Skin penetrating injuries

Health and safety information for skin penetrating injuries, sharps and needlestick injuries.

Sharps (including needles and syringes) may be used at work (e.g. in healthcare), or may be found discarded at workplaces (e.g. in public bathrooms or car parks). Sharps are a cause of skin penetrating (needle-stick or sharps) injuries, which can expose workers to blood-borne viruses such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV). Skin penetrating injuries may also expose workers to other infection risks, such as tetanus, and sharps used in veterinary practice may expose workers to zoonoses.

Preventing skin penetrating injuries

Persons conducting a business or undertaking (PCBUs) should undertake the four step risk management process in order to eliminate or minimise the risk of skin penetrating injuries caused by sharps, so far as is reasonably practicable.

Step 1 - Identify if there are sharps hazards at the workplace by:

• consulting with workers, health and safety representatives and 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, administering medication
• conducting workplace health and safety audits
• analysing records and data e.g. injury records and registers of discarded needle collections
• obtaining information from other organisations e.g. government authorities, employer bodies and unions.

Step 2 - Assess risks 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 discarded sharps found at the workplace
• number of workers who handle 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 suitable equipment such as sharps containers been provided for the safe collection and disposal of sharps?
• skills and experience of 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:
  • using needle-free IV delivery systems
  • stopping dangerous work practices e.g. recapping needles, and 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 sharps such as retractable needles and blood collection systems) and sharps removal systems (e.g. scalpel blade removal devices) in health care and veterinary facilities
• 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 suitable sharps containers and have these available close to where sharps are generated
  • 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
    • passing sharps between persons
    • manually compressing rubbish bags
    • holding rubbish bags close to their body
    • holding the base of rubbish bags
    • overfilling sharps containers
  • provide a sharps disposal kit for managing discarded sharps, and train workers in how to use it
  • arrange for the safe disposal of sharps containers
  • provide, and keep records of, information, training, instruction and supervision regarding:
    • 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
  • ensure that workers who are at risk of regular contact with sharps and/or blood and body substances are immunised against 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
    • safety eyewear.

Step 4 - Review control measures to ensure they:

• have been implemented as planned
• are working
• are being maintained
• have not introduced any new problems.

More information

Further information on the safe handling and disposal of discarded sharps is visit Queensland Health's Sharps Safety Programs or call Queensland Clean Needle Helpline (1800 NEEDLE/1800 633 353).

More information on the effectiveness of safety engineered medical devices can be found in the following references:

Zanni, G., & Wick, J. (2007). Preventing Needlestick Injuries. The Consultant Pharmacist, 22(5), 400–409. doi:http://dx.doi.org/10.4140/TCP.n.2007.400

Sohn, S., Eagan, J., Sepkowitz, K. A., & Zuccotti, G. (2004). Effect of Implementing Safety‐Engineered Devices on Percutaneous Injury Epidemiology. Infection Control and Hospital Epidemiology, 25(7), 536–542. doi:10.1086/502436

Tuma, S., & Sepkowitz, K. A. (2006). Efficacy of Safety-Engineered Device Implementation in the Prevention of Percutaneous Injuries: A Review of Published Studies. Clinical Infectious Diseases, 42(8), 1159–1170. doi:10.1086/501456