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 (Department of Health, 2014).
To reduce the 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, e.g. 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
Where it is reasonably practicable to do so, the use of traditional, unprotected medical sharps should be substituted with safety-engineered devices (Health and Safety Executive (HSE) 2013).
Blood or body fluid contaminated needles
- Contaminated needles MUST NOT be re-sheathed.
- Do not send syringes with needles to other departments e.g. 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 (Scottish Executive Health Department, 2001). Use appropriate safe equipment for neonatal use.
For injuries with blood- or body fluid contaminated sharps the GOSH ‘Sharps injuries and exposure to blood borne viruses’ guideline must be followed.
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 Control of Substances Hazardous to Health (COSHH) 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, 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.
- Where possible, used sharps should not be taken to the sharps box, the box should be taken to the patient.
- Place sharps boxes at eye level and within arm’s reach.
- Establish means for the safe handling and disposal of sharps devices before the beginning of a procedure (Royal College of Nursing, 2013).
The following procedure must be adopted with regards to the use of containers provided for the disposal of used needles and other sharp objects. The sharps container:
- Must be taken to patient when using sharps, where possible.
- 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/young people.
- 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/young people.
- Must be labelled with the:
- Hospital name, ward/department/clinic.
- Name of the individual who assembled box, and date of assembly.
- Name of individual who closed and locked/disposed of it.
- The box must be dated before being sent for incineration as stated in.
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 arrange for disposal. This is booked through CARPS.
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 (HSE, 2013).
- Large pieces of broken glass and crockery etc. should be disposed of according to the Trust Waste Management Policy.
DEPARTMENT OF HEALTH (2014). AIDS/HIV Infected Health Care workers: Guidance on the Management of Infected Health Care Workers and Patient notification, updated guidance. London: Department of Health. [Accessed on 05.02.16]
HEALTH AND SAFETY EXECUTIVE (2013). Health and Safety (Sharp Instruments in Healthcare) Regulations - Guidance for employers and employees. [Accessed on 05.02.16]
ROYAL COLLEGE OF NURSING (2013). Sharps Safety – RCN Guidance to support the implementation of The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. [Accessed on 05.02.16]
Scottish Executive Health Department (2001). Safety Action Notice SAN(SC)01/31. Blood sampling from small infants: Improper disposal of needles. Scottish Healthcare Supplies. Edinburgh