The Mölnlycke O.R. blog
The Human Face of the EU Sharps Directive: A nurse's view on needlestick and sharps injuries
Compliance with the EU Sharps Directive has ignited a lot of discussion in the past three years about the cost of undertaking the work needed to ensure implementation – and excuses have been made for waiting until the very last minute to initiate change. But no one has really talked about the personal experiences of those unfortunate healthcare workers who sustain needlestick and sharps injuries in the interim. Putting a human face on an otherwise bureaucratic-seeming set of rules may ensure that the healthcare industry sees that real lives and livelihoods are safeguarded by the directive.
One practitioner’s quest
It has been almost ten years since I joined the Health Protection Agency in the UK. During that time, it has been my quest to implement procedures and best practices to ensure that no healthcare worker would be harmed by sustaining a sharps injury or mucocutaneous splash during their shift.
The European Union wants to safeguard healthcare workers’ safety, which is exactly what we should all be striving for! The EU legislation on protecting healthcare workers from sharps injuries was published almost three years ago in June 2010. From 11 May of 2013, though, it becomes mandatory for healthcare employers to have undertaken risk assessments and put safe practices in place.
A nurse’s tale from the field
In my time as an occupational health nurse and manager, I have dealt with many sharps injuries and exposures. Among these injuries, many went unreported, creating even greater risk. Why? In my experience, this lack of reporting could come down to ignorance of risk, a perceived lack of time to leave the department to make a report, an “ostrich in the sand” attitude (pretending it did not happen) or fear of the potential impact on their careers if they were to contract a blood-borne virus. Naturally there were always those who followed procedure and reported their injuries – but what about those who did not?
Thinking back over my career, I don’t think I have ever had a needlestick injury, but then, in the pre-1987 period when I had my hepatitis B vaccine, I don’t seem to remember we were ever taught about possible risks or the importance of reporting! To this end, I would always try to encourage new starters to have their hepatitis B vaccine, as this is the most transmissible of the three main blood-borne viruses (HBV, HCV and HIV) at a 1:3 chance of transmission1 with only an innoculum of 1/10,000 ml of HBV-infected blood or blood-stained fluid! With immunity following vaccination, the chance of transmission becomes highly unlikely! According to WHO, the hepatitis B vaccine is 95 percent effective in preventing infection2, and among healthcare workers in the United States, the incidence of HBV infection decreased 95 percent between 1983 (the year of the vaccine’s introduction) and 19953.
The human face of sharps injuries
In the conclusion to this two-part blog series, I will tell three stories from my clinical experience that highlight the personal anguish that affects not only the victim of a sharps injury but all the people in the victim’s lives (family, colleagues and so on).
On the surface, the EU Sharps Directive may sound like just another document filled with rules that will take time and resources to implement – without any clear connection to what benefit compliance will offer. Taking the very real risk of infection, potential costs and potential loss (temporary or otherwise) of livelihood out of the equation, it is essential to recognise that the EU Sharps Directive is being put into practice precisely for the safety and well-being of healthcare workers.
Are you ready for the EU Sharps Directive where you work?
1. Rapiti, E, Prüss-Üstün, A, Hutin, Y. Sharps injuries: assessing the burden of disease from sharps injuries to health-care workers at national and local levels. Geneva, World Health Organization, 2005. (WHO Environmental Burden of Disease Series, No. 11).
2. Hepatitis B Fact sheet No. 204. Geneva, World Health Organization, July 2012.
3. Mahoney FJ, Stewart K, Hu H, Coleman P, Alter MJ. Progress toward the elimination of hepatitis B virus transmission among health care workers in the United States. Arch Intern Med 1997;157:2601-5.