The eye of the needle (part 1)

Sharps injuries are a subject greatly reported on in the dental press, as they are one of the most common and serious risks for any healthcare worker including dentists and DCPs. This first article in a series of two, covers the relevant legislation and equipment to make your practice a safer working environment.

The facts

On a daily basis you are at risk from infectious agents such as prions (CJD), bacteria (like MRSA) and viruses (such as hepatitis viruses or HIV - Human Immunodeficiency Virus).

If the sharps you are injured with are contaminated with an infected patient's blood, they can transmit more than 20 different diseases. In the ten years before 2013, nearly 5,000 blood and bodily fluid exposures were reported from healthcare workers in England, Wales and Northern Ireland, where the person involved was known to, or thought to, be infected with Hepatitis B, C or HIV and these reported cases have increased year on year. So with 40,000 incidents of needlestick injuries reported every year (and many unreported), it’s no wonder it is a major concern for the NHS, as well as for every individual potentially at risk.

The focus

Last December, in their annual conference, Public Health England (PHE) focused on the issues of exposure to bloodborne viruses (BBVs) for healthcare professionals, as their round table session was specifically dedicated to discussing how they could raise awareness of the risk of needlestick injuries. This was due to the release of new data that highlighted the fact that the risk of needlestick injuries continues to be an issue. They suggested that as well as using safety devices, increasing awareness and education could play a key role in reducing the occurrence of injuries.

The conference was supported by an update of the publication the 'Eye of the Needle' covering all aspects of healthcare workers' occupational risks to bloodborne viruses. The report stated that ‘NHS Trusts and all employers in the healthcare setting ought to provide healthcare workers with safety-engineered devices in line with the EU Sharps Directive (2010) and the Health and Safety Executive (Sharps Injuries in Healthcare) Regulations (2013) regarding safer working conditions.‘

The unexpected

Until it happens to you, the threat of infection from these viruses may not be at the forefront of your mind. But unless you can be certain that your patient is not infected, then sustaining a needlestick injury could be an alarming experience. So having effective protocols in place to enable you and your team to act quickly and effectively is essential to support a safer working environment.

“We’ve had a number of dentists tell us that they have recently had a needlestick injury, but haven’t followed the protocols, which includes having a blood test. It’s vital to have a blood test as soon as possible after the injury so that the risk of transmission can be assessed. It’s a good idea to get down to your nearest A&E (or occupational health service) to get an independent assessment.” says Bryan Gross head of underwriting and claims at Dentists’ Provident.

The legislation 

The EU ‘Sharps’ Directive (2010)

This Directive aims to help you reduce accidents by giving guidance for the safest possible working environment. They state, the purpose of the Directive is ‘to achieve the safest possible working environment; to prevent workers’ injuries caused by all medical sharps; to protect workers at risk; to set up an integrated approach establishing policies in risk assessment, risk prevention, training, information, awareness raising and monitoring and to put in place response and follow-up procedures.’

Health and Safety (Sharps Instruments in Healthcare) Regulations (2013)

This UK law came into force in May 2013, and was brought in alongside the Directive. Employers are asked to promote the safe use and disposal of medical sharps; provide detailed information and training for employees; respond effectively if an injury occurs and review procedures on a regular basis. This applies to private as well as NHS practices. The HSE has produced Health Services Information Sheet 7 for detailed guidance, and the NHS employers website has a briefing document called ‘Protecting Healthcare Workers from Sharps Injuries’ that you can download.

The CQC  

In the CQC’s Provider handbook they indicate that they will inspect the systems, processes and practices to protect people to ensure that the ‘premises and equipment are clean, secure, properly maintained and kept in accordance with current legislation and guidance such as, The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance, HTM 01-05 and HTM 04-01, National Patient Safety Agency (NPSA) guidance and safe sharps directive to keep people safe.’ And make sure that ‘Providers meet the requirement of relevant legislation to ensure that premises and equipment are properly purchased, used and maintained such as, Ionising Radiation Regulations 1999 and Ionising Radiation (Medical Exposure) Regulations 2000 (IRMER), Sharps regulations 2013, HTM 07-01 (healthcare waste).’

They also produce a new series of ‘Dental Mythbusters’ and No.7 is entitled ‘Use of safer sharps’ and gives a succinct summary of the mandatory requirements and recommended practice.

HTM 01-05

The ‘decontamination in primary care dental practices’ document states that all practices should have guidelines and procedures in their infection control policy that include ‘a written policy with regard to minimising the risk of blood-borne virus transmission, with particular attention to the possibility of sharps injuries. The policy should include arrangements for an occupational health examination of all staff thought to be at risk of hepatitis B. (This is related to risk reduction in blood-borne virus transmission and general infection). Confidential records of all such examinations should be maintained. In addition, a record of all sharps injuries must be maintained in accordance with current health and safety legislation. Further details can be found in the Green Book,’ This book, updated in September 2013, contains the most up to date information on vaccines and the UK procedures for vaccine preventable infectious diseases.

The equipment

The UK regulations from the HSE have focused on reducing the risk through the use of ‘safer sharps’, or ‘medical sharps that incorporate features or mechanisms to prevent or minimise the risk of accidental injury.’ Needles must not be recapped after use unless the employer’s risk assessment has identified that recapping is itself required to prevent a risk (e.g. to reduce the risk of contamination of sterile preparations).’      

The guidelines specifically refer to the fact that ‘a range of syringes and needles are now available with a shield or cover, that slides or pivots to cover the needle after use.’ The CQC indicate that ‘the employer must substitute traditional, unprotected medical sharps with a ‘safe sharp’ where it is reasonably practical to do so’ and in the best practice section they recommend you use ‘single use disposable local anaesthetic delivery syringes that incorporate a mechanism to protect against accidental injury.’  Septodont's Ultra Safety Plus is one such device that has been clinically researched and proven to reduce needlestick injuries from an average of nearly 12 to zero per one million hours worked.

“Dental needles are different to most other medical needles because they are double ended,” explains Mike Cann, Septodont’s Managing Director. “This means that if you recap the point, you still have exposure to the reverse end (which punctures the cartridge diaphragm). Both ends could potentially be contaminated since the act of aspiration draws blood back through the needle canula and into the cartridge. That’s why it makes sense to use a device with a sheath that locks into position while you dispose of it and avoids the need for potentially dangerous recapping.”

The dental team obviously use needles for local anaesthetic (LA), as one of the most commonly carried out procedures, and as a prescription-only medicine, these can usually only be prescribed by a doctor or a dentist. However, both dental hygienists and therapists can administer LA either under a written, patient-specific prescription or under a Patient Group Direction, so it poses a risk to them too. “Another thing to bear in mind” Mike continues “Is that a great many needlestick injuries are sustained by dental nurses, who are at risk because of their proximity to unprotected devices (needles), for example, when they are placed at rest on bracket tables between injections.“

Ensuring your practice complies with all regulations may mean making some changes to both your equipment and your methods, however it could be the only way to avoid that seemingly inconsequential ‘scratch’ and safeguards the health and career of you and your team.

References available on request.

This article is intended for information only. It is not designed to give financial or medical advice, nor is it intended to make any recommendations of the suitability of our plans for a particular individual. Full details of our contract can be found in our rules on our website www.dentistsprovident.co.uk. Dentists’ Provident Society Limited does not accept liability and responsibility for changes made to this information. Some of the information in this article has been obtained from third parties. While we believe the information to be reliable; we make no representations as to its accuracy and accept no responsibility or liability for any error, omission or inaccuracy in the data supplied by any third party.