Sharps incidents are one of the most common causes of injury to midwives. They are of particular concern as they carry a serious risk of harm through the transmission of blood-borne infection (NHS European Office, 2013). Injuries occur when a sharp instrument such as a needle, scalpel or stitch cutter, penetrates the skin. If the instrument is contaminated by blood then transmission of infection is possible. The injuries can cause anxiety and distress to affected midwives and can, in the most serious cases, result in infection with blood-borne pathogens such as HIV or hepatitis B or C (NHS European Office, 2013).
Health and Safety Law
The Health and Safety Executive (HSE), who police health and safety law, have stressed that there are laws in place to protect employees from sharps incidents. In R v Worcestershire Acute Hospitals NHS Trust [2010], an NHS Trust pleaded guilty and was fined £12 500 with £9000 costs when a trainee phlebotomist, taking blood from an infected patient unmonitored, caught her wrist on the needle. The trainee had not been made aware of the patient's infection status and there were failures relating to risk assessments to blood-borne viruses, training and review of safe working practices.
The need for further regulation
Despite the general duties on employers to safeguard the health and safety of their staff the number of sharps injuries in health care throughout the European Union has continued to rise. In response to this growing concern, the European Parliament adopted a resolution promoting health and safety in the workplace that included a specific request to the European Commission to ensure preventative measures to protect health care workers from injuries caused by sharps injuries. This led to an agreement on measures to prevent sharps injuries throughout the European Union that has been given legal effect in Council Directive 2010/32/EU on preventing sharp injuries in the hospital and health care sector and has been implemented in the UK in the Health and Safety (Sharp Instruments in Healthcare) Regulations (2013).
Application of the regulations to midwives
The 2013 Regulations apply to organisations whose primary activity is to manage and provide health care, including situations where employees provide care for people in their own homes. The regulations relate to hospital and community-based midwives and managers must ensure that risk assessments and arrangements to comply with the Regulations take account of the circumstances that midwives work in, including arrangements for lone workers.
Duties under the 2013 regulations
The safe management of sharps is underpinned by existing health and safety legislation that emphasises the need to assess the risks, provide appropriate information and training, and consult with employees.
Health and Safety (Sharp Instruments in Healthcare) Regulations (2013) build on the existing law and set out specific requirements that must be taken by health care employers and their contractors.
The key change in approach is now the prevention of unnecessary exposure to sharp instruments.
Prevention of exposure to sharps
The HSE recognises that midwives will continue to use instruments such as needles, scalpels and stitch cutters as they are essential tools in practice. However, the regulations now require that midwifery managers and employers ensure that these sharp instruments are only used where they are absolutely necessary. Managers must audit the use of sharps and identify situations where their use can be excluded. The HSE cites an example of needles being used to collect urine samples from catheter bags when this is not necessary (HSE, 2013). Midwifery managers must also introduce sharps and needle free equipment where it is available and reasonably practicable to do so (Health and Safety (Sharp Instruments in Healthcare) Regulations, 2013: regulation 5).
Use of safer sharps
Where midwifery managers do not consider it reasonably feasible to avoid the use of sharp instruments in a procedure, the 2013 Regulations require the use of safer sharps that incorporate protection mechanisms where it is reasonably practicable to do so. This might include the use of syringes and needles that have a shield that covers the needle after use.
Procedures for the safe use and disposal of sharps
Where safer sharps are not available, procedures for working with and disposing of the sharp instrument must be in place. This must include a requirement for managers to ensure safe procedures for the use and disposal of sharps used by midwives.
Recapping of needles
Midwifery managers must ensure that midwives do not recap needles and sharps unless a risk assessment demonstrates that it is required to prevent a risk. Where this is the case then devices such as needle blocks must be provided to control the risk of injury.
Sharps disposal containers
Clearly marked secure containers must be provided and placed close to where sharps are used together with instructions for midwives on how to safely dispose of the sharp. Managers must ensure that suitable containers are provided for use in a woman's home. A risk assessment will have to demonstrate that the type of sharp, portable sharp container and information for staff is appropriate for the environment the midwife is working in.
Information and training
The Regulations place a duty on midwives and their managers to work with safety representatives to develop information to be given to staff about the risks from sharps. The regulations require that such information covers (Health and Safety (Sharp Instruments in Healthcare) Regulations (2013): regulation 6(2)(3)):
Managers must also ensure that staff are given training on how to work safely with the sharps used by them in practice. The Regulations require that this training covers (Health and Safety (Sharp Instruments in Healthcare) Regulations, 2013: regulation 6(4)):
Duty to report sharps injury
Under the Regulations, midwives have a legal duty to notify their managers of all sharps incidents at work. Managers must ensure that there are arrangements in place for the timely reporting of these injuries including arrangements for out-of-hours reporting. Managers must then record the incident and investigate the circumstances and causes of the incident. The investigation must be proportionate to the seriousness of the injury. A clean needle injury will not require as rigorous an investigation as an incident where there is exposure to blood-borne infection.
Where an injury has or might have exposed a midwife to blood-borne infection, then immediate medical advice and post-exposure treatment and counselling must be available to that member of staff.
Duty to review procedures
The 2013 Regulations require all midwifery services to review procedures for the control of sharp risks by (Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, regulation 7(2)):
Conclusion
The Health and Safety (Sharp Instruments in Healthcare) Regulations (2013) implement the provisions of Council Directive 2010/32/EU on preventing sharp injuries in health care. The regulations place new duties on midwives and their managers to prevent the risk of exposure to blood-borne infection from injury caused by sharps.
Midwives must ensure that they are familiar with local policies, procedures and risk assessments relating to their work and that they comply with the safe systems of working with sharps set out by their employer. There is now a duty not to recap needles and sharps and to report all sharps injuries no matter how apparently trivial.
Midwives must ensure that the equipment, risk assessments, information and training in relation to sharps are suitable for the unique areas they practice in.