Preventing Sharps-related Injuries
Sharps injuries can occur at any time when people use, disassemble, or dispose of sharps including needles, lancets, glass, and scalpels. Sharps can hide in linen or garbage and cause injury when someone encounters them.Sharps injuries can transmit infectious diseases, especially blood-borne viruses.
Sharps injuries are caused by needles or
sharps that accidentally puncture the skin.
Working safely with sharps is key to reducing the risk of exposure to blood borne pathogens to midwives and clients. The Centre for Disease Control reports 40% of sharps-related injuries occur after use and before disposal of a sharp device, 41% of injuries occur during use of a sharp on a client, and 15% during or after disposal1. In Ontario, the Occupational Health and Safety Act requires that all workplaces, including hospitals, birth centres and clinics, use hollow-bore safety-engineered needles. These include needles that retract into the syringe or sliding sheath, needle hood that is pressed over the needle, shielded or retracting catheters and IV systems containing a catheter port with a needle housed in a protective covering.
Public Health Ontario’s, IPAC Checklist for Clinical Office Practice: Core Elements, provides the following risk reduction measures to support the safe use of sharps:
Use safety engineered needles; needles should be used as intended
(i.e. do not recap or break off needle)
- Use ONLY single use supplies when giving injections, drawing blood
or providing IV fluids
- Use ONLY single-client use needles
- Use ONLY single-client use syringes
- NEVER re-enter a vial with a used needle OR used syringe
- When preparing or drawing medication, use a blunt fill needle and
then replace it with a new safety-engineered needle prior to injection
- Dispose of sharps at point of use in a designated sharps container
- Have written policies and procedures to prevent and manage sharps injuries
Appropriate use, placement and disposal of sharps containers is necessary to minimize risk of sharps injuries, including:
- Have sharps containers available at all points of care, including portable sharps containers for point of use during home visits.
- In clinic, if possible, mount sharps containers on a wall to prevent tipping, and to keep out of reach from children.
- Never empty sharps containers and never fill them past the fill line which is usually the 3/4 mark.
- Use sharps containers that follow PHO’s Sharps Safety Program:
- Clearly labelled as a sharps container, preferably with a biohazard symbol
- Puncture resistant
- Tamper proof and out of reach of children
- Closable so that content are not able to fall out
- Leak proof on sides and bottom
- Never stored with clean or sterile equipment and/or supplies
- If for transport, have tight-fitting, puncture proof closable lids to prevent spilling during transport.
Highest Risk Activities in Midwifery
Anecdotally, the activities in midwifery with the highest risk for sharps injuries are cord blood collection and the use of lancets for newborn blood draws.
When drawing cord blood for cord blood collections, close the needle hood after blood collection and remove the needle from the syringe unless the blood in the syringe will be immediately transferred.
If transferring immediately into a blood collection tube, only do so into a tube that has been secured (e.g. taped to the edge of the table) not into a tube that someone is holding. Alternatively, remove the vacutainer tube lid and either directly drain the cord blood into the collection tube or remove the needle from the syringe where cord blood has been collected to fill the tube using the syringe without a needle.
Caution should be taken to avoid splash or spray when removing the vacutainer lid if some blood has already been inserted into the tube.
Lancing devices are single-client use and should auto-disable.
1. Centers for Disease Control and Prevention. Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. [Internet]. [Cited 2019 May 16]. Available from: https://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf