Disposal of used sharps

The purpose of this guideline is to provide guidance about the correct use and disposal of needles and other sharp items at Great Ormond Street Hospital (GOSH).

Incidents involving the unintentional inoculation of health care workers with used needles or other sharp materials (collectively known as 'sharps incidents') are the most important factor in the transmission of blood borne viruses (Reference 1).

To reduce risk of this occurring, all sharps must be used and disposed of safely in accordance with this guidance. It is the responsibility of the USER to ensure compliance. Where this task is delegated, eg operating theatres, the user must be sure that "at risk" staff are aware of the presence of the hazard and their responsibility for disposal.

Safe use of needles

Blood or body fluid contaminated needles

Contaminated needles MUST NOT be re-sheathed.
Do not send syringes with needles to other departments eg laboratories. Use syringe caps or other appropriate devices.
DO NOT BREAK the hub off the hypodermic needle to obtain blood from neonates. This has led to adverse incidents. Use appropriate safe equipment for neonatal use.

Non-blood contaminated needles

Care must be taken with needles which have been used for drawing up purposes to prevent inoculation of syringe contents into the employee with possible deleterious side effects. An approved method can be seen on the GOSH video for 'Aseptic non-touch technique' which is on each ward. Follow normal first aid measures for a contamination incident.

For non-blood contamination further information can be obtained from:

The relevant COSHH (Control of Substances Hazardous to Health) assessment available in the unit.
Occupational Health between 9am-5pm Monday to Friday, excluding Bank holidays. Telephone extension 8554.
UK National Poisons Centre, open 24 hours. Telephone: 0870 600 6266. This service is for professional use only and employees must not contact this number about themselves. However, the Occupational Health Nurse Advisor, an attending doctor, the nurse in charge or a clinical department manager may contact this number for information on behalf of the exposed employee.

Safe use of other non-disposable sharp items

The following procedure must be adopted to render these items safe:

Scalpel blades must be removed from handles using purpose made blade removal kits, as appropriate, or forceps. Needles are to be removed from needle holders.
Sharps requiring return to HSDU must be packaged safely and securely.

Disposing of sharps and syringes

Discard sharps items and complete needle and syringe units directly into sharps box immediately after use.

Used sharps SHOULD NOT be taken to the sharps box: the box should be taken to the patient/client.

Sharps box

The following procedure must be adopted with regards to the use of containers provided for the disposal of used needles and other sharp objects.

Must be taken to patient, where possible, when using sharps.
Must have been approved by the Infection Prevention & Control Team and will comply with the requirement of UN 3291 as required by the Carriage of Dangerous Goods Legislation.
Must be easily available in all areas where clinical sharps are used but must not be accessible by children.
Must be assembled correctly and checked to ensure all connections are solid.
MUST NOT be overfilled (not more than 75 per cent full).
Must be made secure prior to placing for collection and must not be left where there may be access by children.
Must be labelled with the:
- hospital name, ward/department/clinic
- the name of the individual who assembled box, and date of assembly
- the name of individual who closed and locked/disposed of it.
The box must be dated before being sent for incineration as stated in the Trust Waste Management Policy.

If any sharps are protruding through the container or opening, DO NOT attempt to remedy the situation by pushing the items inside.

If a container has been overfilled, DO NOT decant any of the contents. If possible place inside a larger sharps container and call the Domestic Services to arrange safe disposal.

An incident form should be completed as a “near miss” and the head of department informed.

Sharps in use

The following should be taken into consideration when sharp instruments or objects, including needles, are in use:

DO NOT separate needles from syringe routinely. Blood contaminated syringes together with needle should be placed in the sharps containers.
For blood gas analysis carefully remove the needle and place sealing cap on the syringe taper.
If it is absolutely necessary to re-sheath the needle for an overriding safety reason, slide the needle into the sheath on an even surface using one hand, thus avoiding the risk of injury. Large pieces of broken glass and crockery etc. should be disposed of according to the Trust Waste Management Policy.

References

Reference 1:
Department of Health (2002) AIDS/HIV Infected Health Care workers: Guidance on the Management of Infected Health Care Workers and Patient notification Viewed on: 03/01/2012

Document control information

Lead author(s)
Deidre Malone, Lead Nurse in Infection Prevention & Control, Infection Control

Additional author(s)
John Hartley, Consultant Microbiologist, Infection Control Department
Margaret Clapson and Jacquie Flynn, Clinical Nurse Specialists, HIV/AIDS
Susan Gorton, Head of Occupational Health, Occupational Health
Barbara Brekle, Clinical Nurse Specialist, Infection Control

Document owner
Deirdre Malone, Lead Nurse in Infection Prevention & Control, Infection Control

Approved by
Clinical Practice Committee

First introduced: 1 July 2007
Date approved: 3 January 2012
Review schedule: Two years
Next review: 3 January 2014
Document version: 2.0
Replaces version: 1.0