Health and Safety # 1-81 / Approved: June 7, 2010
Revised: June 13, 2017
Reviewed: Aug 22, 2017
Policy:Safe Sharps Handling &
Safety Engineered Medical Sharps (SEMS)

Cheshire is committed to providing a safe and healthy working environment for all staff and consumers. Our organization will demonstrate its commitment by providing financial, physical and human resources to reduce the risks of injury fromitems that could cause a puncture, cut or abrasion (razor, etc.) and exposure to blood and body fluid. To this end, the organization will implement the use of safety engineered medical sharps and other safe work practices aimed at reducing the risks of injury from sharp objects.

Goals

  • To decrease the risk of transmission of blood-borne pathogens through injuries from sharp medical devices
  • To promote and support the health and safety of all employees through a comprehensive program of safety engineered medical sharps
  • To provide equipment, resources and effective training
  • To achieve compliance with relevant legislation including The Occupational Health and Safety Act, The Health Care and Residential Facilities Regulations (O. Reg. 67/93) and the Needles Safety Regulation (O. Reg. 474/07)

Definitions

Sharp: Any sharp object used during the care and treatment of consumers that could cause an injury to a worker or other person.

Safety engineered medical sharps (SEMS) are sharp medicaldevices or instruments designed to include safety features to help protect workers from injuries.

“safety-engineered needle” means:

1)a hollow-bore needle that ,

a) is designed to eliminate or minimize the risk of a skin puncture injury to the workers, and

b) is licensed as a medical device by Health Canada, or

2)a needleless device that

a) replacesa hollow-bore needle, and

b) is licensed as a medical device by eahtl Canada. Health Canada.

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Health and Safety # 1-81 / Approved: June 2010
Revised: April 2015
Reviewed: aug 22, 2017

Roles and Responsibilities of Workplace Parties

Employers:

  • Enforce the policy, procedures and program
  • At Cheshire, consumers are obligated to supply medical devices such as insulin syringes and glucometers. Cheshire will ensure it has inspected the SEMS provided to each of its employees by consumers and only allow Cheshire employees to use SEMS
  • Provide equipment and necessary resources forinitial and ongoing staff training
  • Maintain the sharps safety program through continuous quality improvement
  • The JOHSC will take a lead role in the planning, coordination and implementation of the sharps safety programs
  • Ensure that an appropriate training program on sharps safety, including the use of safety engineered medical sharps is development in consultation with the joint health and safetycommittee and implemented in the workplace
  • Evaluate and update the program annually

Managers/Supervisors:

  • Enforce program through regular monitoringstrategies. Maintain a record of all consumers/clients who use Sharps and what device is being used. This will enable you to verify if employees have been trained with this equipment.
  • Ensure employees have training on the device being used in the booking.
  • Conduct accident/incident investigations; all needlestick injuries are required to be reported to the Workplace Safety and Insurance Board (WSIB). A special addendum called a Needle Stick Injury Report is required along with the Form 7. Even if there is no first aid ought or lost time, needle sticks must be reportedto WSIB within 72 hours. The incident need only be reported to the Ministry of Labour should the incident result in an occupational illness. Maintain trainingrecords for a three year period.
  • Ensure all new staff receives general and site specific orientation to the policy and program.
  • Include the auditingof work practice in the planned inspections and report on findings to senior management.
  • Facilitate medical attention for employee as required.
  • Take every reasonable precaution for the protection of the worker.
  • Plan for the safe handling and disposal of sharps before beginning any procedure.

Employees:

  • Comply with policy and procedures at all times.
  • Participate in regular training program as established by the organization.
  • Report any unsafe acts, hazards, equipment problems or and other untoward issues immediately to the supervisor or delegate.
  • Report any incidents, accidents and near misses to the supervisors and cooperate in the investigation as required by management.
  • Report any use of non-safety engineered medical sharps which have not been previously approved for use in the workplace.
  • Seek medical attention as required.

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Health and Safety # 1-81 / Approved: June 2010
Revised: April 2015
Reviewed: aug 22, 2017

Joint Health and Safety Committee (JHSC):

  • Review quarterly incident/accidentdatarelated to sharps injuries or exposures to blood and body fluids.
  • Participate, through consultation, in the development of a SEMS program.
  • Be consulted and make recommendations to the employer in the development of an education and training program that supports the sharps safety program.
  • Take part in an annual review of the SafetyEngineered Medical Sharps policy and program
  • Make recommendations in writing to management.
  • Exchange relevant information with other internal and external committees as necessary for the useful exchange of information with regard to safe practice

Consumers/Clients

  • Consumers/Clients are responsible for purchasing their own SEMS and disposal container for their home.

Reporting and Investigation:

  • Workers are to report all incidents or hazards/threats to their supervisor or manager immediately.
  • The manager or supervisor receiving the report investigates the report to assess the risk of infection to the employee.
  • The employer reports all needlestick injuries to the WSIB as required by the Occupational Health and Safety Act and Workplace Safety and Insurance Act. The injury only needs to be reported to the Ministry of Labour if it results in an occupational illness.

Evaluation:

The sharps safety program will be evaluated annually. The following indicators will be collected in a timely manner by the designated authority and forwarded to senior management with any recommendations:

  1. Employee incidents/accidents
  2. Accident investigations
  3. Near misses/hazards
  4. Planned monthly inspections – auditing of worker practice

Any change to the program will be documented and communicated immediately to all affected staff and management. The designated authorities will implement any changes within their area.

General Provisions:

Each program where medical sharps are used or are otherwise present shall develop specific procedures outlining the use and disposal for the products as appropriate and in keeping with the following general provisions:

  • All needles and caps shall be handled and disposed of in a manner that will not endanger the health or safety of the user or others.
  • It is the responsibility of the user to ensure appropriate handling and safe disposal of needles and medical sharps.
  • Needle-less products and products with inherent safety features shall be used when such alternatives are available.
  • Needles will not be recapped, bent or removed (with the following exception: with some insulin pens and glucometers you must recap to get the needle out. Please follow manufacturer’s directions for safe handling.)
  • Uncapped needles, scalpels or other medical sharps must not be left unattended or covered with a towel/drape.
  • All needles and medical sharps shall be disposed of properly in an appropriate sharps container by the person who used the device.
  • All sharps injuries must be reported immediately to a supervisor. A risk assessment shall be performed and appropriate follow up measures taken as per policies and procedures related to blood and body fluid exposures.

In the absence of your immediate supervisor, contact yourDirector of Community Support.

Any worker found to be in violation of this policy shall be subject to disciplinary measures, up to and including dismissal.

Response Procedures:

  • The supervisor documents all reports of sharps injuries and hazard reporting and measures taken to address them using the incident/accident investigation form.
  • Management reviews all incident reports, monitors trends and makes recommendations for prevention of needle stick injuries.
  • These findings are shared with the JOHSC, which is consulted about any revision to the Sharps Safety Program.
  • TheJOHSC or designate reviews reports of Needlestick injuries and ensures that actions have been taken.

Supports for Employees with Needlestick injuries:

Management will respond promptly, assess the situation and ensure that these interventions are followed:

  • Facilitation of medical attention
  • Debriefing (by skilled professional, if needed and appropriate)
  • Assist with completion of incident reports, WSIB reports, reports to MOL Team debriefing (by skilled professional, if needed and appropriate)

Risk Assessment:

Program Managers will be asked to visit consumers who use medical sharps to determine if they are Safety Engineered Medical Sharps. If they are not the consumer will need to ensure that they now order only Safety Engineered Medical Sharps if they are to be used by Cheshire employees.

Any employee who requires the use of SEMS while at work will follow the procedure for proper disposal of medical sharps so as not to injure another worker.

Education:

All new employees will receive both general and consumer specific orientation to the use of SEMS in their programs.

Any training developed, established and provided shall be done in consultation with and in consideration of the recommendations of the joint health and safety committee.

Accountability:

All workplace parties are accountable for complying with the policy, program, measures and procedures related to the sharps safety program and policy.

Records:

All records of reports and investigations of sharps injuries are kept for five years.

Safe Sharps Handling Procedure

Sharps refers to sharp objects and can include medical care items such as used needles, used syringes with needles attached, soft-sets, used lancets, and any item that could cause a puncture, cut or abrasion, razor blades, broken glass, knives and exacto-knives.

The following procedures must be used for handling Sharps:

  1. Plan for the safe handling and disposal of Sharps before beginning any procedure.
  2. Wear gloves while performing any procedure. Wash hands (or sanitize if washing not possible) upon removing gloves and before beginning next task.
  3. Avoid handling the Sharps near the “sharp” end.
  4. Dispose of lancet or needles in an approved, puncture resistant Sharps container immediately after use. (Note: containers cannot be glass or thin plastic).
  5. Sharps containers must be disposed of properly (by consumer or arrangements with Program Manager).
  6. Report sharps containers nearing full to the consumer or Program Manager.

DO NOT

  • Handle needles, lancets or soft-sets under the direction of a consumer unless it is required by the service plan, authorized by the Program Manager and training or instruction has been arranged by the Program Manager;
  • Bend, break or manipulate a needle by hand;
  • Leave a used sharp in a lancet or insulin pen;
  • Re-cap a needle or a lancet; (with the following exception: with some insulin pens and glucometers you must recap to get the needle out. Please follow manufacturer’s directions for safe handling.)
  • Discard a sharp into the garbage;
  • Discard a sharp with dressings or other waste that contains body fluids; and
  • Remove a sharp from the consumer’s home.

If Exposure Has Occurred

  • Needle Stick Injury: Allow the wound to bleed freely (you can squeeze to promote bleeding) and cleanse the wound thoroughly with soap and water. Employees who break skin by coming into contact with a needle-end used or contaminated with blood will be sent to their physician or medical facility for assessment and possible treatment.
  • Exposure to Blood-Borne Pathogen: If an employee experiences contact with mucous membranes (eyes, nose or mouth) flush well with water. If clothes are contaminated by blood or body fluids, they should be removed as soon as possible.
  • Employees must immediately report the exposure to the Program Manager. Alternatively, if a Program Manager is not available, the On-Call Director must be contacted.
  • Program Manager/Director will assess staff level of anxiety, offer support and encourage staff to seek medical attention.
  • The employee is required to complete and submit an Employee Incident/Accident Report.
  • In incidents where exposure has occurred Cheshire will cooperate with Local Health Authorities in investigation and risk management. (This may include completion of a “Report on Needlestick Injury or Body Fluid Splash” and seeking permission of the consumer to reveal contact information).

Related Policies, Procedures and Forms

H&S #1-122 Hazard/Incident Reporting and Investigating

H&S #1-123 Hazard Reporting

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