilities, as a part of implementing the EU Sharps Directive, should look carefully at practices and processes to see how safety can be proactively improved as a matter of course.
Key takeaway: Do not delay – Protect your healthcare employees today
Given the potential consequences of sharps injuries and the related emotional anguish and long-term physical and emotional effects they can cause, it amazes me that employers still try to delay making improvements to education and safety until the absolute deadline for compliance.
Please do not let your healthcare workers go through the stress that my three examples bring to life. None of us go to work thinking we may contract a potentially life-threatening virus, but every year over 32 million healthcare workers across the world do just that! It does not just affect the individual, but their family, their job and ultimately, their life!
This is our opportunity to ensure that we as healthcare workers can work as safely as possible in an environment where safe practices will be the ‘norm’, thus ensuring a culture of safety for staff and patients.
Have you experienced or witnessed any events like this? How is your organisation handling compliance with the EU Sharps Directive?