Prevention of needle stick injuries

An effective sharps safety program should be based on a risk management approach that uses the hierarchy of controls.

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Figure 1 Hierarchy of Controls - Worksafe QLD

The hierarchy of controls ranks types of control methods from the highest level of protection and reliability to the lowest. It’s a step-by-step approach to eliminating or reducing risks.

You must work through the hierarchy of controls when managing risks, with the aim of eliminating the hazard, which is the most effective control. Please see some examples of each control measures below.

Level 1:

  • Eliminate the risk
    • Use an alternative route of administration for a medication
    • Use alternative types of skin closure instead of a suture.

Level 2:

  • Substitute the sharp with a safer alternative
    • blunt tip drawing up needles
    • use needle free intravenous access systems.
  • Isolate the hazard from people
    • recapping avoidance
    • ensuring sharps are not passed by hand.
  • Reduce the risk through engineering controls
    • use of sharps disposal systems that conform to Australian Standards (AS4031 or AS/NZS 4261)
    • sharps removal systems (e.g. single handed scalpel blade removers)
    • providing medical devices incorporating safety engineered protection mechanisms that are ideally passively activated (e.g. retractable syringes).

Level 3:

  • Reduce the exposure to the hazard using administrative controls
    • education on induction and annual refresher as it should not be assumed that new staff are familiar with specific devices used or policies and procedures related to sharps safety
    • have a clearly documented local procedure in place for sharps safety and management that is part of the workplace safety program
    • training, including the correct use of devices and procedures for safe disposal
    • mandatory vaccination for diseases transmitted by blood and body fluids.
  • Use personal protective equipment
    • double gloving in operating theatres
    • ensuring PPE is correctly fitting
    • ensuring closed in shoes are worn.

Recommended practices

Implement safe sharps management practises

Despite the removal of sharps from many work practises, there are times where sharps are unavoidable in the health care environment. Health and care workplaces that use, or may encounter, sharp devices should have guidance, policies and procedures in places that reduce the risk of a sharps injury. This includes for:

  • the handling and disposal of sharps
  • removal of sharps from procedures where appropriate
  • ensuring appropriate safety devices are used
  • processes for exchanging/replacing sharps containers
  • training programs for new starters, annual refreshers and for any new devices introduced in the workplace
  • records of vaccination
  • an agreed documented process for injuries, including occupational exposures, to be assessed and first aid provided.

Use safety-engineered medical devices with protection mechanisms

  • Use medical devices that incorporate safety-engineered protection mechanisms
    • These devices eliminate or reduce the risk of occupational exposure when the sharp cannot be removed from the procedure.
  • Passively activated protection mechanisms should be used where practical and feasible
    • A passive safety device activates itself during normal clinical use and provides protection.
  • Implementation of safety-engineered devices must be combined with relevant training and education on the use of the device.

Use needle-free intravenous access systems

  • Needle-free systems should be used to access intravascular devices.
  • Injuries caused by needles prior to use that are used to access intravenous devices are considered lower risk but uniformity of access leads to less confusion and increased compliance with other safety devices.

Product selection

When considering safety-engineered medical devices the following selection criteria should be considered:

  • the device must not compromise patient care
  • the device must perform reliably
  • the safety mechanism must be an integral part of the safety device, not a separate accessory
  • the device must be easy to use and require little change of technique on the part of the health professional
  • the activation of the safety mechanism must be convenient and allow the care-giver to maintain appropriate control over the procedure - passive activation is preferable
  • the device must not create other safety hazards or sources of blood exposure
  • the activation of the safety mechanism must manifest itself by means of an audible, tactile, or visual sign to the health professional
  • the safety mechanisms should not be easily reversible once activated.

Sharps disposal

  • All hollow-bore needles including those with safety features must be disposed of into an approved sharps disposal container that complies with AS4031 or AS/NZS4261.
  • Ensure sharps containers being used are large enough to accommodate the types of devices being used in the area
  • Point of use disposal of sharps is encouraged by ensuring adequate placement of sharps containers in areas where sharps are generated.
  • Sharps containers should be either wall mounted or fixed to a trolley/similar.
  • Sharps containers should be fixed at a height between 900mm and 1100mm, as per the Australasian Health Facility Guidelines.
  • Sharps containers should be exchanged or replaced when they are full or near full to prevent over filling.

Disposable Multiple-Dose Injecting Devices (i.e. injector pens)

  • Healthcare workers should only administer medication using a disposable multiple-dose injecting device (i.e. injector pen) if a safety-engineered needle is used.
  • Hospital inpatients who can self-administer should ideally do so as normal, provided they can remove and dispose of their pen needle.
  • If the patient is unable to self-administer, healthcare workers should use a single-use safety-engineered needle/syringe.
  • Product information for disposable insulin pen devices, pen cartridges and vials indicate that they are for SINGLE PATIENT USE. Pen devices, cartridges or vials of insulin must NOT be used for more than one person.

Safety device failure/product complaint management

Product complaints should be documented to ensure potential statewide problems are identified.

If a device fails:

  • Report through normal facility product complaint process.
  • The product complaint should be investigated at the local level to determine if it was due to:
    • product failure/quality assurance problem
    • user technique requiring in-service/remedial training.

Trends in product complaints should be reported to the company for quality assurance and analysis of failed product for manufacturing/design faults.

Last updated: 5 January 2024