Sharps injury is a particular risk for healthcare professionals and healthcare ancillary workers and laundry workers, but also for waste handlers and those working in recycling operations, community support staff and street scene personnel, police and prison services, drug- and sex-worker support workers, community parks and gardens staff, those suffering street violence and sporting injuries, and many others.
Sharps injury is a term frequently used to refer exclusively to needle-related or needlestick injury but has a far broader definition. Any penetrating injury has the potential to transmit infection if the source is contaminated. Hypodermic needles are an obvious risk but blades and broken rigid plastic items, glass and metals can each inflict injury.
Injury may occur during the use or the disposal of sharps, or later when individuals come into contact with sharp items that have been carelessly discarded, placed into inappropriate containers, or hidden from view.
Blood and body fluid exposures
Blood and body fluid exposures are common in violent and abusive encounters, trauma and first aid, sporting injury, healthcare and more general social care activities. Piercing and tattooing as well as some cosmetic and related encounters including epilation and deep dermabrasion may also expose individuals to blood and body fluid exposure.
Though often overlooked, similar high risk exposure events include exposure to blood, bloodstained body fluids and saliva to the mouth and eyes, and to broken skin including eczematous and similar pre-existing lesions.
The risks of blood and body fluid exposures to healthcare professionals are well recognised, but Blenkharn Environmental research studies have identified a previously unrecognised and unreported risk of blood and body fluid exposures for clinical waste handlers also. Exposure may occur by leakage of filled, often inappropriately filled, waste containers and though widespread secondary contamination of the work environment including vehicles, plant and restroom facilities. These risks are compounded by deficiencies in PPE use and the management failures that omit suitable training and supervision, by repeated manual handling of wastes and by hygiene deficiencies.
Blenkharn Environmental has developed sensitive analytical techniques applicable to the evaluation of task-related and more general workplace blood spillage applicable to healthcare and related environments, and across the waste industries.
Urgent medical attention is required and those suffering sharps injury or other blood or body fluid exposure must not be fobbed off with some minor first aid – though first aid and wound hygiene is an important first step in prevention -and a rebuff from A&E staff for a superficially trivial injury. Specialist referral may be warranted and in addition to possible post-exposure prophylaxis and long-term follow-up, specialist psychological support may be required for post-exposure anxiety and sometimes debilitating post-traumatic stress that can prevent return to the workplace.
Blenkharn Environmental has a long-established research and publication record in sharps injury and related studies that embrace the safe use and disposal of sharps, sharps containers, the management of clinical wastes from domestic sources and the retrieval of discarded sharps from the community. Particular interests include Local Authority approaches to sharps management, the sometimes deficient interface between healthcare providers and Local Authorities in the effective management of sharps and other clinical wastes generated by patients receiving care in their own home, sharps container design and testing, training and education, and the limitations and use of PPE items by those at risk of occupational exposure.
Delivering training and audit for staff engaged in healthcare waste-related activities, biosafety and safety management review, and more general review of waste management performance, Blenkharn Environmental is perhaps uniquely placed to provide science-led and research-driven advice and guidance and expert opinion in sharps injury, safe disposal and the prevention of injury and exposures.
Identifying failures, improving standards
With presentations to various special interest and representative groups, and to contractors and their trade body, Blenkharn Environmental continues to support improvement in the safety and more general performance standards of sharps disposal.
Published research studies of sharps injury in waste handlers, of Local Authority appropaches to the disposal of clinical wastes in the community, and of Local Authority management of discarded sharps and other drug litter, Blenkharn Environment continue to promote the highest standards of safety.
Our published audit of Local Authority services identified several particularly dangerous recommendations to members of the public and various hazardous procedures that would place individuals at great risk of sharps-related injury. We are encouraged by the improvements in Local Authority performance and safety standards in sharps and clinical waste management that have occurred since publication of our findings. However, a follow-up audit (Q3 2010 – Q2 2011 (awaiting publication) still identifies some poor performance standards, waste management procedures that are contrary to prevailing waste management, environmental, health & safety and other regulations, and which promote unsafe practice.
Work with international standards organisations involving the development of standards for the design, construction and testing of sharps containers provides additional insight into the safe disposal of sharps.
Blenkharn Environmental continues to publish the results of on-going research projects of sharps design and use, disposal, sharps bin hygiene, and the impact of waste management practices on hygiene and safety in the user [healthcare provider or disposal contractor] environment.
With additional interest and a continuing program of research study in hand and general hygiene issues, and PPE use, for those handling sharps bins and other wastes as they enter and pass along the disposal chain Blenkharn Environmental is uniquely placed to offer specialist assessment, guidance and training support to those involved in sharps use and particularly in the disposal of sharps. This includes PPE selection, use and evaluation, the selection of equipment, techniques and containers for the safe retrieval of sharps and their subsequent disposal, approaches to the prevention of sharps injury and associated blood and body fluid exposures, the provision of immediate and follow-up care for those suffering sharps injury or other blood and body fluid exposure, and reserachexpert support in legal action.