a competing list of priorities. In common with Ireland,
training in all infection prevention may be as little as
one hour per year. This is supplemented by reactive,
targeted education when NSI incidents occur. As
reported by UK Trade Unions (please refer to Report): 3
Follow-up of the root causes of the incident is very
poor, i.e. an investigation into how it happened covered
by clause 10 is lacking by employers. How can one report
on the main causes (locally and nationally) if no local
investigation of the incident as required under clause 10
has been done?”
It could be the focus on [the] implementation of safety
devices has led to employers being less vigorous
re[garding] disposal of sharps. There is evidence that
although there is [a] decline in injuries to clinical staff,
there has not been a corresponding decline in injuries to
cleaning and housekeeping staff. UNISON personal
injury data suggest these injuries are being caused by
failure to dispose of non-safety devices.”
(available in NL) retrieved on 17 April 2018) and the
United Kingdom (14. Report on the post implementation
review (PIR) of the Health and Safety Sharps Instruments
in Healthcare) Regulations 2013 HSE 17 53 retrieved on
17 April 2018)
Italy deploys a practical, evidence-based approach to
the implementation of the Directive, incorporating
an integrated approach to the prevention of sharps
injuries. It rests on the premise that the health and
safety of HCW is paramount and is closely linked to
the health of patients, the ultimate goal being the
provision of better care. A recent national survey
conducted in 2017 on a representative sample of 97
hospitals showed that all the Directive requirements
were implemented, with, however, only a partial
conversion from conventional devices to devices
integrating a safety mechanism. Every hospital is
obliged to provide education and training on risks
from biological agents and exposure prevention to
the whole staff, whose length is differentiated
according to their level of risk, to be repeated every
five years or in case of a change of duties, according
to EU directives. Additionally, since 1990, all HCW
working in infectious diseases receive 36 hours of
training annually, with a specific focus on the
prevention of occupational exposures. In a national
survey, 89% of nurses reported having participated in
training activities on the safety of needles and sharps:
35% in previous years, and 54% in the last year, for an
average of 3.3 days.
In the UK, ‘The Health and Safety (Sharp
Instruments in Healthcare) Regulations 2013
Guidance for employers and employees’ implemented
aspects of the European Council Sharps Directive that
were not specifically addressed in existing British
legislation. The Health and Social Care Act 2008: code of
practice on the prevention and control of infections (the
‘Hygiene Code’, last updated July 2015) 3 applies to
registered providers of all healthcare and adult social
care in England. While not mandatory, it sets out ten
criteria against which the Care Quality Commission
judges a registered provider on how it complies with
infection prevention requirements. Criterion 10
specifically states that providers must have a system
in place to manage the occupational health needs and
obligations of staff in relation to infection. These
include training for infection prevention, HCW
protection, monitoring and follow-up of NSI, and
training in the use of SEDs.
Reporting of NSIs is disseminated throughout
the organisation. Notwithstanding the fact that there
is a general process of Ward-to-Board escalation,
compliance with the Directive may not be as strong
as it could be, owing to cost constraints and
The Directive has been fully implemented in
The Netherlands, and rests on four pillars:
communication, the safe handling of biological
waste, distribution of SEDs when there is risk of
infection and strict enforcement of the banning of
recapping of needles. When sharps are not necessary,
they are not used. The delegate from The Netherlands
reported that, in her hospital, blunt needles are used
where possible (for example, in drug preparation),
and only one type of SED for each type of needle in
the hospital is used in all departments throughout
the hospital, so as to promote uniform working
methods and standardise nurse training. The
Netherlands cites cost as a major barrier to the
uptake of SEDs. As elsewhere in the EU, there is
competition between cost and safety.
Transposition has also been effected in Poland,
where hospitals are required to write their own internal
procedures according to the estimated risk of injury.
In Spain, where the employer has responsibility
for HCW safety (HCWS), there is no global reporting
system for NSI, and no penalties for non-reporting of
NSI. In 2013, all aspects of the Directive were
transposed into Spanish legislation. Some Spanish
regions have legislated more rigorously than others
have.
Excerpts from the 2019 HOSPEEM-ESPU Report 2
highlight the state of the Directive implementation
in Spain, and include the following sample of Trade
Union conclusions:
Not all sharps instruments that are currently used in
health centres have the same level of protection for
avoiding accidents.”
sharps instruments [injuries] are included under
the “Contact with unspecified sharp, pointed or hard
instruments” section” but explained that “The
Autonomous Community of Madrid pioneered the
obligatory use of products with safety devices,
established by Order 827/2005(16).”
owing to the [economic] crisis ..., there has been a rise
in temporary contracts, meaning that healthcare
workers are contracted to provide nursing care for short
periods of time. As a result, accidents may not be
registered by staff for fear of losing their jobs.”
occupational risk assessments are carried out in most
health centres, but there is usually a delay in
implementing preventive and corrective measures.”
new employees are not given training prior to using
safety devices, which is usually the most common cause
of accidents.”
after the Directive was issued, information sessions
were held, with UGT involved in the organisational
elements.” This involvement concerned the aspects of
“elimination, prevention and protection”, “training”
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