Dental mythbuster 7: Use of safer sharps

We will review the topic of safer sharps when we review if the practice is safe. This relates to regulation 12 (safe care and treatment) and regulation 15 (premises and equipment).

The European Council Directive 2010/32/EU (the Sharps Directive) was introduced to prevent injuries and blood-borne infections to hospital and healthcare workers from sharp instruments such as needles, matrix bands and scalpel blades. The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 implement aspects of the directive that are not specifically addressed in existing GB legislation.

• Health and Safety (Sharp Instruments in Healthcare) Regulations 2013

Mandatory requirements

Professional guidelines:

• HSE guidelines
• European Council Directive 2010/32/EU (the Sharps Directive)
• HTM 01-05: Decontamination in primary care dental practices

1. Employers ensure that risks from sharps injuries are adequately assessed and appropriate control measures are in place.
2. There is a written practice policy/protocol in place, including a risk assessment explaining why they continue to use traditional local anaesthetic reusable syringes (see 3 and 4 below).
3. The employer should ensure that sharps are only used where they are required.
4. The employer must substitute traditional, unprotected medical sharps with a ‘safer sharp’ where it reasonably practicable to do so.
5. Place secure containers and instructions for safe disposal of medical sharps close to the work area (but not sited on the floor)
6. Regulation 7(6)(c) of COSHH requires systems to dispose of contaminated waste safely.
7. Employees are trained so they know how to work safely and without risk to health with the specific sharps equipment and procedures that they will use.
8. An employee who receives a sharps injury at work must notify their employer as soon as practicable. The employer must ensure they have sufficiently robust arrangements to allow employees to notify them in a timely manner, including where the employee works out-of-office hours or away from the employer’s premises.
9. If an employee has been injured by a sharp that has or may have exposed them to a blood-borne virus, the employer must:

• ensure that the employee has:
  • immediate access to medical advice
  • has been offered post-exposure prophylaxis and any other medical treatment, as advised by a doctor;
• considered whether the employee should receive counselling

10. An employer must

• record a sharps injury when they are notified of it, whoever provides that notification
• investigate the circumstances and causes of the incident, and
• take any action required.

Recommended practice

Best practice:

11. Single use disposable local anaesthetic delivery syringes that incorporate a mechanism to protect against accidental injury.

Acceptable practice to meet Essential Quality Requirements and the EU Directive

12. Injuries can occur after a needle has been used if a healthcare worker holds the needle in one hand and attempts to place a cap on the needle with the other hand (two-handed recapping). Needles must not be recapped after use unless the employer’s risk assessment has identified that recapping is itself required to prevent a risk (for example to reduce the risk of contamination of sterile preparations). In these limited cases, appropriate devices to control the risk of injury must be provided, for example:

• needle-blocks to remove and hold the needle cap and allow safe one-handed recapping.
• traditional metal local anaesthetic delivery syringes in conjunction with other measures.

13. A wall mounted flow chart within the practice detailing the process for dealing with a needlestick injury and the contact numbers for Occupational Health or A&E. Members of staff will be asked to describe the process.
14. If there is a sharps injury, the extent of the accident investigation should be proportionate to its potential severity. For example:

• an injury with a clean needle as it is removed from the packet - usually sufficient to record the details and give any first aid required
• injuries involving a used needle will involve more analysis and an appropriate record should be kept of the findings of the investigation.