Prevention of needle stick injuries
- Recommended practices
- Product selection
- Sharps disposal
- Disposable multi-dose injecting devices (i.e. injector pens)
- Safety device failure and product complaint management
Use safety-engineered medical devices with protection mechanisms
Use medical devices that incorporate safety-engineered protection mechanisms that eliminate or reduce the risk of occupational exposure to the lowest feasible extent
- Passively activated protection mechanisms should be used where practical and feasible
- A passive safety device activates itself during the course of normal clinical use and provides protection
- Implementation of safety-engineered devices must be combined with relevant training and education on the use of the technology.
Use needle-free intravenous access systems
- Needle-free systems should be used to access intravascular devices
- It is acknowledged that needle stick injuries that occur from needles used to access intravenous lines are low risk however, uniformity of access leads to less confusion and increased compliance with other safety devices.
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
- The device must not create other safety hazards or sources of blood exposure
- A passive activation is preferable
- 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.
When introducing retractable syringes keep in mind that they may not be suitable for some purposes, and therefore some non-safety devices may be required for specific purposes, for example:
- Administration of local anaesthetic (LA) >3 mL
- Most procedures require no more than 1-2 mL of LA for effective anaesthesia
- Using low volume syringes also reduces the chance of an excess volume being used; excessive volume may cause more pain
- Pre-packed medications +/- administration needle
- Procedures where non-retractable needles form part of the procedure kit/pack.
Conventional needles that may still be required:
- 18 gauge (blunt) needles for drawing up medication
- 21 gauge needles for injection of medication into infusion bags and blood collection (only if necessary)
- For the administration of LA >3 mL.
- 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 Standard Components Room Layout Sheets for; Dirty Utility 10m2, Patient Bay - Recovery, Stage 1, and Patient Bay - Resuscitation.
- Hospital inpatients who are able to self-administer should ideally do so using safety engineered pen needles.
- Note: safety-engineered pen needles are not routinely used by people with diabetes in their homes so will need to be provided and their use demonstrated by the facility.
- Healthcare workers should only administer medication using a disposable multiple-dose injecting device (i.e. injector pen) if a safety-engineered needle is used.
- If safety-engineered pen needles are not available:
- the patient may self-administer as normal provided they can remove and dispose of their pen needle.
- If the patient is unable to self-administer
- and if the medicine is dose specific (e.g. High concentration insulin (e.g.Toujeo), exenatide (Byetta), liraglutide (Victoza)), the medical officer must be informed and an alternate medication SHOULD BE sourced.
- If the medication is not dose specific, healthcare workers should use a single-use safety-engineered needle/syringe.
- Product information for disposable insulin pen devices, pen cartridges and vials indicates that they are for SINGLE PATIENT USE. Pen devices, cartridges or vials of insulin must NOT be used for more than one person.
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.
Product complaints should be reported via your local internal complaints/feedback channels.
Trends in product complaints should be reported to the company for quality assurance and analysis of failed product for manufacturing/design faults.