Recommendations for improving HCWS and
eliminating NSI
• Timely national and international data to enable benchmarking between hospitals
of similar size across the EU
• Meaningful penalties for not conducting risk assessments combined with
incentives for quality improvement/CQUINS (UK: Commissioning for Quality and
Innovation)
• Companies designing out potential SED issues
• HCW who incur NSI have stories to share about how it has affected their lives and
careers; these should be brought to bear on decisions regarding the procurement
of SEDs
• Creation of a safety checklist that could be used for accreditation
• Hospital inspections that are proactive rather than reactive
• Cost of devices to be integrated into the cost of the procedure
• Mandatory HCWS training in medical/nursing schools
• Convincing insurance companies that HCWS and patient safety are linked
• Develop protocols to shorten time for infection testing
are responsible for preventing NSI and for treating
injury to its workers; in the private sector,
responsibility for the prevention service is outside the
hospital, as is the responsibility for care of the worker
who has sustained the injury.
Employers and HCWs must integrate their work
practices to create a no-blame culture for the
systematic reporting of NSI, of which everyone
working in a healthcare setting is at risk. Training
and education must be perceived by managers and
personnel alike to be aligned to practical needs,
nowhere more so that in the correct use of SEDs.
In France, there is national legislation to prevent
accidental blood exposure (ABE), which includes the
prohibition of recapping, the disposal of sharps in
specific containers and the strong recommendation
to use SEDs. These measures are part of a
multidimensional preventative program to be carried
out in hospitals and other affected settings to prevent
the transmission of blood borne pathogens. These
measures include vaccination, training, compliance
with Standard Precautions, surveillance of ABE,
evaluation of preventive measures and management
of occupational exposures. It is the obligation of the
employer to provide this preventive program to
protect employees.
In summary, there are notable similarities in the
preventative measures against NSI in hospital settings
across Europe, such as a consistent practice of
disposing of sharps in specific containers. While
countries may have their own legislation, health
systems and working cultures, it is the universally the
collective responsibility of HCWs to take action to
stop potentially hazardous situations from arising.
The discussion then moved on to assessing the risk
of NSI.
Risk assessment
The assessment of the risks to safety and health at
work has been a pillar of all EU legislation on these
issues since release of the first Council Directive
89/391/EEC, and procedures to conduct risk
assessment are included in this first Directive as well
as in subsequent ones. The employer shall carry out
the assessment of all risks, including those from
biological agents, mandatorily whenever a new
facility opens, when changes occur in the working
activity that are significant for the purposes of
safety and health at work and, in any case, within
a maximum of three years since the last assessment
(all EU countries).
In Directive 2010/32/EU, however, aiming at
6 | 2020 | hospitalpharmacyeurope.com
We should aim
at zero tolerance
for avoidable
accidents
Gabriella De Carli
preventing sharps injuries in the healthcare sector, it
is further specified that ‘risk assessment shall include
an exposure determination,[…] and shall cover all
situations where there is injury, blood or other
potentially infectious material’, to ‘reveal a risk
of injuries with a sharp and/or infection’. This risk
assessment is mainly finalised to deciding where
and when to provide medical devices incorporating
safety-engineered protection mechanisms as well as
implementing other general or specific measures to
prevent injuries and infections. In this regard, some
differences within countries emerged during the
discussion.
Hospitals in Italy appear to rely mostly on NSI to
tell them where the risk is. Accordingly, in national
surveys, a trend was observed towards the
introduction of SED in high-risk units, and in units
with a high prevalence of blood-borne pathogens.
Also, conversion to safety was most frequent for
high-risk devices (e.g. hollow-bore, blood-filled
needles). What is needed is a procedure based on
systematic factors, rather than individual mistakes,
e.g. identifying and addressing risky healthcare
procedures in all units, regardless of whether
accidents occurred, or were reported. In greater
detail, the methodology applied for the assessment
of biological risk is that of carrying out an evaluation
and weighting as follows:
• analysis of work processes and safety procedures,
of the tasks involved in the various phases and the
consequent workload per HCW
• identification of the phases at risk of injuries and
contact with blood or other potential infectious fluid
• evaluation of historical data to assess the incidence
of injuries, accidents and near misses caused by
sharps and needle devices
• analysis of the levels of harm caused by accidents
• assessment of the devices used and related safety
devices
• ascertainment of worker training/information
• definition of the risk index (frequency x magnitude)
• development of improvement and adaptation plan
• periodic check and review of procedures.
Risk assessment in The Netherlands is also based
on incidents, and is conducted annually by the
occupational hygienist.
In the UK, risk assessments tend to be dynamic
rather than scheduled at yearly intervals, but
constant reminders are necessary. Trusts may be
fined for non-compliance with respect to the Safer
Sharps Regulations (2013) 5 by the Health and Safety
Executive. However, the fines may be too small to be
punitive, and the risk to reputational damage may
have a greater impact.
The delegate from Ireland reports that risk
assessments in some cases are being analysed at
hospital level, and are not being driven by CEOs.
Waste managers will report NSIs but may or may
not have capacity to drill down to safety
measures. Risk assessments are not a key
performance measure for either CEOs
or department managers: further
lobbying is needed for this to come
into effect.
In France (as reported by
Gabriella De Carli), the risk
assessment process for the
prevention of ABE is comparable
to that of the risk assessment in the
Single Occupational Risk Assessment
Document required by Directive
89/391/EEC, but it is specific to ABE.
In any event, the procedures (ABE risk and
other risks) must be linked to each other; they