Injuries from sharp objects in the healthcare sector

Situations and risk factors

• Risky practices. Recapping of needles, manual removal of needles and blades, transport of instruments without protection and disposal in full, distant or inadequate containers.
• Procedures. Extractions, injections, IV insertion, suturing, surgery, wound care, punctures, and handling of samples and waste.
• Environments and people. Emergency rooms, operating rooms, critical care units, home care, and agitated or uncooperative patients.
• Organization. Time pressure, workload, shifts, lack of training and safety devices, and absence of containers at the point of use.
• Personnel especially exposed. Nursing, medicine, laboratory staff, cleaning and waste management, and temporary or trainee staff.
• Biological agents. Hepatitis B and C viruses and human immunodeficiency virus, among others, with different transmission risks depending on the agent and the type of exposure.

Obligations of Order ESS/1451/2013

Employers in the public and private healthcare and hospital sector must assess the risks of injuries from sharp and pointed instruments in accordance with Royal Decree 664/1997, taking into account the nature of the exposure, the organization of work, and the qualifications of the staff. They must eliminate or reduce the risk through safe use and disposal procedures, the immediate prohibition of re-encapsulation, the provision of clearly marked disposal containers located as close as possible to the point of use, and the provision of medical devices with integrated protective mechanisms, removing conventional devices once safe ones are implemented. These measures must be adopted with the consultation and participation of workers’ representatives.

The standard requires training and information on the correct use of devices, exposure risks, prevention measures, notification procedures, and how to respond to injuries, with mandatory training for all personnel, including temporary and trainee staff. Free vaccination against biological agents with an effective vaccine must be offered, with written documentation of acceptance or refusal. In the event of an accident, the individual must report it immediately, and the employer must investigate the causes, ensure medical attention, post-exposure prophylaxis when appropriate, and subsequent health surveillance, record the incident confidentially, and implement corrective measures.

Effective preventive measures

• Safety devices. Needles and catheters with active or passive protection systems, safety scalpels, retractable lancets, and needle-free connection systems.
• Safe procedures. Do not recap, do not disassemble needles by hand, transport instruments on trays, transfer hands-free in the operating room, and dispose of immediately in the container.
• Containers. Rigid, marked, with controlled closure and maximum fill level, located at the point of use and on treatment and extraction carts.
• Training and supervision. Hands-on training with real devices, regular reinforcement and supervision of practices, especially for new staff.
• Vaccination and health surveillance. Hepatitis B vaccination and serological and clinical follow-up after exposures.
• Notification and analysis. Accessible and non-blaming notification system, exposure logging, and root cause analysis to improve devices and procedures.

Organizational application: how to prevent injuries from sharp objects

1. Evaluate the risks by unit and procedure, with the participation of professionals and worker safety representatives, identifying the tasks, devices and practices of greatest risk.
2. Implement medical devices with safety mechanisms in all procedures where they exist, remove conventional ones, and verify their acceptance and correct use.
3. Establish safe use and disposal procedures, prohibit re-encapsulation, and place rigid, labeled containers at the point of use, with filling control.
4. Train all staff, including temporary and trainee staff, with practical exercises on real devices and regular reinforcements.
5. Offer and document vaccination, and establish the protocol for action in case of accidents with immediate attention, post-exposure prophylaxis and follow-up.
6. Implement the exposure notification and recording system, investigate each accident, and take corrective action.
7. Periodically analyze exposure data, review the assessment and measures, and communicate the results to the staff.

Preventive management software allows for the recording and analysis of exposures by unit, procedure, and device with the required confidentiality, the management of the post-exposure protocol and the monitoring of health surveillance, the control of vaccination and training of all personnel, and the traceability of corrective measures and the implementation of safety devices.

Limits and common mistakes

1. Maintaining conventional devices due to cost or habit when alternatives with safety mechanisms exist.
2. Tolerate recapping or manual removal of needles in urgent situations.
3. Having insufficient containers, containers far from the point of use, or containers filled above the limit.
4. Train only permanent staff and forget about temporary staff, newly hired staff, and staff from external cleaning and waste management companies.
5. Underreporting accidents due to fear, lack of time or lack of knowledge of the procedure, which hinders monitoring and improvement.
6. Failure to investigate the organizational causes (workload, shifts, supervision) that are behind the injuries.

Specific post-exposure protocols depend on prevention services and health authorities; this information sheet is for informational purposes only.

Regulatory and reference framework

• Order ESS/1451/2013, of July 29. Provisions for the prevention of injuries caused by cutting and piercing instruments in the health and hospital sector.
• Directive 2010/32/EU . Implements the framework agreement for the prevention of injuries caused by sharp and pointed instruments in the hospital and healthcare sector.
• Royal Decree 664/1997, of May 12. Protection of workers against risks related to exposure to biological agents during work.
• Law 31/1995, of November 8. Law on the Prevention of Occupational Risks.
• Royal Decree 773/1997, of May 30. Use of personal protective equipment.
• Royal Decree 1299/2006, of November 10. Table of occupational diseases; infectious diseases of healthcare personnel.

Order ESS/1451/2013 applies to all staff in the health and hospital sector, public and private, including temporary and trainee staff, and its measures are adopted with the participation of workers’ representatives.