Memorandum submitted by the Safer Needles
The NAO Report, A Safer Place to Work,
demonstrates the failings in the enforcement of current health
and safety legislation to protect healthcare workers from infection
from blood borne viruses acquired through needlestick injuries,
and these failings have significant cost implications for the
NHS. Estimates have shown that the number of needlestick incidents
has increased since the last NAO Report in 1996, Health &
Safety in NHS Acute Hospital Trusts in England, and remains
the second highest reported incident after moving and handling
The Safer Needles Network believes that the
Government must take action without delay to reduce needlestick
injuries, thereby reducing the risk of staff becoming infected
with blood borne viruses, and the significant economic burden
which they place on the NHS estimated at £500,000 per Trust
The immediate objective of the Safer Needles
Network is to secure a commitment from the Department of Health
to issue a Health Service Circular and accompanying guidance to
encourage the provision of training, education and safer technology.
A dramatic reduction in the incidence of needlesticks will be
achieved by implementing proper surveillance and reporting procedures;
a range of preventative measures and safer working practices;
and the adoption of "needle protection" technologies
through the purchase of safety engineered devices that are made
available to all healthcare workers in the place of work.
The Network is made up of organisations that
represent workers, such as trades unions and professional organisations,
together with individual clinicians and government agencies with
expertise in this area and manufacturers of the different technologies.
Needlestick injuries and occupationally-acquired
blood borne viruses
The NAO Report, A Safer Place to Work,
demonstrates the failings in current HSE legislation in terms
of protecting healthcare workers from infection from blood borne
viruses (BBVs). It shows the overall number of needlestick incidents
in the NHS is increasing and that needlestick injuries remain
the second highest reported incident after moving and handling.
In the worst case scenario, staff can and have
sero-converted following a needlestick injury, becoming infected
with BBVs such as HIV, Hepatitis "B" and "C".
Health Protection Agency data demonstrates that five health care
workers have "certainly" acquired HIV occupationally,
four of whom are deceased. A further 12 health care workers have
"probably" acquired HIV occupationally.
Needlestick injuries impose a significant economic
burden on the NHS. The cost of follow-up testing and treatment
is substantial, staff replacement costs are increasing not to
mention the human cost in terms of anxiety and stress. NHS Trusts
also face increasingly large compensation claims and difficulty
in retaining trained staff.
Cost in use model
A comprehensive cost in use model has been developed
(by BD, a medical devices company specialising in this area) for
hospitals and Trusts to help them to develop a business plan aimed
at reducing needlestick injuries. Such software enables Trusts
to evaluate the true costs of introducing safer needle technology.
Many if not most Trusts will find that the introduction of safer
medical devices will be either revenue neutral or positive once
all costs are factored into the financial equation.
The cost in use model, and the underlying assumptions
used, are attached
to this memorandum and include the following highlights:
Assuming 3% of needlestick injury
victims make a claim, this results in 2,032 annual claims.
At a cost of £2,037 per claim,
this results in an annual total cost of £4,139,225.
Absence Cover and Staff Replacement Costs
The annual cost for absenteeism as
a result of needlestick injuries is estimated to be £43,349,943.
5% of absentees do not return to
worka further staff replacement cost of £5,228,308
for nursing staff.
The overall estimate of all costs
relating to needlestick injuries is around £500,000 per NHS
Trust per year.
The estimated total cost of introducing
safer devices to prevent needlestick injuries is £136,000
per NHS Trust per year.
Ensuring the enforcement of existing health and
While other nations such as the USA have seen
fit to legislate to ensure that health care workers are protected
from the risk of exposure to BBVs, existing UK legislation should
provide a reasonable foundation of protection for workers. However,
in practice the application and enforcement of current health
and safety regulation in the healthcare setting has not been effective
with regard to needlestick injuries.
The Needlestick Safety and Prevention Act passed
in the USA in November 2000 requires employers to monitor the
incidence of NSIs and train their staff in appropriate safety
procedures. It does not stop at monitoring, training and enforcement
of best practice. The legislation requires that employers provide
safety engineered medical devices and related equipment to protect
their staff from needlestick and other "sharps" injuries.
In the UK, RIDDOR 95 regulations require employers
to report diseases acquired during discharge of normal work functions.
Reportable diseases include BBVs such as hepatitis. However, the
incidence of such infection as a result of occupational hazard
is not effectively monitored and consequently left unreported.
Health service circular
An appropriate device to ensure that the existing
legislation and regulation is enforced would be a Department of
Health generated Health Service Circular and accompanying guidance
to Trusts. The circular would remind Trusts of their responsibility
for ensuring that the right of healthcare staff to work without
undue risk of acquiring HIV or other BBVs is protected. A circular
(a) proper surveillance and reporting procedures
relating to the incidence of injury;
(b) a range of preventative measures and
safer working practices appropriate to the riskincluding
improved training and education of staff in the safer use and
disposal of sharps, and the use of universal precautions; and
(c) adoption of "needle protection"
The safer needles network
The Safer Needles Network is made up of organisations
that represent workers, such as trades unions and professional
organisations, together with individual clinicians and government
agencies with expertise in this area and manufacturers of the
different technologies. The Network's objective is to achieve
a change in the UK to require the use of safety devices to protect
staff and patients by drawing decision makers' attention to the
risks from needlestick injuries. The Safer Needles Network has
a website at www.needlestickforum.net.
Dr Paul Grime
2 May 2003
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