Re: Sharps Safety and Recapping Drawing up Needles

15/10/2019 at 8:26 am #75911

Participant

Author:
Bellis, Kaye

Email:
K.Bellis@ALFRED.ORG.AU

Organisation:

State:

Good morning, Im similar to Donna in thats its been many (many ) years since I worked in pathology but we always broke the needle to bleed the NICU and SCN babies.
Regards Kaye

Kaye Bellis
Hand Hygiene Project Co-ordinator
Inf Dis – Infection Control
(Tuesday, Wednesday and Thursdays)

t: 03 90766550
m: 0417636179
e: K.Bellis@alfred.org.au

Alfred Health
55 Commercial Road
Melbourne VIC 3004
PO Box 315 Prahran
VIC 3181 Australia
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Alfred Health incorporates The Alfred, Caulfield Hospital and Sandringham Hospital
http://www.alfredhealth.org.au

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From: ACIPC Infexion Connexion On Behalf Of Donna Cameron
Sent: Friday, 11 October 2019 5:05 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Sharps Safety and Recapping Drawing up Needles

Hi,

Although it has been a long time since I worked in paeds, the practice of breaking a needle was relatively common to take blood from babies. Their veins are small and can easily collapse with pressure from drawing back with a syringe. The blood drops were collected directly into the blood tube. I presume the hub was broken off because blood would fill the hub first, that way as much blood as possible could be collected and not be wasted staying in the hub.

Here is an article I found mentioning a similar method but they cut some of the hub off.

https://acutecaretesting.org/en/articles/heel-or-back-of-the-hand

As I said, that was quite a long time ago that I observed that practice so I dont know if it still occurs.

Regards,
Donna

Donna Cameron
Infection Control Consultant
T +61 (0) 3 8344 3574 (Monday, Wednesday & Friday); +61 (0) 3 9096 5233 (Tuesday & Thursday)
donna.cameron@unimelb.edu.au
Microbiological Diagnostic Unit Public Health Laboratory
The Peter Doherty Institute for Infection and Immunity
792 Elizabeth Street | Melbourne | Victoria | Australia | 3000
doherty.edu.au

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On 10 Oct 2019, at 13:48, Michelle Fernandez (NSW Ambulance) <Michelle.Fernandez@health.nsw.gov.au> wrote:

Completely agree Michael, this is an unsafe practice. I have never heard of this either.

Kind regards,
Michelle
Michelle Fernandez
CNC | Manager, Infection Control | Clinical Systems Integration
Part time work days: Wednesday, Thursday, Friday
Balmain Road, ROZELLE NSW 2039
p: 02 9320 7868 | m: 0429 926 505 | f: 02 9320 7729 | Michelle.Fernandez@health.nsw.gov.au
http://www.ambulance.nsw.gov.au
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From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Claire Nayda (SCHN)
Sent: Thursday, October 10, 2019 1:29 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Sharps Safety and Recapping Drawing up Needles

Hi
Ive never heard of or practiced breaking needles in any Paeds setting.

From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Michael Wishart
Sent: Thursday, 10 October 2019 1:14 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Sharps Safety and Recapping Drawing up Needles

Hi Hannah

Please explain why needles have to be broken for paediatrics. In this patient population, I would be very concerned about manipulation of any clinical device (such as a needle) and the potential to cause the patient harm because the device had been damaged or changed.

I would reinforce the need to use specific devices where necessary, rather than staff trying to change an existing device. How would facility or a practitioner defend harm caused through a device that had been changed?

Any manipulation of a sharp, whether prior to, during or after use, should definitely be avoided.

Too often we make choices that we are not in a position to make because we did not consider the risk (or thought the risk was too small to be of concern). But altering medical devices is way beyond the engineering, ergonomics and clinical safety expertise of most of us.

Apologies for the rant; I have strong views on this. And its my view, at least, and I would welcome further comment from others

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

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From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Brien, Hannah
Sent: Thursday, 10 October 2019 11:47 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Sharps Safety and Recapping Drawing up Needles

What about the breaking off of needles for paediatrics!!

Hannah Brien
Infection Control Clinical Nurse
Phone:07 4052 8029

From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Michelle Fernandez (NSW Ambulance)
Sent: Thursday, 10 October 2019 11:00 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Sharps Safety and Recapping Drawing up Needles

Hi Sam,

As per Michaels response below, bending needles increase the risk of sharps injury. Here are a few documents that reference bending as an increased risk of sharps injury.:

https://www.cdc.gov/sharpssafety/pdf/WorkbookComplete.pdf (page 10)

Injection safety at primary health care level in south-western Saudi Arabia: https://ciap.ovidds.com.acs.hcn.com.au/discover/result?acc=36422&logSearchID=34195713&pubid=6057-medline%3A19554992

Effect of changing needle disposal systems on needle puncture injuries: https://ciap.ovidds.com.acs.hcn.com.au/discover/result?acc=36422&logSearchID=34195713&pubid=6057-medline%3A3644804

From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Michael Wishart
Sent: Thursday, October 10, 2019 9:07 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Sharps Safety and Recapping Drawing up Needles

Hi Sam

In my understanding no manipulation of sharps is recommended because of the risks of either sharps injury or damage to the sharp resulting in harm to the patient (eg needle breaking off inside patient). Even manipulating clean needles may result in an exposure if the manipulation is done using gloves contaminated with blood or body fluid.

Where needles are required to have angled tips, there should be specifically manufactured needles used for this, rather than manipulation of the needles.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

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From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Sam Dickson
Sent: Wednesday, 9 October 2019 8:17 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Sharps Safety and Recapping Drawing up Needles

Hi Brains Trust,
what are your thoughts on ‘bending’ CLEAN needles for anaesthetic or ophthalmic procedures? I’m currently reviewing our ‘Sharps Handling Procedure’ and it was suggested that ‘bending’ should be added to the procedure. In my research ‘bending’ is not supported by any standard/guideline. Your thoughts appreciated….

Kind regards
Sam Dickson
E+E Hospital
Victoria

On Mon, 7 Oct 2019 at 12:24, Lesley Lewis <Lesley.Lewis@nhw.org.au> wrote:
Dear all,
Safety devices for recapping needles have been on the market for many years.
Recapping needles by hand is a risky practice (and habit) that should not be encouraged for any needles clean or used (a one size fits all approach)

Fiona raises a good question and I too am interested to hear if there is any literature and evidence validating the risk of chemical exposure (medications/drugs) to clinical staff through aerosol and splash when priming syringes and other equipment.
How can the risk be managed?
Is recapping the only possible risk management method?
Are there any alternative methods?
If the risk is serious should fume cabinets have a place in ward medication rooms?

As noted in the original post a needle (blunt or otherwise) should never be recapped. The recommendation against recapping needles is clearly articulated in the national IPAC guidelines.

Page 2 and on page 51: Statutory Requirement. 7. It is good practice to follow safe sharp handling practices including: not passing sharps directly from hand to hand keep handling to a minimum not recapping, bending or breaking needles after use.

Page 51: In dentistry, recapping or disassembling sharps may be unavoidable. If so, a risk assessment must be undertaken and safety devices should be used where appropriate[89].

Page 52: Certainty of the Evidence. This advice is based on limited evidence, but on sound theoretical principles and supported by expert advice. National and international guidelines are consistent in the advice regarding the importance of the safe use and disposal of sharps. The Epic Guidelines[78] recommend that sharps should not be passed directly from hand to hand, and that needles must not be bent, broken or recapped.

Regards,
Lesley Lewis
Regional Infection Control Consultant HRICRCS Program
Tel: (03) 57 225486 Lesley.Lewis@nhw.org.au

From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Angela Carvosso
Sent: Friday, 4 October 2019 11:01 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Sharps Safety and Recapping Drawing up Needles

Hi Fiona,

I personally recap just to remove the needle from the syringe as I was taught to never touch the coloured hub. The premise of not recapping is to prevent transmission of infection via needlestick from needles used on people. A risk analysis would indicate that as the needle has not been used on a person then it is safe to recap.

Regards Angela Carvosso
RN Warwick Hospital

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________________________________
From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> on behalf of De Sousa, Fiona M <fiona.de.sousa@THS.TAS.GOV.AU>
Sent: Wednesday, October 2, 2019 4:28:46 PM
To: ACIPCLIST@ACIPC.ORG.AU <ACIPCLIST@ACIPC.ORG.AU>
Subject: [ACIPC_Infexion_Connexion] FW: Sharps Safety and Recapping Drawing up Needles

Hi All,

We are currently having discussions about how to safely draw up medications and whether it is suitable to recap a blunt fill drawing up needle to expel air from a syringe.

One side of the argument is that the blunt fill is recapped so that when air is expelled the contents are not aerosolised. The other side is that a needle (blunt or otherwise) should never be recapped.

I would be interested to know other peoples thoughts and what evidence if any you have for this.

Kind regards,

IPCU By working together we promote a culture of safety to reduce preventable infections and transmission of multi-resistant organisms

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