Occupational exposure through inoculation injuries can arise in several ways. Most common is the ‘sharps’ injury, where the injury occurs from the handling of needles (needlestick) or other sharp objects (e.g. during instrument decontamination). These may have been in contact with blood or other body fluids. Inoculation risk can also exist from splashes of blood/body fluids to mucous membranes, including the eye, or open wounds/damaged skin.
Precautions such as Personal Protective Equipment (PPE) are put in place to prevent exposure to potentially infected blood and body fluids. In addition to existing legislation, the Health and Safety (Sharp Instruments in Healthcare) Regulations (2013) [1] provide further detail about the requirements for prevention of sharps injuries and actions to be taken in the event of an injury. An information sheet to help understand obligations under these regulations is also available. This legislation includes the use of ‘safer sharps’ that incorporate features to reduce the risk of accidental injury.
Carry out a risk assessment following the principles of a COSHH assessment.
Put together a written policy and procedures for management of occupational exposure, including measures to prevent unnecessary exposure and control the risk of exposure (ways of working, personal protective equipment, waste disposal), and actions for dealing with sharps and other inoculation injuries (see Occupational Exposure Management (including Sharps) Policy template).
Ensure that staff are aware of this policy and the related procedures and train staff in the risks from and prevention of inoculation injuries and how to deal with any that occur.
Avoid the unnecessary use of sharps, for example, do not use a medical sharp unless the task requires it and there is no alternative.
If use of a medical sharp is necessary, use alternative, safer sharps if at all possible.
Wear appropriate PPE to reduce the risks of inoculation injuries.
Avoid recapping needles or, if assessed as the safest option, use a suitable device to allow safe one-handed recapping.
Have secure containers with instructions for safe disposal of medical sharps as close to the work area as is practicable.
If sharps injury occurs:
- encourage bleeding by squeezing above the wound – do not suck the wound;
- wash the injury thoroughly with warm running water and soap;
- cover the injury with a waterproof plaster.
If the eyes, mouth or damaged skin are exposed to splashes of blood/body fluids:
- rinse/irrigate with copious amounts of water;
- if contact lenses are worn, after removing the lenses irrigate the eye;
- the water which has been used for mouth rinsing must not be swallowed.
Report the injury to the practice principal or employer.
Ensure details of the incident are recorded accurately in the practice accident book.
Refer to clinical records of relevant patients to identify any risk factors (e.g. HIV, hepatitis B, hepatitis C etc).
Contact your local Occupational Health Service (OHS) to discuss the incident and, where necessary, ask them for appropriate advice and follow up.
In cases where there is a risk of exposure to blood-borne viruses or other serious infection, arrange for counselling if the injured person feels this would be beneficial.
Investigate the incident to identify whether changes to practice would reduce the risk of future injuries and amend procedures accordingly.
Inform staff of any changes to procedures.
Occupational Exposure Management (including Sharps) is one of the Standard Infection Control Precautions (SICPs) described in Health Protection Scotland’s National Infection Prevention and Control Manual.