INTRODUCTION TO INFECTION CONTROL

Considering disposal of sharps, it is a good practice that sharps should be disposed off as a single unit. In case if it becomes necessary to remove the needle or blade, it should be done with a safety device (Sharps Policy: Safe Handling and Disposal of Sharps, 2013). This practice is followed by the Infection control is a highly deserved aspect for patients, health care professionals, nurses and decision makers. It is an essential component of care. There is a risk of developing infection in the patients who receive health and social care. The reasons behind this is in contact with health care interventions or underlying medical condition (Wilson, 2006). It is the responsibility of the health care staff to prevent and control infections. For this, various aspects of infection control policy are followed. However, there remain some areas of deficit. The present report is a proposal for change which is based on critical analysis of one aspect of infection control practice. Presently working in the operation theater, the aspects related to sharps disposal has been chosen. The report critically analyzes this aspect by highlighting aspects of good infection control practice and identifying areas of deficit. Critical analysis of multifarious factors that currently impact on infection control practice has been done. Following this, change to be brought in the practice has been proposed.

SAFE HANDLING AND DISPOSAL OF SHARPS

Definition of medical sharps

Sharp is a medical term which is used to to describe all those devices that possess sharp points or edges which is capable of puncturing or cutting skin (Sharps Waste Definition, 2015). Sharps include thefollowing items:

  • Needles
  • Needles from vacutainers
  • Needles with syringes
  • Needles with attached tubing
  • Blades which include razors, scalpels etc.
  • Broken glass ware which are contaminate with bio - hazardous waste are also considered as sharp. These care required to be disposed in a sharps container. This consists of contaminated pasteur pipettes, glass slides and contaminated broken glassware.

Disposal of sharps

Improper management of disposed needles and other types of sharps acts as a serious health risk to waste workers and public. These also a hazard for the health care workers. This is because if these are not handled and disposed safely, they may lead to needle stick and other types of injuries to the nurses, health care staff and professionals. These place the health care staff and service users at the risk of being exposed to various infections and blood borne viruses (Mehta and et.al., 2010). In this way, improperly disposed sharps may cause spread of infection. Thus for controlling infections, safe handling and disposal of sharps is essential.

Spread of blood borne disease through sharps

Blood borne disease is that condition which is caused by pathogens that live in human blood. The most common germs that spread through blood are:

  • Hepatitis B virus and Hepatitis C virus- These viruses are responsible for causing infections and damage to liver.
  • HIV (Human Immunodeficiency virus)- This virus causes AIDS (Bloodborne pathogens, 2015).

These blood borne diseases spread if a health care worker is stuck with a needle or any other sharp object which has come into contact with the blood or other body fluids of a person who is infected with these viruses.

Critical analysis of one aspect of infection control practice

My area of work

I currently work as a senior nurse in operation theater. Working in this area presents several responsibilities such as management and supervision of sterilization devices. This includes preparing the theater for operations and participating in the surgical procedures directly. From the present and previous work experience, it has been learnt that infection control is to be given prime importance. This is in relation to various practices that are carried out in operation theatre. Since this area of work deals with surgery, infection control practice pertaining to use of sharps is of utmost importance (Vong and et.al., 2005). While focusing on sharps, their proper handling and disposal is essential for controlling infections. During previous work experience, these aspects was given prime importance in the organization. The staff followed all the aspects of good infection control practice. These are important to be followed for the safety of service users, health care staff as well as others. However, certain issues have been observed with respect to safe handling and disposal of sharps. There are certain places where the this aspect of infection control practice is not appropriately taken care of.

Critical analysis of one aspect of infection control practice

Critical analysis of the aspect related to safe handling and disposal of sharps is being done by highlighting aspects of good infection control practice and identifying the areas of deficit. In operation theater there is an extensive use of sharps. These are of various types such as needles, stitch cutters, scalpels, glass ampoules and other types of sharp instruments (Blenkharn and Odd, 2008). Sharps may cause injury which expose health care professionals to hazards such as hepatitis B, hepatitis C and HIV. Moreover, these also expose the health care workers and others to blood borne viruses. As per good infection control policy, it is of vital importance to use and dispose sharps carefully. This is required to reduce the risk of injury and exposure to blood borne viruses. There are some procedures in which the risk of causing injury is higher. These are venepuncture, intra vascular canulation and injection.

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As per good infection control practice, sharps should not be directly passed from hand to hand (Handling sharps and needles, 2015). This increases the chances of injury and may expose another person to blood borne viruses. It is a good practice to put the sharp on a tray so that another person can pick it up. Another aspect in this is to tell the people working in the operation theater about when one plans to put the sharp object down or pick it up. In the operation theater, the practice of putting the sharp on a tray is practiced. This allows the other people to pick up the instrument with care thus reducing the chances of injury. Also, handling is kept to a minimum which is a good practice. While disposing of the sharps, it is a good practice to not to dismantle the needles with hand. These should be handled with the help of a tong and disposed (Rampal and et.al., 2010). However, it can be critiqued that in the operation theater, this practice is not appropriately followed. In the absence of tongs and due to scarcity of time, health care staff sometimes dismantle the needle with their hands. This exposes them to risk of injury due to the sharp end of the needle. The staff is also exposed to various types of blood borne viruses. Thus, the chances of infection are increased.

It is a good practice to not dispose the sharps in containers which are used for storing other types of wastes. Rather, there should be separate bins for disposing different types of sharps. Orange lidded bins are for sharps which are not contaminated with medicines. Hence, these sharps should be carefully disposed off in bins with orange lid. Sharps that are contaminated with medicines but not cytotoxic medicines should be disposed in a separate bins (Lachowicz and Matthews, 2009). Following this, sharps that are contaminated with cytotoxic or cytostatic medicines need to be disposed in a different bin. For this, it is necessary that bins should be available at the point of use. However, it can be critiqued that sometimes, the sharps such as needles and blades are disposed with other types of wastes. This generally happens if separate bins for disposal of sharps are not available at their point of use. But, also if these bins are present, the staff sometimes disposes the sharps with other types of wastes. However, it can be critically analyzed that good infection control practice indicates that staff should take responsibility for any sharps used by them (Ishtiaq and et.al., 2012). Following this, the sharps should be disposed in a designated container which conforms to British standard.

Another good practice for controlling infection is not to fill the sharp containers by more than two thirds (Ghauri and et.al., 2011). This container should be tamper and puncture resistant. It should also be impenetrable by sharps. There should be a tight fitting lid present on the container. It should also contain a biological hazard label which is clearly identifiable. However, it can be critically analyzed that in my area, the sharp containers are sometimes filled beyond the manufacturers limit. It can be analyzed that this increases the risk of some sharps accidentally falling out of the container and injuring other people (Watterson, 2004). However, the staff in my area takes care and that the containers are not probed neither with fingers nor forceps.

According to good practice of infection control, sharps need to be disposed off at the point of use (Guidance for nursing staff, 2005). In current area of work, this practice is followed. The staff disposes off the sharp instruments at the place where they are used. However, it can be critiqued that sometimes, as the bins are not present, they could be disposed off at the point of use.

Legal framework

There are various laws that are concerned with safe handling and disposal of sharps in UK. They are the following.

Health and safety (Sharp Instruments in Health care) Regulations 2013

These regulations provide guidance for the health care employers as well as employees. According to these regulations, it is the responsibility of all employers to ensure that adequate assessment of risks from sharps and injuries is done (Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, 2013). The employers also have the duty to ensure that they have in place appropriate measures for controlling injuries from sharps. Sharps are to be safely managed at health care organizations. As per these regulations, the employers are responsible for avoiding unnecessary use of sharps. Needles, scalpels, etc. are essential tools which are required for providing medical care. However, it is to be ensured that sharps are only used when they are required. From this, it can be analyzed that staff should not use sharps for carrying out other works for which they are not needed. According to sharps regulations, the employers should use safer sharps which incorporate protection mechanisms. However, it can be critically evaluated that safer sharps are not effective at removing all the risks that are associated with the use of sharps (Sawalem, Selic and Herbell, 2009).

These regulations also require the staff to prevent re-capping of needles. Secure containers are to be placed for disposal of sharps close to the work area. However, it can be critically analyzed that this practice is not followed in the current working area. The regulations also require employers to place instructions for safe disposal of sharps close to the area where they are being used. However, no such instructions are present in the current work area. It can be critically analyzed that sharps bis should be placed next to the health care worker so that used sharp can be dropped straight into it (Perry and et.al., 2012). According to regulation 6, information and training need to be provided to the employees.

Control of Substances Hazardous to Health regulations (COSHH) 2002

As per these regulations, the employers are responsible for identifying any exposure to substances which cause hazard to health. Sharps are included among these. Following this, the employers are needed to assess risks that arise from exposure to sharps. As such, measures are to be adopted by them for controlling and preventing exposure (Sharps safety, 2013).
Critical analysis of multifarious factors that currently impact on infection control practice

There are various factors which currently impact on infection control practice in my area of work. The important ones have been discussed as under:

Inadequate facilities

This is another factor which currently impacts infection control practice in the operation theatre. If the facilities are not adequately provided, staff is not able to comply with infection control practice even if they want to. Considering the practice of safe handling and disposal of sharps, it is necessary that there is availability of facilities for disposing sharps safely (Trim and Elliott, 2003). However, it can be critically analyzed that containers for disposing sharps are not located at point of use. Hence, the staff is not able to dispose the sharps at the place where they are used. Thus, chances of spread of infections are increased. In order to control infections in operation theater, it is essential that sharps are not disposed in containers which are used for storing other types of wastes (Tabowei, Kombo and Mukoro, 2012). But, due to lack of sufficient number of containers, the staff is compelled to use the same containers for disposing sharps which are meant to be used for other types of wastes. However, it can be critically evaluated that initiative can be taken by the staff to bring this factor to the notice of higher authorities so as to comply with good practice of infection control.

Lack of time

Another reason that leads to non compliance with infection control policy is lack of time (Manyele and Mujuni, 2010). This factor currently impacts infection control practice. In operation theater, the health care staff experiences high workload. As such, limited time is available with the staff. This restrains them from following good infection control practice for safe disposal of sharps. There are a number of tasks that are to be performed by the staff. These range from tasks performed at pre - operative, anaesthetic, surgical and recovery stage (Grimmond and et.al., 2010). Apart form that, other works are also to be performed by the staff. Due to high work load, health care staff working in the theatre experiences lack of time. As a result of this, actions which are a required to be performed by them for safely handling and disposing sharps, are not undertaken. This impacts infection control practice as sharps are not disposed safely and separately (Tso and Athreya, 2012). However, it can be critically analyzed that even if enough time is available with them, workers do not dispose sharps safely due to careless attitude.

The factor of lack of time is the reason behind not cleaning the multi use containers. As such, it leads to non compliance with infection control practice. Due to lack of time, the workers do not clean the containers that are used for storing disposed sharps. Also the transportation vehicles are not cleaned owing to lack of time.

Insufficient knowledge/ lack of training

Appropriate training of waste collecting personnel is important for proper management and disposal of waste. Similarly, health care staff needs to be educated about safe handling and disposal of sharps. This is essential for infection control (Diaz, Savage and Eggerth, 2005). However, due to insufficient knowledge and inadequate training, the current practice of infection control is significantly impacted in the work area. The waste collecting personnel do not have proper knowledge regarding the importance of cleaning sharp disposal containers as well as transportation vehicles. This lack of knowledge results into negligence on the part of waste collecting staff. Regular cleaning of multi use containers is not done (Kermode and et.al., 2005). Also, the transporting vehicles are not cleaned. As such, the chances of spread of infection increase.

Another factor is lack of training of the health care staff in the operation theater regarding safe handling and disposal of sharps. As the workers are not trained, they do not consider it important to use tongs while disposing sharps or dismantling the needles (Mathur and et.al., 2011). The potential harm caused by these actions is not known to them. Workers who are inadequately trained dispose of sharps with other wastes. Thus lack of training impacts the current practice of infection control.

Proposal for change to current practice

In relation to the aspects of practice of safe handling and disposal of sharps and wastes, proposal for change can be made. There are various areas of deficit identified in the infection control practice in operation theater. On the basis of these, the following changes in practice have been proposed.

Programs to improve compliance with good infection control practice

Infection control practice consists of various aspects (Wilburn and Eijkemans, 2004). In current area of work, deficits have been identified in the practice of handling and disposal of sharps and wastes. Although the health care staff complies with infection control policy. However, there is a need to improve compliance. For this, implementation of programs, that could improve compliance with infection control policy, can be proposed. This includes educations and training programs for training workers. It has been found that the waste collecting staff is not aware of the importance of cleaning bins used for keeping waste. They also do not know that it is essential to clean the transporting vehicles. A program that contains regular training schedule for workers can be implemented. It has also been found that health care staff dispose of sharps along with other wastes. This indicates that there is a need of appropriate training. Programs that inculcate the procedures for training and educating staff can be implemented (Do and et.al., 2003). These will also include training for use of needle free devices so as to reduce the risk of injury to the patients as well as other workers. The progress of these programs can be reviewed so as to determine the level of compliance with infection control practice.

Bins made available at the point of use

Another change that can be proposed is to make available bins for disposing sharps. These should be present at the site of use of sharps. The practice of keeping the bins available at the point of use of sharps will help in proper disposal of sharps (Rajasekaran and et.al., 2003). With this, the sharps used by health care staff will be disposed at the point at which they are used. Thus, the chances of spreading of infection will be lessened. Also, exposure to blood borne viruses will be reduced as sharp will not be carried openly to the waste containers but will be disposed of in bins. This change will help in compliance with infection control practice of safe handling and disposal of sharps.

Needle stick injury prevention policy

Needle stick injury exposes health care workers to various blood borne viruses such as HIV, hepatitis B virus, Hepatitis C virus etc. (Moro and et.al., 2007). It is important to prevent injuries from needle stick so as to control infections in the work area. The proposal is to implement a policy for prevention and management of needle stick injuries. This will be inclusive of practice of replacing needles by safer sharps device or needle free device so as to reduce the risk of exposure to blood borne viruses.

Conclusion

Safe handling and disposal of sharps is an aspect of infection control which is important to e considered by health care organizations. Sharps are medical instruments with sharp edges. Improper handling and disposal of these can lead to spread of infections. Sharps, if not handled or disposed properly my expose the health care staff and service user to the risk of blood borne viruses and infections. Legal frameworks that pertain to this aspect of infection control are Health and safety (Sharp Instruments in Health care) Regulations 2013 and Control of Substances Hazardous to Health regulations (COSHH) 2002. There are certain deficits in the current work area with respect to the aspect of safe handling and disposal of sharps. Sharps are not handled with the help of tongs. Also they are disposed with other types of wastes. Sharps are not disposed at the points where they are used. Various factors are responsible for the current practice such as inadequate facilities, lack of time and training to the staff. Change can proposed to the current practice. This consists of programs to improve compliance with good infection control practice. Needle stick injury prevention policy can be made and implemented. Also, bins can be made available at the point of use of sharps.

References

  • Blenkharn, J. I. and Odd, C., 2008. Sharps injuries in healthcare waste handlers. Annals of occupational hygiene.
  • Buraidah, A. Q. and Jahan, S., 2005. Epidemiology of needlestick injuries among health care workers in a secondary care hospital in Saudi Arabia. Ann Saudi Med.
  • Diaz, L. F., Savage, G. M. and Eggerth, L., 2005. Alternatives for the treatment and disposal of healthcare wastes in developing countries. Waste Management.
  • Do, A. N. and et.al., 2003. Occupationally acquired human immunodeficiency virus (HIV) infection: national case surveillance data during 20 years of the HIV epidemic in the United States. Infection Control.
  • Ghauri, J. A. and et.al., 2011. Sharps injuries in ophthalmic practice. Eye.
  • Grimmond, T. and et.al., 2010. Sharps injury reduction using a sharps container with enhanced engineering: a 28 hospital nonrandomized intervention and cohort study. American journal of infection control.
  • Ishtiaq, O. and et.al., 2012. Disposal of syringes, needles, and lancets used by diabetic patients in Pakistan. Journal of Infection and Public Health.
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