BMA sets out guidelines on needlestick injury

Needle with drop of bloodGuidance designed to protect doctors’ safety and patients’ rights following needlestick injuries has been published by the BMA.

It provides information on the legal and ethical requirements faced by doctors wishing to test patients who are unable to give their consent for blood-borne diseases following a needlestick injury.

It also sets out the process that must be followed to reach a lawful decision about testing.

Patient consent is normally required prior to any test for disease, but patients are sometimes unable to provide this consent for a medical reason, such as being unconscious.

The guidance advises that doctors should determine whether a patient is likely to regain their capacity to provide consent in advance of testing being needed, and, where possible, delay testing until that point.

In cases of patients being unable to consent, the guidance outlines who has the legal authority to make a decision on behalf of the patient — such as a welfare attorney or a court-appointed deputy.

In instances where there is nobody with the legal authority to consent on behalf of a patient who lacks capacity, doctors can decide whether it is legally and ethically appropriate to test the patient without consent.

In making a decision a doctor must assess:

  • Whether testing is in the best interests of the patient (England, Wales and Northern Ireland)
  • Whether testing will benefit the patient and whether it is reasonable in the circumstances to safeguard or promote the physical or mental health of the patient (Scotland).

Doctors must also follow the decision-making process set out in the guidance.

All testing without consent should be done using pseudonyms and patients should be given the choice about whether or not to receive the results of testing once they regain capacity.

BMA medical ethics committee chair John Chisholm said: ‘As a health professional, receiving a needlestick injury can be very stressful.

‘Where the source patient lacks capacity to consent to testing for blood-borne viruses, uncertainty around whether, and when, testing can be undertaken without consent adds to that stress.

‘In response to requests from our members for advice, we have produced this guidance explaining the legal situation in the different jurisdictions across the UK and, crucially, setting out the process that must be followed in order to make a decision about testing that is legally and ethically robust.’

Download the full guidance here


It’s a pity that there is not so much consideration for members of the public and others exposed to sharps injury, and to waste handlers. Too often, these groups are fobbed off in A&E for an injury described as ‘trivial’ with not a thought for its implication.

And who is it that still drops unsheathed needles into thin walled waste sacks?


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