Anyone working within supported housing is potentially at risk of injury from hidden or neglected sharps. So what is the risk, what can be done to minimise it, and what arrangements need to be in place in case of an injury? 

Year on year there seems to be more risk from injury due to sharps as the incidence of intravenous drug use, particularly as heroin misuse, increases.

Unfortunately, the only available professional advice comes from the Health and Safety Executive (HSE) and the British Medical Association (BMA). This is aimed at health service staff who face different hazards, mainly   the re-capping of needles and the risk of injury from carelessly discarded needles.

In supported housing and emergency accommodation the staff face the added risk of dealing with used needles that have been hidden, carelessly discarded or sometimes even deliberately left as booby-traps.

Why sharps are often hidden

The reasons for this are straightforward. We have increasingly more stringent legislation and case law surrounding drug misuse and consequently more rules and regulations in an attempt to protect staff from prosecution. The client group will, therefore, go to great lengths to hide their drug use in order to avoid losing their accommodation. There may also be the genuine losing of “works” if a client is under the influence. In addition we also have to take into account the actions of clients who are leaving due to their conduct and may have a grievance against staff or other individuals.

Hazards associated with needlesticks

HIV, Hepatitis C, Tetanus etc. These are the main risks from needlestick injuries and body fluids. As medicine is advancing, specific advice should be sought from healthcare professionals such as your local control of infection nurse or team.

Incidence and location of sharps

One might ask where sharps are usually hidden. In reality experience shows it would be easier to identify where they are not. Sometimes the needles found will have been used,  but “clean” needles will also be stored for later retrieval and use. The following is a suggested list of items that require careful checking. The list in your own scheme could be ten times as long:   

• beds, bedding, quilts, pillowcases, duvets, sheets, blankets   
• underneath mattresses, bed bases or taped onto headboards   
• clothing, pockets, shoes or socks   
• hems of curtains   
• beside and under furniture – in drawers or taped underneath them   
• underneath tables and chairs, again usually taped out of sight   
• on top of window, door and cupboard frames, especially above normal line of sight   
• ceiling hatches and airing cupboards   
• rubbish bins   
• in everyday objects such as packets of crisps or cornflakes, hi-fis, televisions, books, etc.   
• behind wall panels and above suspended ceiling tiles   
• in vases and other ornaments    
• in bushes and other vegetation around windows and where there is evidence of drug use   
• used as booby traps by being taped to banisters, inside letterboxes, or placed in discarded items such as empty cigarette packets

Risk assessments and regular review

There is a simple example of sharps risk assessment shown on page 10. However, there are many variables depending on the scheme, client group, experience and knowledge of staff, etc. The risk assessment identifies what the hazards are, who is at risk and details of control measures which will reduce those risks to an acceptable level.

It is important as with other aspects of health and safety that there is commitment from management to ensure all staff (including all locum and agency staff) know what these controls are and that they have sufficient resources and training to implement them.

Change is always happening and it is important to review risk assessments, both as things change as well as on a periodic basis.

Control measures for protection

The list is not exhaustive, but could include the following:   

• provide sharps bins, provide pick sticks, provide tweezers and flexible clamps   
• provide sealable sharps bins for disposal of any sharps found   
• provide training on the location of sharps and the use of the equipment described above using “non-direct” handling procedures   
• provide waterproof dressing to cover cuts   
• provide latex gloves   
• provide clinical disposal for gloves and dressings (i.e. yellow sacks for incineration)   
• provide training for the control of infection, including the safe removal and disposal of latex gloves and soiled dressings   
• identify procedures for dealing with sharps injuries, including instructions for medical advice

Please note that before issuing Personal Protective Equipment (PPE) there is a legal requirement to undertake a risk assessment. The principles are that you should try and eliminate the hazard rather than simply issue protective equipment, which may actually increase risk for the wearer.

For example rather than issue gloves and goggles for a cleaning substance such as oven cleaner you should first consider if it is needed at all or if the cleaning material could be substituted for something less harmful such as an abrasive cleaner.

The problem with issuing a lot of Personal Protective Equipment (PPE) such as “stout gloves” and so-called “hypodermic-resistant” gloves is that unfortunately none of those currently on the market offer 100 percent protection from needlestick injuries.

They may actually increase the control of infection risks associated with body fluids and dried blood. In fact, unless effective training is implemented they may give the casual wearer a false sense of security and therefore may increase the risk of injury. Again, a risk assessment will show which is the most effective method of safe sharps removal and whether such equipment should be issued.

Staff training

All staff, including agency locum staff, should receive appropriate training, supervision and instruction on dealing with room clearing and sharps handling before they are asked to undertake such tasks. It is also good practice to keep a register of training and to ensure this is kept up to date with the latest developments in medical knowledge and specialist equipment available.

Financial pressures versus safety

In an ideal world, double staffing to clear a room would always be available to allow sufficient time to undertake the task safely. In the real world this cannot be guaranteed. Any staff asked to clear rooms where there is a risk of needlestick injury should be given sufficient time and resources to do this work in a safe and controlled manner.

Disposing of sharps

Used needles, latex/neoprene gloves, blood stained clothes, bedding, etc. and medical dressings should be classified as “Clinical Waste” and disposed of in a controlled way, i.e. using sharps bins and yellow clinical waste sacks. Disposal of these is usually left to a specialist waste contractor, many of whom can be found in the Yellow Pages.

Control of Infection

During the process of removing sharps and handling body fluids, dried blood, etc., gloves will inevitably become contaminated. Measures need to be introduced to protect the handler and others from becoming directly or indirectly contaminated. This can be as simple as getting a colleague to open a door rather than touching it using soiled gloves.

What if someone suffers from a needlestick injury?

If someone receives a needlestick injury, your local control of infection nurse or team can advise on a simple list of practical steps to take. This could include things such as making the wound bleed, washing of affected areas, etc. The advice may change from time to time, so this should be a subject of review and risk assessment to ensure this is as up to date as possible. It goes without saying that in all cases medical advice should be sought and that there should be a system of counselling and other help available to the individual concerned. Incidents may also need to be reported under the RIDDOR regulations – your local environmental health department should be able to advise on this.

Note: This information and the example risk assessment overleaf are provided for awareness raising purposes only. Organisations should ensure they have the most up to date and appropriate advice for their particular area of work.