In a surprisingly practical note to the The European Journal of Hospital Pharmacy: Science and Practice (EJHP) a UK pharmacist discusses the many situations occurring outside the immediate clinical environment where the use of engineered safety devices may be inconvenient and, in some cases, positively disadvantageous.

Others similar scenarios arise, with needles and blades used for a diversity of higher-risk patient focused interventions. The rationale is that it may just not be possible to obtain a safety engineered device for a particular purpose, or that may be significantly more difficult to use and patient care standards may decline. After all, it should be risk assessed.

But somehow or other, sharps must enter the clinical waste stream. In a suitably designed sharps bin that is acceptable though some bins are far better than others. Regrettably, not all sharps are disposed that way and a constant stream of used sharps find their way into clinical waste sacks intended only for soft wastes. Inevitably therefore, the interpretation of any risk assessment should assess also that possibility, as well as the impact of use. And let’s not pretend that ‘professionals’ don’t get it wrong. That is patently incorrect.

In addition to used needles and blades, other sharp wastes find their way into teh clinical waste sack. Sharp plastics can cut or tear their way through a sack and cut or puncture the skin surface. Some will say that its a piece of so and so packaging, perhaps even something that shouldn’t have been there in the first place! Well, that’s as maybe, but once it has cut a finger or punctured a leg, there can be little solace in such words.

Others will say, and regrettably I have heard this also, that the item would not have been contaminated so will be OK, discounting and possibility for cross-contamination with fresh blood in the milieu of the clinical waste sack.

I have no doubt that there are many cases for NOT using engineered safety devices, in circumstances where the various risks might properly outweigh the advantages. However, overall, those should be few in number. Shrouded in mis-understanding and mis-interpretation, this can lead to an incorrectly dismissive attitude toward sharps injury. It can be difficult for waste handlers to obtain adequate care for sharps injury in A&E as workers are still being fobbed off with an admonition for wasting NHS time for a trivial invisible injury without a moments thought for the implications.

Beware sharps injury. Take it very seriously if you are affected – adding blood splash to the mouth or eyes, or to raw broken skin caused by an earlier cut or graze, dermatitis or eczema, together with an obvious sharps injury. Go straight to the nearest A&E department, selecting a larger university hospital if this is available nearby as the service will more likely have access to specialist infectious diseases physicians. And lastly, make a fuss. Don’t be fobbed off or referred to your GP, don’t be dismissed from the department or pushed down to the bottom of the waiting list as time is critical. The probability is hugely in favour of no infection, but that’s not a gamble that you should take.