Select Committee on Public Accounts Minutes of Evidence


Memorandum submitted by the Safer Needles Network

  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 incidents.

  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 each year.

  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.

SUBMISSION

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[9] to this memorandum and include the following highlights:

Compensation

    —  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 work—a further staff replacement cost of £5,228,308 for nursing staff.

Safer Devices

    —  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 safety regulations

  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 would require:

    (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 risk—including improved training and education of staff in the safer use and disposal of sharps, and the use of universal precautions; and the

    (c)   adoption of "needle protection" technologies.

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

Chairman

2 May 2003




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