Skin penetrating injuries
Discarded sharps (including needles and syringes) are a cause of skin penetrating (needle-stick/sharps) injuries, which can expose workers to blood-borne viruses such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV).
The risk of acquiring a blood-borne disease from skin penetrating injuries is highest for healthcare workers. The risk to other workers is lower because the viruses that cause blood-borne diseases do not survive for long periods in the environment. However, all skin penetrating injuries can cause considerable anxiety and distress.
Skin penetrating injuries may also expose workers to other infection risks, such as tetanus.
Employers should undertake and document the five step risk management process in order to prevent or minimise the risk of skin penetrating injuries caused by discarded sharps.
Step 1 - Identify if there are any discarded sharps in the workplace
Step 2 – Decide who might be harmed and how
Step 3 – Decide on the control measures to be used
Step 4 – Put controls in place
Step 5 – Monitor and review control measures
Step 1 - Identify if there are any discarded sharps in the workplace by:
- consulting with workers, workplace health and safety representatives and workplace health and safety committees
- conducting walk-through surveys to identify locations, tasks and activities where the hazard exists e.g. public toilets, emptying garbage bins
- conducting workplace health and safety audits
- analysing records and data e.g. injury records and registers of needle collections
- obtaining information from other organisations e.g. government authorities, employer bodies and unions.
Step 2 – Decide who might be harmed and how by considering the:
- frequency of exposure e.g. how often discarded sharps are found at the workplace
- volume of materials e.g. the number of sharps found at the workplace
- number of workers who come into contact with sharps
- environmental conditions such as inadequate lighting or poor housekeeping that contribute to sharps concealment and/or skin penetrating injuries
- effectiveness of existing control measures e.g. has appropriate equipment such as sharps containers been provided for the safe collection and disposal of sharps?
- skills and experience of exposed workers e.g. have workers received adequate training on safe work practices to prevent skin penetrating injuries?
Step 3 – Decide on the control measures to be used:
- get rid of the harm or prevent the risk by:
- stopping dangerous work practices e.g. manually compressing rubbish bags which may contain sharps.
If you can't get rid of the harm:
- consider using safety engineered medical devices (e.g. safety engineered needles or other sharps) in health care facilities such as hospitals, doctors' surgeries and nursing homes
- change work processes or the physical environment for example:
- install washroom features that deter sharps concealment e.g. concealed toilet cisterns in public washrooms
- provide adequate lighting so that discarded sharps can be readily detected
- separate people from the harm by isolating sharps in a rigid-walled puncture resistant sharps container for example:
- provide workers with suitable sharps disposal containers
- install sharps containers in high-risk locations such as public toilets and other identified 'hot spots' to encourage responsible sharps disposal
- apply administrative arrangements for example:
- develop safe work practices which could include workers not:
- recapping, bending or cutting discarded sharps
- placing their hands or fingers into areas or objects where sharps may be concealed such as rubbish bins
- manually compressing rubbish bags
- holding rubbish bags close to their body
- holding the base of rubbish bags
- provide workers with a sharps disposal kit that includes disposable gloves, a sharps handling device such as sturdy tongs, and a sharps container, and train them in how to use it
- arrange for the safe disposal of sharps containers
- provide, and keep records of, induction and ongoing training to workers including information about:
- infection risks
- safe work practices
- safe handling and disposal of sharps
- managing skin penetrating injuries
- sharps reporting
- maintain good housekeeping practices so discarded sharps will not be concealed
- undertake surveillance to ensure prompt detection and disposal of discarded sharps e.g. regularly inspect and undertake needle sweeps of high-risk areas
- implement a sharps reporting system e.g. maintain a register of needle collections so that high-risk areas and new 'hot-spots' can be identified
- immunise workers who are at risk of regular contact with sharps and/or blood and body fluids for diseases such as hepatitis B and keep immunisation records
- have a system to manage skin penetrating injuries which includes:
- instructions for first aid
- prompt medical referral
- counselling
- do not collect sharps involved in a skin penetrating injury for testing as the reliability of testing is unclear and the sharp may be hazardous to people handling it
- investigate all skin penetrating injury incidents
- provide appropriate personal protective equipment (PPE) and instruct workers on its use. PPE could include:
- gloves, e.g. disposable gloves or puncture-resistant gloves
- sturdy footwear
- protective clothing
- eyewear.
The control measure chosen should:
- adequately control exposure to the risk and not create another
- allow workers to do their work without undue comfort or distress.
Step 4 – Put controls in place:
- communicate changes to workers
- provide instruction and training to workers about the changes
- supervise workers to ensure that the new control measures are being followed
- maintain any new controls.
Step 5 – Monitor and review control measures to ensure they:
- have been implemented as planned
- are working
- have not introduced any new problems.
See the Risk Management Code of Practice 2007 for more information.
Further information on the safe handling and disposal of sharps and how to manage skin penetrating (needlestick) injuries is available from Queensland Health's Clean Needle Helpline on 1800 633 353.
More information on the effectiveness of safety engineered medical devices can be found in these references:
- Zany G, Wick J. Preventing needle stick injuries. Consult Pham 2007;22:400-2
- Son S, Eagan J, Sepiolite K, Succoth G. Effect of implementing safety-engineered devices on percutaneous injury epidemiology. Infect Control Hosp Epidemiol 2004;25:532-42
- Tuma S, Sepkowitz K. Efficacy of safety-engineered device implementation in the prevention of percutaneous injuries: a review of published studies. Clin Infect Dis 2006;42:1159-70
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