Health care workers face serious risks from sharps injuries. These are injuries which occur when needles, scalpels, or other sharp medical instruments accidentally puncture or cut the skin — often during procedures such as injections, blood draws, or waste disposal.

They should also never be accepted as part of the job. Here we highlight best practices and legal obligations for safer sharps management.

Please note: This is a shortened version of a more detailed publication (16-page PDF).

A 2021 survey of RCN members found that of 7,500 respondents, 63% had suffered at least one sharps injury in their careers. 15% had an injury in the past year. This is a 50% rise since 2008, with 3% reporting multiple injuries.

Most incidents occurred "before procedure" (29%), "during procedure" (26%), or were "disposal-related" (32%). Bank and agency staff, nursing home and mental health practitioners, and black and minority ethnic staff had higher rates.

The findings, influenced by pandemic-related factors, such as fatigue and high workloads, highlight disparities in training and access to safety equipment.

Sharps injuries occur when health care workers accidentally prick or cut themselves with medical instruments, such as needles or scalpels. These are often contaminated with a patient’s blood.

These incidents can transmit serious infections, particularly when the injury involves hollow bore needles (although subcutaneous needles also present a risk). They may expose you to blood-borne pathogens like hepatitis B, hepatitis C and human immunodeficiency virus (HIV).

The risk of infection will depend on several factors. They include:

• the depth of the injury
• the type of sharp used
• whether the device was previously in the patient’s vein or artery
• how infectious the patient is at the time of the injury.

Some procedures have a higher-than-average risk of causing a sharps injury. These include intra-vascular (IV) cannulation and venepuncture. Devices involved in high-risk procedures are:

• lancets
• scalpels
• suture needles
• razors
• scissors
• test tubes
• fragments of bones or patients’ teeth.

Sharps injuries typically occur during:

• procedures (for example, inserting IV lines)
• disposal of sharps
• handling equipment before or after procedures
• recapping needles (which should be avoided).

The probability of infection varies by pathogen:

• Hepatitis B: One in three.
• Hepatitis C: One in 30.
• HIV: One in 300.

Even when infections don’t occur, the treatment and follow-up can cause a great deal of anxiety and stress and take its toll. This is because infections such as those caused by hepatitis B and C and HIV can take months to diagnose. Blood tests and the side effects of anti-viral drugs may cause weeks of anxiety.

Preventing such injuries is a collective responsibility, from organisational leaders to frontline workers.

Since the late 1990s, at least 20 health care workers got hepatitis C. There are also five confirmed cases of HIV.

The Health and Safety at work etc Act 1974 and the Health and Safety at Work Order (Northern Ireland) 1978 require employers to protect their employees' health, safety, and welfare at work, as far as is reasonably practical.

The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 aim to reduce sharps injuries. Key employer obligations include:

• conducting risk assessments
• implementing safer sharp devices
• providing appropriate training and incident reporting mechanisms. Non-compliance can result in significant penalties, including fines and legal action.

Everyone has a role to play in the prevention of sharps injuries to health care workers and other health and social care staff.

1. Elimination: Avoid using sharps when possible.
   
   
2. Engineering controls: Use devices with safety features, like retractable needles.
   
   
3. Administrative controls: Develop and enforce policies, conduct training and ensure safe systems of work.
   
   
4. Work practice controls: Adopt safe practices, such as the immediate disposal of used sharps.
   
   
5. Personal Protective Equipment (PPE): Use gloves and goggles as barriers, although PPE alone doesn’t prevent injuries.

Risk assessments help identify potential hazards and put in place control measures. The process includes:

1. Identifying hazards (for example, procedures involving sharps).
   
   
2. Identifying who may be harmed.
   
   
3. Evaluating risks and deciding on precautions.
   
   
4. Recording findings and implementing controls.
   
   
5. Reviewing assessments at regular intervals or following incidents.

All health care workers should be trained on sharps safety at induction and then at regular intervals.

Incident reporting is crucial to improving safety practices, but underreporting remains challenging. Employers must foster a culture that encourages reporting without fear of blame.

Immediate actions following a sharps injury include:

• Encouraging the wound to bleed.
• Washing the area thoroughly with water.
• Covering it with a sterile dressing. Seek medical advice promptly for potential post-exposure prophylaxis and follow-up testing. Psychological support should also be available.

• Assess the risk of sharps injuries.
• Prevent sharps injuries occurring, for example, by providing safety engineered devices and training on use.
• Investigate reports of sharps injuries to identity root courses.

Additionally, employers should:

• Offer hepatitis B vaccinations.
• Ensure easy access to incident reporting and follow-up care.
• Involve safety representatives in policy development and risk assessments.

• Follow your employer’s policies and procedures for safe use and disposal of sharps.
• Report all sharps injuries.
• Seek prompt specialist advice following a sharps injury.

Sharps safety is an essential component of health care worker protection. Health care organisations can reduce sharps injuries by:

• Implementing strong controls.
• Providing proper training.
• Fostering a supportive reporting culture.

If you have concerns about sharps safety in your work environment, contact the RCN or speak to your RCN Safety Representative.