The importance of implementing safe sharps practices in the laboratory setting in Europe

Abstract

Healthcare workers are at risk of sharps injuries and subsequent infection from more than 40 bloodborne pathogens or species. Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) together account for the vast majority of cases. The Directive 2010/32/EU “Prevention from sharp injuries in the hospital and healthcare sector”, issued to protect workers from these risks, requires an integrated approach to prevention including awareness-raising, education, training, elimination of unnecessary needles, safe procedures for sharps use and disposal, banning of recapping, vaccination, use of personal protective equipment, provision of safety-engineered devices, and appropriate surveillance, monitoring, response and follow-up.As laboratories represent a high-risk setting both in the preanalytical and analytical phase, we reviewed accidents and prevention in this setting in the light of the new legislation.Phlebotomy is the procedure carrying the highest risk of exposure and infection, involved in 30–50% of HIV and HCV cases detected in nationwide systems following accidental blood exposures implemented since the 1990s in Italy and France. In laboratories, problems in the management of sharps containers, recapping, needle disassembly by hand and blood transfer from syringes into tubes were observed and accounted for two-thirds of injuries. These accidents could be reduced through education and monitoring of behaviours, and introduction of medical devices incorporating safety-engineered protection mechanisms with appropriate training. Laboratory staff should be immunized against HBV, and know policies and procedures for the post-exposure management and prophylaxis. The management commitment to safety is crucial to ensure the necessary support to these changes.

Preanalytical quality improvement. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE)

“…The purpose of Directive 2010/32/EU is to protect workers in healthcare settings from injuries caused by all medical sharp devices, and from their consequences such as occupational human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) infection, by setting up integrated policies in risk assessment, risk prevention, training, information, and monitoring [21]. The deadline for its transposition into national law by the 28 Member States has expired in May 2013.…”

Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: An observational study by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PRE)

“…Amongst the errors are patient/sample misidentification so that analytical results are not associated with the correct patient [3]; alteration of the concentration of some analytes by prolonged use of a tourniquet [4,5] or by contamination of the sample with intravenous fluids [6] and contrast media [7]; inadequate patient preparation, i.e., fasting [8][9][10] or increased physical activity [11]; not achieving the specified blood collection volume, which may lead to the incorrect additive to blood ratio and thus affect the test results [12] and many others. In addition to factors that can affect sample quality, some practices can also have an impact on patient or healthcare worker safety [13]. For example, if the collection site is not correctly disinfected, or is touched post disinfection, then the site will not be sterile.…”

Accidental Needlestick Exposures linked to the Administration of Local Anesthesia by Healthcare Workers

“…The laboring woman is especially vulnerable to invasive GAS infection acquired via disrupted mucosal or cutaneous barriers during delivery. 2 Outbreaks of postpartum GAS infection continue to be reported and are often related to the spread of GAS among postpartum patients by asymptomatic colonized healthcare workers (HCWs). 2 In May 2012, the Hadassah Hospital Clinical Microbiology Laboratory informed the infection prevention team that GAS had been isolated from vaginal and blood specimens of 2 women, who had vaginal deliveries a few days earlier.…”

“…2 Outbreaks of postpartum GAS infection continue to be reported and are often related to the spread of GAS among postpartum patients by asymptomatic colonized healthcare workers (HCWs). 2 In May 2012, the Hadassah Hospital Clinical Microbiology Laboratory informed the infection prevention team that GAS had been isolated from vaginal and blood specimens of 2 women, who had vaginal deliveries a few days earlier. In according with Centers of Disease Prevention and Control (CDC) recommendations, 3 an epidemiological investigation was initiated.…”

“…Accidental sharps injuries put healthcare workers at risk for >20 pathogens, including HIV, hepatitis B, and hepatitis C. 2,3 In addition to the concern for healthcare workers well-being, exposure management incursa significant cost to healthcare, with cost estimates of well over $100 million annually in the United States. 4,5 Consequently, continued efforts to identify and eliminate the causes of sharps injuries are essential.…”