HEALTH AND SAFETY AT WORK ACT
Preventing needlestick and sharps injuries and the related prevention of infection are health and safety, risk management and clinical governance issues. All employers in the NHS, including primary care medical and dental practitioners, community pharmacists and those working privately in the NHS have legal obligations under the Health and Safety at Work Act 1974 (HSWA). They have a duty to protect their employees and others that may be affected by their work activities such as contractors, agency staff, patients and visitors. Under HSWA employers must ensure their employees are appropriately trained and proficient in the procedures necessary for working safely. Employees have duties to comply with systems and procedures put in place by employers to ensure their health, safety and welfare; they also have a duty not to do anything that would put others at risk. These requirements apply throughout England, Scotland and Wales. In Northern Ireland, separate legislation and regulations apply.
MANAGEMENT OF HEALTH AND SAFETY AT WORK REGULATIONS
Under the Management of Health and Safety at Work Regulations 1999, employers must carry out a risk assessment and must have arrangements for the effective planning, organisation, control, monitoring and review of the preventive and protective measures. They must also provide their employees with adequate health and safety training.
CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH
The Control of Substances Hazardous to Health Regulations 1999 (COSHH) are designed to protect employees against recognised hazards, which include those related to needlestick or sharps injuries. The key duty under COSHH, in relation to microbiological hazards, is to prevent exposure. Where prevention is not reasonably practicable, employers must take steps to eliminate, reduce or control the risk of exposure by using the measures listed in Schedule 3 to the Regulations. These measures include: the design of work processes and engineering control measures (such as safer needles) so as to prevent or minimise the release of biological agents into the place of work; instituting means for the safe collection, storage and disposal of contaminated waste; and specifying procedures for taking, handling and processing samples that may contain biological agents. Employers must carry out a risk assessment considering all the factors pertinent to the work and make an informed and valid judgement about the risks, the steps which need to be taken to achieve and maintain adequate control, and whether health surveillance is necessary.
REPORTING OF INJURIES, DISEASES AND DANGEROUS OCCURRENCES REGULATIONS 1995 (RIDDOR)
Some needlestick injuries will be reportable to the enforcing authority (generally the Health and Safety Executive) under RIDDOR. Those which result in an absence from work for more than 3 working days will be reportable, as will those where the source patient is known to carry a blood-borne virus e.g. Hepatitis B, Hepatitis C or HIV. All forms of viral hepatitis contracted by those at work are reportable where the work involves the exposure to human blood products or any source of viral hepatitis. HIV and any other infection, will be reportable where it can be readily attributed to work with people (living or deceased) during health care work or during investigation involving exposure to blood or body fluids.
RELATED GUIDANCE
The Advisory Committee on Dangerous Pathogens (ACDP) has published guidance entitled "Protection Against Blood-borne Infections in the Workplace: HIV and Hepatitis" (1995). UK Health Departments have issued guidance via "Protecting Health Care Workers and Patients From Hepatitis B" (1993) and "Guidance for Clinical Health Care Workers: Protection Against Infection and Blood-borne Viruses" (1998). Additionally the Scottish Office and subsequently the Scottish Executive Health Department has guidance on related matters such as HDL (2000)3, "Hepatitis B Infected Health Care Workers" and "Guidelines on Post-Exposure Prophylaxis (PEP) for Healthcare Workers Occupationally Exposed to HIV" which covers recommendations developed by the Chief Medical Officers Advisory Group on AIDS (EAGA) amended for Scotland. Guidance concerning PEP has recently been updated and issued by the UK Health Departments (July 2000). The Scottish Infection Manual was published by the Advisory Group on Infection, Scottish Office Department of Health in 1998. Guidance on the "Decontamination of Medical Devices" issued as NHS HDL(2001)10.
The Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) came into effect on 1 April 2000 (MEL (2000)18) and relates to claims for liability arising from the work of NHSScotland staff. This covers clinical negligence claims for all NHS clinical activities and selected non-clinical claims including employers liability. The scheme detailed in the MEL does not cover personal accident. NHS Organisations are legally liable for the negligent acts or omissions of their employees or agents with a clear responsibility to act to reduce the incidence of liabilities.
NORTHERN IRELAND LEGISLATION
In Northern Ireland the Health and Safety Executive (NI) are the regulators. The base legislation is the Health and Safety at Work (NI) Order 1978 from which the following EC "6 pack" regulations flow: