28.05.14
Room for improvement
Source: National Health Executive May/June 2014
A new report has shown that more needs to be done to prevent sharps injuries, says Paul de Raeve, Secretary General of the European Federation of Nurses Associations.
It is a topic that has increasingly come to the fore in recent years, and it is evident that, when it comes to safety, healthcare professionals, especially nurses, are committed to engaging.
When undertaking research for a report which evaluates the implementation of EU Directive 2010/32/EU [1] on the prevention of sharps injuries in the healthcare sector, the European Federation of Nurses Associations (EFN) received almost 7,000 replies to a questionnaire from nurses across 28 EU member states, including the UK. In my opinion, this demonstrates that nurses want to have their say and that they recognise a need to keep safety and quality high on the EU political agenda.
The UK successfully incorporated the Directive into national law through The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 [2] almost a year ago, but it must continually commit to its enforcement.
The response to the EFN Report on the Implementation of Directive 2010/32/EU on the prevention of sharps injuries in the healthcare sector [3] has shown that overall, professionals feel that their respective member states have put into place measures for the prevention of sharps injuries and that their practice has improved thanks to the design and implementation of the Directive.
Data analysis reveals that respondents believe that the issuing of the Directive has had a positive impact on the daily practice and clinical environment of health professionals as more safety-engineered medical devices (SEMDs) are available and responsibility for reporting an injury is clear.
However, respondents also identified significant areas that aren’t being covered and that need addressing. The areas lacking were: specific education on sharps injuries prevention; the performance of risk assessments in the workplace; the explicit ban of recapping; and, arguably surprisingly, the lack of awareness campaigns.
Furthermore, respondents stressed that professionals are in need of further guidance when they suffer a sharps injury and that guidelines need to be better rooted in daily practices. It is very important that nurses are engaged in risk assessment and that it does not simply become a theoretical exercise carried out by managers or directors. Nurses working in the field must be involved in these assessments and the role of the unions is very important in ensuring this.
The prevention of sharps injuries in healthcare settings can be emboldened by strengthening those areas that nurses believe are currently missing. Respondent nurses placed emphasis on a need for further education, awareness, as well as follow-up support subsequent to an injury.
Such efforts are crucially important to making progress with the EU safety and quality agenda. After all, as stated in Directive 2010/32/EU, a well-trained healthcare workforce is essential to preventing injuries and the transmission of infections from sharps. To overcome this lack of training, the UK should strengthen its continuous professional education and make use of the European Social Funds available during the period 2014-2020 with the objective of strengthening knowledge transfer and implementation (Horizon 2020). [4]
Perhaps the most concerning finding was that training in the use of SEMDs is often weak or non-existent, despite multiple independent studies [5] showing that a combination of training, safer working practices, and the use of SEMDs can prevent more than 80% of sharps injuries. The capability of certain manufacturers to provide excellent training needs to be taken into account in procurement. Where SEMDs are purchased in accordance with tenders, the tenders should include training and support services as a specific requirement. Furthermore, nurses should be more involved in the selection of suitable SEMDs as, in my experience, the performance and quality of such devices does vary.
The data gathered shows that the EU Directive has had a positive impact on clinical practice. However, it exposes that there is still work to be done in key areas that have been proven to reduce the risk of sharps injuries. There has also been increasing indication of low awareness and compliance of the Directive in non-hospital and long-term care settings, which is a growing concern that needs to be addressed. NHS employers have a responsibility to strongly enforce The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 and adopt a ‘zero tolerance’ policy in relation to sharps injuries.
References and sources
[1] Council of the European Union, COUNCIL DIRECTIVE 2010/32/EU
[2] UK Government, (2013) Statutory Instruments, 2013 No. 645 Health and Safety, The Health and Safety (Sharps Instruments in Healthcare) Regulations 2013
[3] European Federation of Nurses Associations, EFN Report on the Implementation of Directive 2010/32/EU on the prevention of sharps injuries in the healthcare sector: Descriptive and Explorative Cluster Analysis of Directive
[4] European Commission, Horizon 2020: The EU Framework Programme for Research and Innovation 2014-2020
[5] a) Adams D, Elliott TS. Impact of safety needle devices on occupationally acquired needlestick Injuries: a four-year prospective study. J of Hosp Infect 2006; 64: 50-5. b) Advances in Exposure Prevention; vol. 3, no. 4; Libourne study GERES day 09/2001. c) Tarantola A, Golliot F, Astagneau P, Fleury L, Brucker G, Bouvet E; CCLIN Paris-Nord Blood and Body Fluids (BBF) Exposure Surveillance Taskforce. Occupational blood and body fluids exposures in health care workers: four-year surveillance from the Northern France network. Am J Infect Control. 2003 Oct;31(6):357-63. d) Cullen BL, Genasi F, Symington I, Bagg J, McCreaddie M, Taylor A, Henry M, Hutchinson SJ, Goldberg D, 'Potential for reported needlestick injury prevention among healthcare workers in NHS Scotland through safety device usage and improvement of guideline adherence: an expert panel assessment' J of Hosp Infect 2006, 63: 445-451
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